Navigating the Maze of Addiction: Marcia Bremenour's Guide to Recovery and Hope

Embark on a transformative journey with Marcia Bremenour, a highly experienced therapist in addiction care, who shares her profound insights into America's drug addiction crisis and the courageous path to recovery. This episode offers an honest look at the societal tremors caused by substance abuse, evolving trends in addiction. 

With Marcia, we untangle the intricate web of addiction treatment, from the temptation of short-lived coping strategies to the cultivation of lasting self-care practices that kindle genuine well-being. We peel back the layers of complexity surrounding various treatment options, dissecting everything from support meetings to inpatient programs, and zero in on the necessity of medical detox, particularly for alcohol addiction. Our exchange equips you with practical advice for seeking treatment, providing a guiding light for anyone embarking on the road to sobriety, with or without insurance.

We confront the harrowing introduction of potent substances like fentanyl into the recovery equation and the reality of relapse as an integral part of the healing process. Marcia advocates for a holistic recovery approach, encouraging self-compassion and employing tools like EMDR, yoga, meditation and mindfulness to aid in self-regulation. We close on an uplifting note, sharing triumphant recovery stories that affirm each step toward healing is a profound leap towards the restoration of hope and life. Join us for this candid and hopeful perspective on overcoming addiction.

• To learn more about recovery and Marcia Bremenour please visit https://www.mbremenour.com/ 
• Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357)                                                                  Website: www.samhsa.gov SAMHSA is a government agency that provides a national helpline, treatment facility locator, and resources on substance abuse and mental health issues for people of all incomes.
• Partnership to End Addiction Helpline: 1-855-378-4373                                    Website: www.drugfree.org This non-profit provides a free, confidential helpline as well as online support groups, coaching, and resources for parents and families affected by substance abuse.
• Shatterproof Helpline: 1-800-597-2557
  Website: www.shatterproof.org Shatterproof is a national nonprofit working to reverse the addiction crisis through advocacy, resources for families, and  treatment options.

Transcript

David Liss: 0:06

Hello and welcome to the Wellness Musketeers podcast, a podcast discussing health, wellness and, more broadly, the art of living. I'm Dave Liss, DC-based journalist, your host for this podcast. In a world where health and wellness advice comes from many directions, we created Wellness Musketeers to help you live with a greater understanding of the world we experience together. Every single day in America, over 230 people lose their lives to drug addiction. In Americans battling addiction and less than 10% receiving treatment, we're confronting a crisis that intertwines societal pressures, mental health and biological factors. The surge in drug overdoses, with more than 100,000 deaths in 2021, and fentanyl playing a lethal role, underscores the urgency of this issue. And while the path to recovery includes the risk of relapse, today's conversation aims to shed light on the resilience that fuels hope for recovery for those in need and those that care for these people.

David Liss: 1:21

Today we have a remarkable guest. Marcia Bremenour is a seasoned therapist and educator who has dedicated her career to addressing the challenges of addiction. With over a decade of experience managing addiction care within the healthcare system and guiding students in the academic world, Marsha brings invaluable insights to our discussion. Her clinical focus is now on supporting recovery and understanding what recovery means from a holistic perspective. Marcia's expertise will guide us through understanding addiction's grip and the transformative journey towards recovery. Welcome, Marcia, it's a real pleasure to talk to you.

Marcia Bremenour: 2:03

Oh, thank you, Dave. It's a pleasure to talk with you as well. Thank you, glad to be here.

David Liss: 2:09

Could we start by your framing for us? What is the drug addiction problem in America today? What trends are you observing and how has the landscape changed over the years?

Marcia Bremenour: 2:22

Well, that's a big question and it's a great one. I think we all know that drug addiction is, of course, as you mentioned, growing at monumental rates and certainly getting into different populations. It's not an inner city issue, it's not a country issue, it's not an urban issue, it's not a suburban issue. It's an across-the-board societal issue. So there are certainly no population that is impacted more or less, but it is certainly an insidious problem that is really hurting all of us.

Marcia Bremenour: 3:02

For healthcare systems, scientists who are busy working really hard to develop and understand research and interventions and technology to confront addiction are neck and neck with those developers who are working for, those scientists who work for developers of illicit drugs. We all know about the same, about what creates and perpetuates addiction, both on a positive and recovery-oriented side and an addiction side. So that gets a little scary because I mean to put it simply, people who are selling drugs, people who are wanting to promote addiction, know how to do it because they have access to the research to do that, just as people in health care systems who want to fight addiction have access to the same research.

David Liss: 4:13

Wow, does that make sense? Yeah, yeah.

Marcia Bremenour: 4:18

It's kind of scary.

David Liss: 4:20

Two different sides looking at the same issue from different perspectives.

Marcia Bremenour: 4:24

Absolutely, and there are good things to every situation. And with the legalization of marijuana, the positive side to that is that research around the impact of marijuana and the uses for it, which are pretty broad, there's a lot more that we know now and because we can legally research. The downside is that that is one of the drugs that's normalized and is very accessible to kids very young, which can, as you and I discussed a little bit a little while ago. You know, it can be very crippling for kids who are developmentally dealing, as we all, during adolescence. For example, if you're going through adolescence, adolescence is difficult for everyone and if you take two kids, one kid is dealing with adolescence and just dealing with the things that the hurdles that that someone would go through during adolescence social hurdles and the self-esteem hurdles and the character things that we go through and they're just dealing with those things and they fall and they get back up. They fall and they get back up and then they get to the adulthood and they have the strength that comes from pushing through those challenges and the confidence that comes from pushing through those challenges and knowing how to make a mistake and survive the mistake and fix the mistake and move through it.

Marcia Bremenour: 5:45

Then you have their counterpart, maybe a kid, who has the exact same challenges. But that kid has what feels to him or her like the luxury of not having to deal with the angst attached to those challenges because someone's introduced them to, for example, marijuana. So instead of dealing with the challenge, they get high. Then they're less stressed, they're less anxious in the moment they're not really experiencing the same challenges, they're just pushing through it.

Marcia Bremenour: 6:15

Well, when they get to adulthood, they're at a deficit because they don't know what it feels like to deal with those kinds of challenges unattended. What's the word without the crutch, if you will of using a substance that actually makes them not care so much about failing and trying again than pushing through the challenges? My personal opinion of what I've witnessed with young adults, and now middle-aged adults as well, is, when you introduce a substance that takes the challenges away for you that you would otherwise deal with yourself, you are actually putting yourself at a disadvantage without intending to. You know it's no one's intention to to at a deficit, but that's what we're fighting for?

David Liss: 7:08

Yeah, but I'd always heard of marijuana as a gateway drug. I don't know if that is. Is that true or along the lines of what you're saying?

Marcia Bremenour: 7:19

You know, Dave, I think that could be true for some people, but I don't think in general. Usually my experience with people who enjoy a relationship with marijuana is they're usually okay with that. They may find that they're introduced to other things and move on. That is not the typical in my experience, in my observation. That is not a typical gateway drug. For many people it's an end goal drug because people develop a love for marijuana like a relationship that is very tight and so it's kind of all they need for many people. And of course now, with the intensities, marijuana is much higher and the THC levels, I'm sorry, is much higher than it was when you know, in the 60s, 70s, even the 80s. So the impact of the THC on the brain is higher than it's ever been before.

Marcia Bremenour: 8:11

So we don't really, we don't know what that's going to look like in 20 years from now, but it is very difficult to get in between a person who has a relationship with marijuana and their marijuana, if that makes sense.

David Liss: 8:27

Yeah, no, that's really interesting. You hinted at this already, but what are the key factors that contribute to addiction and how do they impact a person's life?

Marcia Bremenour: 8:39

So if you're referencing the contributing that make us most likely to be susceptible to addiction, yes.

Marcia Bremenour: 8:49

Different people may use different language, but there are essentially three groups biological, psychological and social. So and there's different language that you can use. They're not, these words are not allcompassing, but the biology is the genetics. For example, if you're born with your parents have brown eyes, you might have brown eyes. Or your parents have blue eyes, you might have blue eyes, for example, any of those things, along with medical illnesses. You know that we're more susceptible to developing because we're genetically predisposed to have those illnesses. So the genetics, the wiring statistics about that, are that usually there's a strong paternal link.

Marcia Bremenour: 9:37

So three out of four boys born to fathers who are diagnosed with an addiction are likely to be diagnosed with addiction themselves. Oh, for girls, it's one out of two. So one out of two girls born to fathers with an addiction are likely to develop an addiction. Now, when I say addiction, it's not necessarily a chemical or substance addiction. It could also be an addiction to gambling, to food, to relationships, to shopping, to sex, to gambling. So there's a plethora of things that we are likely that can contribute to addiction, that can be defined by addiction. It's not just substance abuse.

David Liss: 10:22

Okay.

Marcia Bremenour: 10:22

Yeah, so the biology psychology is pretty much what it says the genetic predisposition to have a psychological influence, like if there's a bipolar disorder that's untreated. Many times people with a psychiatric condition will develop a drug addiction because they're self-medicating. Kids with attention deficit, for example If you have kids in a classroom who have some degree of attention issues, some what we refer to as a diagnosis of an attention issue, and then they happen to be presented with some marijuana, well, the THC has a tendency to calm the person down, so they're less interactive, so they feel better. It actually normalizes them In the moment. Good, longer term not so much.

Marcia Bremenour: 11:21

But the point of that is that the underlying psychiatric condition makes that person more susceptible to developing an addiction later on because they end up self-medicating or more at risk of self-medicating. The third is social and that would be environmental. For example, even if your, even if your parent is and has an addiction, but they're in recovery when you're born, you still have the same statistical likelihood of developing an addiction if they're in recovery. The thing is that you're not going to be exposed to. Is the environmental piece right? So if so, if they're not using in the whole, not witnessing it.

Marcia Bremenour: 12:08

Kids who witness using in the whole as a way of dealing with life or just as a part of life, are far more likely to develop an inclination or a relationship with drugs or alcohol If it's around them, if it's normalized in their lives, so that's the environmental piece, and if their friends, of course, are doing the same things, and if they don't have the structure in their home where they're taught to deal with life on life's terms, as it were.

David Liss: 12:42

From your experience. What is the satisfaction or void that drug addiction or negative behaviors fill in a person? How does the addiction impact a person's emotional well-being?

Marcia Bremenour: 12:59

I love this question, Dave. I really do, because I feel like I could talk about it for six hours, but I won't. We are all comfort-seeking creatures. Every living being is always seeking comfort, moving toward comfort, moving away from discomfort Plants, animals, people, we all. This is what we do. Right? If I'm uncomfortable in my chair, I'm going to shift so I can be comfortable. Right, if I'm uncomfortable in my relationship, I'm going to shift so I can be comfortable, and everything in between, right. So most of the time, often when we're uncomfortable, if we find a substance that helps us regulate that is, helps our nervous system regulate and we use that substance and it helps us regulate we're going to develop an attachment to that substance. Right? So that kind of sums up the question, right? Like? Does that make sense to you?

David Liss: 14:10

Yeah.

Marcia Bremenour: 14:11

Yeah, there are many, many, many behaviors that are regulated right. So self-regulating is in say I'm anxious, right, well, I want to self-regulate, I'm going to do certain things to self-regulating is in say I'm anxious, right, well, I want to self-regulate, I'm going to do certain things. To self-regulate.

Marcia Bremenour: 14:31

When we choose things that are unhealthy ways to self-regulate, like drinking, alcohol, gambling, using drugs, for example, those things will give us a sense of regulation, but it is limited, it's a very short lifespan, if you will, and there's typically negative consequences attached to it. So when we engage in that behavior, we may feel good about it for a minute, like leading up to it, like it's I'm going to drink, right, this is nice, I'm going to do it. And then we drink. And then we end up especially if we have negative consequences historically associated with drinking then we drink and then we feel bad. So then that perpetuates the dysregulation, but we don't have any other tools. If we don't have any other tools to regulate, we go back to the drinking, because we're going for that moment where it does help us regulate. So that's the stuff that is kind of a negative, that develops this snowball effect, this cyclical nature that drives addiction.

David Liss: 15:43

We're always seeking some kind of a comfort state.

Marcia Bremenour: 15:47

So the other and that's absolutely true. The other side of that coin is if we engage in activities and this is just the part that I love because and I know that I'll get more into it I believe later on in our conversation if we do things like exercise, going for a walk, gardening, listening to music, socializing, laughing, those are also self-regulating behaviors and if we engage in those behaviors, the long-term impact of those behaviors is sustainable.

Marcia Bremenour: 16:26

There are no negative consequences attached to it. But the thing about recovery is getting into those things. In the absence of the drug, the drug is just a quicker fix. So that's the fight with recovery is getting into those other things that are actually good for us and getting away from the addictive behaviors, understanding that it's not. The other thing about addiction is our shame attached to it, right? So the shame attached to it is perpetuated by the behavior because it's a self-harming behavior and intuitively we know that. So when someone is doing one of those behaviors they're actually self-harming and the act of self-harming is perpetuating the act of self-harming.

David Liss: 17:18

So it's a self-perpetuating cycle.

Marcia Bremenour: 17:24

Absolutely, absolutely, yeah, yeah.

David Liss: 17:28

So how does drug addiction treatment begin? What are the different kinds of drug abuse treatment and, say, starting from outpatient care and progressing to residential treatment facilities? What options exist out there for people that would like help?

Marcia Bremenour: 17:46

So another great question. First and foremost, if somebody has insurance, you look on the back of your insurance card it says behavioral health. You call that number and they will tell you where you can go to have an assessment. So many times finances are a barrier and I know everyone does not have insurance, obviously, so that's a huge factor. For sure, If you are someone who has insurance, look at the back of your car and make that call and they will direct you to an assessment, and I'll talk more about that in a second. If you don't have insurance, someone does not have health insurance. There are programs, there are systems. Every city has some treatment facilities that are geared toward people who do not have commercial insurance options. It's really a matter of Googling that, like where can I go for?

David Liss: 18:50

an assessment.

Marcia Bremenour: 18:51

Unfortunately, those programs are sometimes difficult to get into. You know they're difficult to access, but they do exist. So there are so many barriers to recovery, accessibility being one of them. But, like I said, every city has some funded program that is designed to at least try to help, and there are lots of great people out there who want to help to help. So once you do find the right place to go, you need an assessment right. So you go in, you meet with somebody. Hopefully if you can take somebody who cares about you and if you're someone who is trying to take someone for an assessment go with them.

Marcia Bremenour: 19:41

The reason for this is that the person who is using drugs and alcohol, or alcohol and other drugs the person who is using does not have the same memory of what their use looks like as their loved ones do Right, as their loved ones do right. It's why people who are using, like people who abuse alcohol, don't understand what the fuss is all about, because they don't remember what it's like when they're drunk. They don't, and usually, so frequently, the family member will clean up the mess. You know the drug user or the alcohol user, all those functions that alcohol does. When alcohol enters the body, it essentially that the blood, the liver. I'm going to get into. Is it okay if I get into a little bit of biology here?

David Liss: 20:40

Yeah, I think it's helpful for people.

Marcia Bremenour: 20:42

The body can absorb and can process about an ounce to an ounce and a half of alcohol per hour. So as we drink and the alcohol enters into our system, anything over and above that, the liver does not work faster because we've added more.

Marcia Bremenour: 21:02

It stays at a steady pace, right? So anything that we've added to our body, over and above that, is absorbed into the bloodstream, to the lining of our esophagus, our stomach, our intestines. It just gets absorbed directly into our bloodstream and travels to the brain and when it gets there it essentially turns off the switches that tell us not to wet ourselves, not to talk funny, not like it, not to walk. The switches that tell us how to walk, how to talk, how to behave, how to respond, how to engage, obviously, how to get things done, how to drive those switches all turn off right. So when that happens, we are not aware of what we're even doing because the switches are all turned off, but the people who are around us are acutely aware of what they see, feel and are not doing right.

Marcia Bremenour: 22:03

So for them it's a problem, but the person who's under the influence does not understand it as a problem at all Because, remember, it is a thing they use to regulate their nervous system, to find comfort.

David Liss: 22:16

I see Does that make sense. Yes.

Marcia Bremenour: 22:21

As far as getting treatment goes, it's critically important to take someone in who can offer a description of what they're witnessing. This takes a lot of bravery on the part of the person with the problem with drugs or alcohol obviously right A lot of courage, Because this substance that they're using is kind of their lifeline in their mind, you know whether they or not.

Marcia Bremenour: 22:45

So they sit down, they do a full blown assessment. The person who's doing the assessment is going to ask all kinds of questions, like I mentioned before biology, psychology, environment, your social life, what's going on with your friends, with your work, with you know, with your life, what is happening in all aspects of one's life. A thorough assessment is critically important to determine the level of care. So when care is determined right, when you determine whether or not someone meets the criteria for addiction, the lowest level of care is where you want to start. That's typically the model that we follow, so the least invasive level of care. So these are education, right, individual therapy, baby AA meetings, other sober support meetings. There's narcotics anonymous. There's, of course, alcohol anonymous, alcoholics anonymous. So there's support systems out there. That may be a recommendation. Typically, people try and the higher level of care is more common. People try and the higher level of care is more common.

Marcia Bremenour: 24:01

That is an intensive outpatient program. That's the next step up, commonly known as an IOP. Typically intensive outpatient program is typically three hours per session and that's three or four days per week. It's group therapy. It includes education, it includes group process checking in, checking for behavioral changes while introducing ideas of addiction and recovery to the client who's involved. It's designed so they can keep their job if they have one, they can stay in their living environment least intrusive as possible but hopefully working in elements of recovery while they're dealing with real life to give them the kind of support they need.

Marcia Bremenour: 24:52

If they fail at that level of care, then they'll be advanced to a partial hospitalization. Then they'll be advanced to a partial hospitalization. Typically partial hospitalization is six hours a day, usually from about 9 to 3 pm, 9 am to 3 pm. More intensive group therapy, more intensive individual therapy, still going home at night. So you still want to maintain as much normal life, typical life as possible with the intention of working recovery into their lives. If the person fails at that level of care, then we move up to an inpatient level of care, typically residential treatment. Some days, some cases are only maybe a week or two weeks, but typically 30 days is recommended. And then of course, there's higher levels of care, even above and beyond that, where somebody will go away for six months, maybe even more. Step down to a halfway house, then step back down to PHP, iob, individual therapy.

Marcia Bremenour: 26:02

So you go up and then you go down. One thing I left out at the time of the assessment the assessor will evaluate the person for the need for a medical detox. So for alcohol it's usually depending on how much the person is drinking they meet. They need to be monitored for withdrawal symptoms, which can actually be pretty serious usually three to five, maybe seven days in a really severe case. But you really want to make sure that they're stabilized to avoid seizures, dehydration, which can be really serious, and so those are medically managed. Other drugs are typically a little bit shorter only because there's nothing much that they can do medically for the person and they're not going to actually die from their withdrawals. They're just very likely to relapse from their withdrawals. Yeah, very likely to relapse from the witch walls?

David Liss: 27:00

Yeah, what kind of a role do mental health considerations play in addiction?

Marcia Bremenour: 27:15

And is that a separate or how does that incorporate it into drug addiction treatment? Well, there's different perspectives on this, different philosophies, and it is case by case. Typically, mental health disorders and substance abuse disorders go hand in hand. In other words, it's hard to say chicken or the egg kind of thing. It is absolutely believed that one needs to be sober from their substance use in order to actually get a valid diagnosis mental health diagnosis, because so frequently substances mimic and create, but can sort of mimic, mental health disorders. Alcohol is a depressant. So if someone comes to me and they don't tell me that they're drinking alcohol every day but they're very depressed, low motivation, disinterest, but they just leave out the parts. They're getting drunk every night, right, and they're using a depressant every single day.

Marcia Bremenour: 28:16

Well, there's no intervention that we can suggest that's going to counter the negative impact of the alcohol use. The same is true for marijuana use. If someone's 24, 25 years old and they've been using marijuana every day since they're 15 or 16 years old and then they come to me at 25, and don't tell me that they're using marijuana, but they have this fear, anxiety, right, well, and then finally they tell me they're using marijuana, I'm like, oh, that makes sense, because I developed the skill to deal with their anxiety without the marijuana and unfortunately it's a short-term fix that creates a bigger problem Using marijuana to treat or using anything. Frankly, if I gamble to relax, I'm going to become dependent on gambling in order to relax and I'm going to undermine my natural ability to relax without gambling.

David Liss: 29:19

Yeah, I mean it's ingrained. I'm going to undermine my natural ability to relax without gambling. Yeah, I mean it's ingrained in your life and in how you function.

Marcia Bremenour: 29:27

Absolutely. It becomes a very real part intrinsically in your style of living and once you develop that relationship, it's very difficult to pull away from that because it's part of what you know and you believe, you know and you know I've had people get really angry with me when I suggest that maybe their marijuana use is a little bit problematic, and I don't like that.

Marcia Bremenour: 29:55

I don't understand why they don't. I don't understand why they don't like that that. I understand why they don't. I do understand why they don't like that. But you know, and now we live in an age where the word medicinal has been added to the word marijuana. So when you present it that way, you know so well, it's medicinal marijuana. As if that changes. And the same is true for Xanax, for example Highly addicting, highly addictive medication that takes years to get off of Again.

David Liss: 30:26

I could talk for a very long time about all this how can families and friends support someone who's struggling with addiction and what role does community support play? And sort of a tangent I've been thinking about as we talk here is, I think, that alcohol, marijuana, food, gambling, I mean all these things that are a person can have as a part of their life, but not a, not an addiction. Like how do you regulate yourself when you're, if you're going to smoke, marijuana or drink and you're going to be with people who have alcohol or addiction problems of some kind?

Marcia Bremenour: 31:13

Yeah, you know, it does get very tricky, because not everybody who uses marijuana is addicted to marijuana and not everybody who drinks alcohol is addicted to alcohol.

Marcia Bremenour: 31:25

There's so many, like we talked about before. I did give the three-pronged perspective bio, psycho, social but each one of those prongs also has so many unique nuances that you know it's, and I know that when we talk about these things, people often come away thinking that I'm saying that well, everyone who's doing this is an alcoholic or a drug addict, and that's just not the case. There are, however, certain drugs like heroin. You use heroin one time right.

Marcia Bremenour: 31:57

Drug dealers know this, by the way. You use heroin one time, you are not necessarily going to develop it. You just use heroin one time, that's it right. Go back for day two, you still might not develop a physiological addiction to it. So you go back for day three and you absolutely are going to develop at that point.

Marcia Bremenour: 32:30

That is where the thing happens right, and drug dealers so you're on the parking lot of the gas station and someone's like you know and they and somehow there's radar, people have radar, they find each other and they give you enough. They give you a phone number, they give you enough for three days, right, come back, see me in three days, right. And then you go home and you do it for three days, you're coming back and they know you're coming back. So the risk, when the other reinforcers are not present, for the person to say I don't need to do that, I feel good as I am, I'm regulated, I'm comfortable, I'm comfortable enough or I'm okay with being uncomfortable, right, if someone knows how to be uncomfortable and then knows how to move through that and fix it, naturally there's certainly the advantage.

David Liss: 33:38

But many, many people don't? They have an awareness that this is just, you know it's deadly or something, or how do you ignore?

Marcia Bremenour: 33:50

I can speak that a little bit that what happens with many, many, is they do have periods of subribe, especially with the powerful opiates. Right with fentanyriety, especially with the powerful opiates, right With fentanyl, with heroin, especially with the powerful opiates and these synthetic opiates that are designed to get the body dependent on it immediately. Right, if someone gets away from it for a while and then they go back to it. That is where the problem really. The likelihood of overdosing is so much greater because the body is not acclimated to it, but the person thinks I can use this much and they go back to where they dropped off the last time. They are likely going to overdose because of the intense drug in their body.

David Liss: 34:41

So is it sort of the case that their effort at sobriety makes the drug more dangerous for them when they go back to it?

Marcia Bremenour: 34:51

Absolutely, absolutely. That doesn't mean people shouldn't pursue sobriety, obviously right. But that really does create a risk when they and I'm not saying people don't overdose, who are using every day, because of course they do. What I'm saying is that there's such a challenge for people in those stages where they're trying to recover because relapse it's so common, it's a natural part of recovery, right? So addiction, the natural part of addiction. So because it is so common and expected and anticipated.

Marcia Bremenour: 35:27

And the problem was that is that people will say dolphin in recovery communities you'll hear people say, well, treatment or recovery is kind of a buzzkill because once you have it in your brain, right, that that okay, I recognize that drug use is not good, it's destructive, it's. I recognize what it's doing. We have a little recovery going on, going back and using the idea of going back and using the idea of going back and using the regulating effect that the thought of using had before. You know that those moments before you pick up and you're like, oh, I'm so happy I'm going to be doing this, that kind of goes away. That gets a little smaller. So the positive impact of using dissipates, but the craving to use does not necessarily dissipate. So the person often uses anyway, and then they feel even worse.

David Liss: 36:25

Cheryl, does that mean that when you talk about returning to drugs, does that mean that it's a failure, or does it mean that you're saying it's part of recovery?

Marcia Bremenour: 36:38

It's actually part of the process. It's an accepted part of the process. It's not an encouraged one, but it's an accepted one. And it's kind of like meditating right. Meditation, as you probably know this, many people know this meditation is not the practice of staying focused, it's a practice of coming back. It's a practice of having a focus, noticing when you wander off and coming back right Same with recovery.

Marcia Bremenour: 37:06

Without the shame attached. So if you are meditating and you wander off and you're like I can't meditate, I keep wandering off, I can't do it, well, no, that's a part of it. So recovery is the same principle would say I keep wandering off, I can't do it, well, no, that's a part of it. So recovery is the same principle Just keep coming back, keep coming back. And in the rooms of AA and other 12-step recovery programs you will hear that all the time Just keep coming back, keep coming back. And many, many, many people keep coming back. So that is the good news Many people keep coming back.

David Liss: 37:41

So it is understood to be a struggle. It's not going to be easy.

Marcia Bremenour: 37:49

And there's so much shame attached to the use. That is back in the day, a long time ago and I'm old enough now to say back in the day it used to be the intention of recovery and treatment programs was to actually really kind of like shame the person and shame their behavior and to beat down the arrogance of addiction is that arrogance is a byproduct of a lack of self-esteem, of insecurity. Nobody is arrogant without an underlying insecurity. And so with recovery in my experience which is why I have focused so much of my attention on recovery and supportive, holistic recovery is to actually feed self-esteem with self-care and self-compassion and coming to understand one's nervous system and how their body, how our bodies respond, how we're talking to ourselves and the value of breathing, like just like what happens when we actually take three deep breaths and we reinforce to our bodies that we're actually okay. When we go through life scared, we're sending messages to our body that there's a fire in the kitchen is really a healthy, supportive way of sort of offsetting the drive toward addiction.

Marcia Bremenour: 39:26

But it takes a lot of work, obviously, and to interrupt that cycle of wanting the quick six right right and not caring about ourselves and not feeling guilty about the pain that we've caused people who love us. You know, as a byproduct of our addiction, you know, hurting ourselves, hurting other people. There's so much self-loathing that goes with addiction that the idea of introducing self-care and self-love is almost like, so foreign to people. So really teaching that in a way that is supportive, but not coddling, because these people, often people, will come to recovery. I say these people, people who are struggling with addiction, are often coddling their own emotional discomfort and, as a byproduct of that, undermining their self-confidence, which undermines their self-love, which undermines their ability to access recovery.

David Liss: 40:30

That's a lot. How has the rise of fentanyl impacted efforts to reduce overdose deaths? Fentanyl impacted efforts to reduce overdose deaths and what is the impact of fentanyl?

Marcia Bremenour: 40:50

Well, my experience with all the synthetic drugs, and fentanyl in particular. It is so fast acting and it is so available and it's insidious because it's being interwoven into other drugs. People are using, you know, recreational cocaine, which I'm not promoting at all, but you know, maybe I should say pot, and maybe it's someone who goes to a club once a month and when they do that, they experiment with cocaine and they've been doing that for a very long time and nothing's going to happen. I'm not promoting that whatsoever, I'm just saying there are people who do that kind of thing.

Marcia Bremenour: 41:21

And that person gets a hold of some cocaine that has fentanyl in it and, all of a sudden, their ease, are addicted to it, right, they're addicted to the fentanyl, or it kills them, they overdose on it, it makes them sick, right. So it's just. And it's such a powerful drug and, like I said, it's so easily accessed now, it is so highly and broadly manufactured and distributed. And, you know, fighting that, fighting society that is globally, that is really leaning toward feeling good, fast, right, like what's easy, what makes me feel good, what makes me look good, what makes whatever, what makes life easy? And it's a ruse, you know. But I think that those things all make us far more susceptible to doing things that are dangerous and ignoring things that are actually good for us.

David Liss: 42:24

Yeah, I mean I can think about, like how I eat. I go to a vending machine and get a thing of cookies, as opposed to looking for a fruit or a vegetable somewhere. It's the easiest thing to find. Right right, so you shouldn't necessarily look at it that people are intentionally trying to kill themselves. It's with fentanyl. It just is a byproduct of how it's included in different drugs.

Marcia Bremenour: 42:47

My experience with people who use advanced, different advanced drugs. You know different synthetic drugs and there's a lot of them out there, right, they're very available and very few people are intentionally trying to destroy their lives, right, At least not in the beginning. Most people are just comfort seeking, and then sometimes that comfort, the way they're seeking that comfort is to just drug, basically drug themselves, remove themselves from the situation.

David Liss: 43:22

So they're not.

Marcia Bremenour: 43:24

And so that that piece of it is a challenge, because intercepting their self-esteem is where recovery comes in. But they're doing, they're behaving and they're participating in behaviors that the rest of the world, if you will, are so judgmental about.

Marcia Bremenour: 43:43

You know it's hard, it is a challenge to intercept it and you know you asked earlier, dave, what can family members do, and what I would say to that is, first and foremost, do your job of just loving the person, just love the person job of just loving the person, just love the person, independent of what they're doing, and then hold them to some standard of self-care, you know, and try to do what you can to support that and and that is about all you can do, whatever that means to you. Helping them access therapy, if possible, certainly is a goal. Al-anon, codependent Anonymous both excellent resources for family members. There's a series of books by an author and they've been around forever Melody Beatty and Codependent Bill Moore, beyond Codependency are the two that come to mind. That are the first two that she wrote. They've been around forever, but I tell you what? The philosophy, the message is timeless, you know, and lots and lots of families who are trying to support people in recovery have benefited greatly from those kinds of resources.

David Liss: 44:58

What are the barriers that keep people that are suffering from addiction from accessing treatment?

Marcia Bremenour: 45:06

I think financially first of all, right, not having the finances. Treatment can be very expensive, you know, and more expensive treatment is not always better treatment. So, keeping that in mind, I think finding motivated people who are motivated in recovery a huge part of it. And I'm not pushing a 12-step recovery program, but I am going to tell you that the 12 steps of recovery are really, if you read them, just a healthy way of living, and many people get caught up in the religious piece of it and you can easily take the word God out and just replace it with nature, sunshine, whatever. But it's just a really healthy way of living in that just acknowledging that you can't control everything there's things you can control, there's things you can't and recognizing the difference, for one thing, being present and being mindful, that's one day at a time is essentially mindfulness, which, of course, has been around since dirt.

David Liss: 46:15

But we've decided, we've just invented it, I think.

Marcia Bremenour: 46:17

And AA is free, no-transcript. The addiction, the unhealthy relationship with the drugs or alcohol, is really an integral part, and so, to answer your question, you know what are the barriers. The main barrier is a lack of fragile protection, if you will.

Marcia Bremenour: 47:05

You know that thing that keeps you from going back out there. In the recovering community there's a saying people, places and things. So in recovery, especially early in recovery, you want to stay away from people you used, with, places you used and things that remind you of using. So for some people they can't go to the same grocery store they once shopped at because that's where they bought their beer, for example. Or if they are at the grocery store and they only have one that they can go to, they can't go down the aisle where the beer is sold.

Marcia Bremenour: 47:42

For example, cigarette smokers are strongly encouraged not to go into a store like a gas station where they sell cigarettes behind the counter, because they're likely to buy a pack and, if they're trying to quit, probably not going to be able to. The brain does a thing and it just goes. So sober people, sober places and sober things are critically important hedges of protection that separate the person from their choice while they develop those behaviors and those activities and those skills that give them the ability to regulate their nervous system. That reminds them safely that there's not a fire in the kitchen. Right, there's no fire in the kitchen.

Marcia Bremenour: 48:27

You're okay, which is where breathing comes in, and grounding and understanding your polyvagal nervous system and understanding all the things that go on inside our bodies that make us tick, basically. So that's more advanced recovery stuff, but it's there.

David Liss: 48:45

It's good to know what role should harm reduction strategies like naloxone, excess or safe injection sites play.

Marcia Bremenour: 48:58

Well, there are medications that people use to curb cravings right, that can. If you drink, for example, you get sick if you're on certain medications. There's nothing wrong with if those serve as barriers to like a hedge of protection. If they serve as barriers to using in a way that is destructive and they give the person an opportunity to practice those things that help them calm their nervous system, naturally, to promote recovery, then they're useful. If they turn into a dependence, which happens sometimes, then that becomes problematic because nothing's changed.

Marcia Bremenour: 49:41

They're just using a different way to get to do the same participate in the addictive behavior. Does that make sense?

David Liss: 49:51

Yeah, yeah, it's sort of a limiting or enabling kind of thing.

Marcia Bremenour: 49:57

Absolutely.

Marcia Bremenour: 49:58

It's not promoting recovery, it's just shifting the damage.

Marcia Bremenour: 50:05

It's the same behavior, you know, just with that different substance less damaging substance potentially, but if without recovery, the person is far more likely to go back to addictive behaviors.

Marcia Bremenour: 50:20

And speaking of it's really you asked before about mental health issues. And so people experience trauma right in their early life or something that they experience is traumatic, and the way our brain functions with trauma store that in this place in our brain, right. We take it away there, it's right there and it's tucked in there and nothing can get to it, and then we have this well-resourced part of our brain that helps us get through the day. And so the problem with this, with addiction, is, once you take away the drug that the person is using to cloud their access to all the parts of their brain and their memories, some of those memories start to come up right. So when that happens, if that person doesn't have ample support around staying sober, they're far more likely to be re-traumatized by memories, and that shame they around, you know. And so that I just want to throw that in because I think it's a really important part to take into consideration when it comes to recovery.

David Liss: 51:31

Yeah, and along the lines of what you just mentioned, could you speak a little bit more about stigma and shame and addiction recovery and their impact on recovery?

Marcia Bremenour: 51:45

Well, I think that sure, I absolutely can. So many people see drug use as a choice and absolutely there are elements that are of the person's choosing. They're choosing to do the thing for sure and certainly at first glance that's absolutely what it looks like, triggered. If you understand that, you'll recognize that once that ball is set in motion they're just going to use. If there's not barriers, they're going to use. And it's not because they're stupid, it's certainly not because they're weak, it's not because they're incapable of something, it's just because they're caught up in this cyclical relationship with this chemical that is driving them to do these things. And the barriers, for whatever reason, are not in place yet that help them to stop doing that behavior. So I think the shame part of it actually just contributes. It's like, well, screw it. Everyone thinks I'm this anyway, I'm just going to go do it. Who cares Right?

Marcia Bremenour: 53:01

So, yeah, there's nothing helpful. Addiction is definitely a shame-based disease, if you will, and it is identified as a disease because, amongst other things, it's symptom-driven, it's progressive, it's fatal and it's chronic. So those are by definition a disease. Are those things? So I don't get into those kinds of debates with people. I don't care if someone calls it a disease or not. Frankly, it doesn't matter to me if they do or if they don't.

Marcia Bremenour: 53:31

You know, what matters to me is the actual mechanics of the behavior and it's person by person. Everybody's different, you know. So I'd have to sit with the person, see what's going on with them, find the similarities amongst other people who struggle with addiction, so we can kind of help, like navigate where they need to be, and then really dig into the subtle nuances that make their situation unique to them in a way, not this terminal uniqueness that keeps them separate, but the kind of uniqueness that recognizes them as a person, separate from their addictive behaviors.

David Liss: 54:07

Going from there. What are some success stories that give hope from your experience to those fighting addiction today, and are there people that you've worked with that bring you some optimism?

Marcia Bremenour: 54:21

Well, I have lots of success stories. Lots of people that I've worked with over the years, who I stay in touch with, still send me people from the recovering community who have just really stuck with it, kept going to meetings, kept doing things to take care of themselves, kept surrounding themselves as much as they can with people who support their recovery, and I witnessed it. I continue to witness it. There are people who do really really care about staying sober and they want to stay sober, and what I see the most is there's an underlying inability to regulate their nervous system, and when we introduce tools and skills to regulate, it's a game changer. So, you know, I practice EMDR with clients, which is I move into sensitization and reprocessing. I practice a neurofeedback, a nonlinear style of neurofeedback which helps with brain training and helps with relaxation.

Marcia Bremenour: 55:30

I promote yoga and just general exercise, just stretching, like paying attention to your body and taking care of it differently than you did before, and those things that is where the holistic part of my approach comes in Like those things all contribute to well-being from the inside out, which is exactly what we need to get to, because once you do that, those aren't cures for addiction. Once you do that those aren't cures for addiction but as they stabilize, they allow the person to actively stabilize from the inside out and take ownership of that Like it's actually theirs, because it's their body they're dealing with, right? Yeah, I think that comes from that, and the ability to self-regulate eliminates essentially, or certainly distinguishes, cravings in many cases and for sure allows them that person to access support systems that serve as that hedge of protection I talked about before.

David Liss: 56:38

What message of hope and empowerment would you offer to anyone that's fighting their own battle against addiction?

Marcia Bremenour: 56:45

If I summed it up in a couple of words, I would really say self-compassion, be nice to you, give yourself oxygen like breathe. The whole idea of three deep breaths. You know you think about the fire in the kitchen, right idea of three deep breaths.

Marcia Bremenour: 57:02

You know you think about the fire in the kitchen, right, you take three deep breaths the first deep breath shows an intention that you're say oh, I'm, I'm doing this, I I must be okay, I'm not gonna stop and take a deep breath. There's fire in the kitchen, right. So first deep breath is the intention is of self-care. The second deep breath allows the body to be more present, more aware, mindful, right, like when you take the second deep breath, you're like oh, then you kind of feel your shoulders drop down a little bit, you're feeling your feet on the floor. The third deep breath, because you've done the first two, the third deep breath does this really magical thing of opening up your circulation. Right, that's what happens when we breathe we dilate our circulation, we get everything moving and it feels really, really good.

Marcia Bremenour: 57:55

So if somebody can give themselves the gift of just doing those three things, they can feel better. Right, they can feel better, at least for the 30, 20, 30 seconds it takes to do that. If they could just get an inkling of what it feels like to feel better. That's something to build on, you know, with the support of therapy and loving people around them and all of the things. But so I say breathe and it feels flippant. You know, you read memes or you see something on social media that's like just breathe, like my mom says, just breathe. Right.

Marcia Bremenour: 58:33

But when it comes down to sitting with a person and doing this exercise and watching them experience things, and then what that feels like when they go outside in the sun and they stretch a little bit, when they recognize the value in stretching for their nervous system and they start to understand themselves just a little bit better, those acts of self-compassion make such a huge difference in the overall impact of their well-being. It's not the end-all be-all by any stretch, but it's an integral part of a foundation toward wellness, right? If you focus on wellness, whatever pathology you experience or whatever you want to call it kind of goes to the background, Right. And then it's kind of behind you, it's in your rear view mirror rather than in front of you.

David Liss: 59:29

Oh, that's great. Sometimes, simplest things are the best things. Yes, absolutely we don't have to overcomplicate our lives sometimes.

Marcia Bremenour: 59:40

Right, right, right, right, right, right, right, right, right. So, to answer your question, I see lots of people with miraculous moments, moments. It's the men who get more moments.

David Liss: 59:51

Thank you, Marcia Bremenour, for being here today and for this conversation. To learn more about recovery, please visit www. b remenou. com that's M-B-R-E-M-E-N-O-U-R. com. And thank you for joining us for Wellness Musketeers. Tune in for our upcoming episodes to learn how to live with a greater understanding of the world we experience together. Please subscribe, give us a five-star review and share this recording with your family and friends. Let us know what you need to learn to help you live your best life. Send your questions and ideas for future episodes to Dave Liss at davidmliss@gmail. com.