Therapy Talks

The Spectrum of Substance Abuse: 6 Crucial Lessons for Addiction Recovery with Evan Lieberman

October 03, 2022 Switch Research Season 1 Episode 43
Therapy Talks
The Spectrum of Substance Abuse: 6 Crucial Lessons for Addiction Recovery with Evan Lieberman
Show Notes Transcript

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If you or someone you love is struggling with addiction, it's time to get help. Addiction can manifest in many forms, from smoking and drinking to workaholism and gambling. And it's not always easy to spot.

This week on Therapy Talks, Evan Lieberman joins Barb Egan to discuss the different forms of addiction and how we can learn to restore our "chemical health." Evan and Barb talk about how to identify addiction, where it comes from, and how it influences our home life, work life, and mental health.

In This Episode:

  • How personality type and biology play a role in susceptibility to addiction
  • Using the "stoplight method" to understand and take control of our emotions
  • Pandemic drinking (negative coping in a stressful situation)
  • What is addiction? (understanding the full spectrum)
  • Our relationship with substances, and the boundaries we create around them
  • Differentiating abuse, dependency, and addiction 

Evan is a Licensed Mental Health and Addiction Professional, Educator, Author, and Entrepreneur. He is dedicated to teaching the public on the importance of mental health and addiction.

If you or someone you care about is struggling with addiction, don't miss this important episode of Therapy Talks.

Find Out More About Evan:
TikTok: @evan.the.counselor
Instagram: @evan.the.counselor
Youtube: @evan.the.counselor

Learn More About Switch Research:
Instagram: @switchresearch

Disclaimer: Therapy Talks does NOT provide medical services or professional counseling, and it is NOT a substitute for professional medical care.

Hi everyone. It's Barb Egan with Therapy Talks, and on today's show we have Evan Lieberman from Minneapolis, and Evan is an addiction specialist. He works in all sorts of areas and talks about how addictions can permeate all areas. And as therapists, we're going to see it, even though most of us. Skin shy away from it.

So today we talk about where does it come from? Where does addiction come from? What does therapy do? How does therapy actually help? And the stoplight model to be very practical, whether it's addiction and alcohol, or it can be applied to anxiety and OCD. And so I think no matter where you're at or who you know, you're gonna resonate with today's show.

So tell us a little bit about you, your practice is in Minnesota. How did you get into therapy? Yeah, I guess the long and short of it, the story I tell and people who ask is my mom worked in special with special needs and so growing up I would, volunteer. I would work and do programs, doing one on one with kids with behavioral intervention.

And I guess I went into college and I didn't really know what I wanted to do. It was I don't know, do I go like the business route like my dad or do I go like more into the human services route? But I kinda found I was more interested. And human psychology helping other people found a head and neck for talking to other people.

And people would like lean on me for support and advice, which I don't understand cause I was a hot mess. But like apparently I was good at listening and giving advice. So I was always attracted to that. So I was going in that direction in college, like studying psychology, but then I.

Some of my own personal issues with addictions. Basically I developed a nasty addiction by the time I was, 19, 20, 21. And as I finally got under recovery, I redirected a little bit and went towards the addiction route. And. But I always was interested in the general mental health piece of it as well.

I was always interested, very interested in both. And given my experience as an addiction, I thought you'll be ashamed to not use that or develop those. And it well needed area for practitioners. So it was second nature to go into addiction as well. And then yeah, so that's the background of how I got to where I am and I guess, Right now what my life consists of is, I have for the last like six years I've had a private practice in one way or another.

Seeing people, individuals, family families, adolescence for individual therapy. I've worked in all sorts of different settings, like for many years like inpatient psych units treatment centers, outpatients, harm reduction. So I've had a little bit of a wide breadth of experience working in different areas, but I think my, Passion.

And what I've always wanted to do is that individual psychotherapy, private practice so I have my own group practice that I've been starting, that's all online where I'm bringing clinicians on. So a lot of my time is spent managing that. I have a recovery housing program. Wow. So I'm.

Oversee that as well. And then I do social media content creation in the mental health and addiction space. So it's kinda like those three things. And I, but I still like to. Keep my feet on the ground and do direct services and work directly with clients. And I think it helps with everything I do, and it's just something that I love to do, even though I maybe don't necessarily need to do it, but I think it's important and I enjoy doing it.

So I do. Part-time private practice compared to other clinicians who saying 30 clients a week or something, right? Yeah, definitely there. But I also supervise new clinicians. So you know, the people who I bring on a lot of 'em are supervisees, so I have my fingers in a lot of things and. keeps it fresh.

It does, it absolutely does. I'm a university clinical supervisor too, so we have a, like the, our interns, we have our graduate students, we have our practicing therapists that we supervise. I have a group practice too, and it is, it's so fun to. Almost coach and mentor in that sense, as well as that individual, That client centered psychotherapy, like you said, which in addictions is really unique because oftentimes you're at treatment facilities or it can look a little bit different, and I loved how you shared just how you worked, not only with individuals but families and a little bit of all of that, and the social media part of just bringing awareness and psychoeducation around that to those spaces that I bet more people than we realize.

Resonate with. So in working with addiction, for our listeners, listening on, could you describe what is addiction, where does it come from, and then some of those processes or treatment approaches to that. Oh, those are some pretty big questions, right? Addiction, I think like the easiest, I don't know if I've ever.

Qu, quantified this. The, as far as a clinical psychological perspective, it's when somebody's use of mind and mood altering substances creates ongoing and pervasive consequences in their life. And so it really spans a spectrum because the people who for chemical health and know if you're a therapist, you cannot avoid it.

You will have, addiction will be an issue. And for some people, they go through the, It's periodic, right? Especially right now, I've seen this just, I can't even count how many times that during the pandemic, they were always like drinkers. But then it became an issue because it became a negative stress coping response.

And then they found that. It was negatively impacting them, their families, through relationships. And so for those guys, a lot of, sometimes they're just getting them back on. These aren't necessarily lifetime chronic relapsing, the disease model that we have. And I think with addiction, that's where people's heads go right away is this chronically relapsing condition of the brain that requires intervention.

Yeah, there's absolutely that. And of course you're gonna see a lot of those folks because they need help and they're gonna seek services, or services will be sought for them, right? Placed it into your lap, on, beknownst to them. But, so it really spans like a very wide spectrum and there's a lot of different ways to look at addiction, to intervene to work with folks with addiction.

Yeah. So I think it spans anything from, working on people's goals to manage their term uses chemical health, which is a term I actually really because everybody has a relationship to substances in some way. Whether that's, I don't use them or having some, everyone has some certain boundaries.

Okay. I. Yeah. Maybe once in a while I go overboard, but I'm not doing cocaine and I'm not doing heroin. You're average person. That would be a boundary for them. Someone comes and offers me little heroin at the party. I'm I'm going to say no, I'm gonna do the ran Nancy Reagan on that one.

So everybody has a relationship with chemicals and it's different and everybody has different goals and everybody has different standards for themself as well. Whether, it's someone who let's say was addicted or is addicted to heroin and like living on the streets, their goals are probably gonna be very different than, the person walking into my office because they're having relationship discord at home, right?

So it's very complicated. So what I'm hearing you say it, it's a bit of a spectrum. Would you say that? Oh yeah, a hundred percent. Yeah. So it's a very, and it's a very wide spectrum and people don't, I think, often realize that because, I you look at addiction, Okay, well if it's an issue, it's probably a very big issue and everybody knows somebody where addiction was a very big issue and potentially had a devastating impact.

So that's obviously where your mind is going to go to, and I think that's difficult sometimes for people to see, and I think it creates a lot of confusion because we look at it very much as a binary. And I could give like a little anecdote where I have a friend who's a lawyer and he started referring me folks to get assessments.

And when he sent me people, he basically, lawyers are, a little bit of a different breed, right? They're, they work a little more in the black and white in some ways, and they're like, it's like Evan, I need to know if they're an alcoholic. , right? I need a yes or no. And I'm like let's see how it's a little less complicated.

He's Don't gimme that soft language. I need to know. I'm like, Look man. That's not how it works, right? I can't, I can diagnose him with a use disorder, but that's gonna be on a spectrum. And just because someone necessarily may not have a use disorder doesn't mean that there's not.

Targets that we could work on, let's say in a therapeutic sense where chemical health is an area to work on. They could have that and not necessarily be an addict or an alcoholic. Those are not clinical terms that are used at this time. So yeah, so really it is a spectrum and there are, we have guidelines like any other disorder of how we diagnose it and how we.

Measure on the spectrum. And before it used to be, like before 2013 on the DSM five coming out, it was, abuse or dependence. And that was it. And actually certain things I do like about that, but it was like no abuse dependence. Now it's just one, two, or three or zero.

So just a little different how they weigh it. And I actually. Dis, I don't know. I disagree with both in a little, just a little bit. But it's my opinion, but I don't, could you speak to, Cause some of our listeners, whether it's themselves, a spouse, a child, someone in their life that probably resonates and they're curious and I bet most of us have inquired or gotten curious or wondered.

Does this person have an issue? And like you said, we all have a relationship with chemicals, whether it's this is my boundary or I don't what are the diagnostic criteria? Like how do you know if someone has a issue? Yeah. I think, there's two ways to look at it. One is, it's a, its a little complicated, right?

There are 11 symptoms, and I'll list as many as I can off the top of my head. I don't know if I'll, I always forget a couple of them, but, at least like on the spot recall, but Right. Also, it ain't rocket scientists, it's like Uncle Bob probably, there's just some people where it's you don't have to be a clinician with a sweater vest, and you're.

The cup of tea it's like that dude's an alcoholic. Like we all know that, he's a drug addict. The guy's like stealing cars and doing meth, like getting in bed, feeling complicated. Sometimes it is a little more complicated, when it's on maybe the lower ends of the spectrum when it's more like in that, what we would call abuse category versus dependence.

Some of the things that we. Look at for example would be how is it impacting your relationships? And for all of these, we look at ongoing. It's not like I got in one fight with my wife, but it's like all of these are ongoing issues more than once. Right? Within more than a one month or something like that period. So yeah, problems in relationships. Is it affecting your work life? Your ability to fulfill your responsibilities at work, home or otherwise. Are you how does it, there's a question of like how it impacts your emotional, your mental health your physical health.

Does that have a recurring impact on that? Are you building a tolerance to the substance, which is, do you need more to get the same effect? Do is do you go into withdrawal? Are you giving up like activities that you used to love or enjoy? You know what else? A lot of others are just like in that vein of the negative consequences that come into your life.

We used to look at legal, they took that out, but like recurrent legal things, clearly correlate that are substance related. What else was a handful of others, But they all are on that. Does it affect your. Emotional, mental

ability to fulfill responsibilities and just live like an overall balanced life. And those are the specifics that we look at. And then, it's if you have two to three, it's a. Mild symptoms. If you have four to six, it's moderate and then you have anything over that is severe is what's considered.

I think of it like the Taco Bell sauces. Sometimes I'm like, mild hot. Yeah, mild, medium, hot. Sometimes I actually accidentally say that. Yeah, , that's re relatable because there's such a stigma around addiction. But like you said, this kind of permeates society. It we probably all know someone or. Are curious about it or for ourselves, we have relationship with substances and chemicals and so that's a good awareness to say, Where am I at?

And then saying, How does it influence my home life, my work life, my physical, my mental, all of that. Those are really relatable categories or symptoms that you gave? Yeah, I think I like where some of the complications come in. I think where a lot of times the traditional addiction model has got it wrong is that like almost everyone has been.

It's usually like college, right? But like you, a very high percentage of college gets like 30 to 40%, meet the criteria for a use disorder, right? But they don't have a chronically relapsing brain disease. But if they came into my office, could say you meet the criteria of symptoms, you're.

Doing coke, this and that, but like a lot of times it is episodic and only a certain amount of people are going, will that be an ongoing recurring issue at different stages of their life? And for some people it does not come till later. Very typically with alcohol, it's one of alcohol could be a very slow burn.

A lot of people, as they start approaching middle age, Really sinks its closet and it's like worse than anything else. But anywhere along the way that could happen as well. I sometimes joke with people, it's most of us have been there, right? A very good amount of people had about, or even they like, had a weird run with some hard drugs because someone, they knew they were just in this weird situation and they found themselves like doing meth for three months.

And if they came to me, I'd be like, Oh, this is a huge, in that time they're like, Wow, this is right. Big issue. They're doing meth, right? So it is really complicated because many people. Have been there. And so I think a lot of people understand, or they've had experiences with something that they have struggled to control.

And I find almost everybody, we all have, it's like we all have our poisons, pick your poison. We all have our, means of coping that may not be the healthiest. We've all had things that we've struggled and. So I think people could understand from that lens where it's imagine that, but potentially times 10, not to like rank because some people could have eating disorder that in some ways may be more severe than an addiction or someone has had a bout of that when they were a teenager.

Or some people struggle to manage their eating, gambling. There's all these different very immediately rewarding negative coping mechanisms. that you could easily relate to. So sometimes I'll frame it in that way. Yeah. Yeah, that's really helpful. I appreciate that perspective a lot when someone comes in and you're working with them, or even if they're hearing this and they're thinking, Yeah, I can resonate, my time in college or just even hearing that about middle age and drinking, like those statistics.

What is it that makes someone, let's say me more susceptible than you to experience maybe a dis, a, an issue with a substance or let's say alcohol or dependence and you don't, even if we've had a similar experience, let's say in those college years or unwind with alcohol or things like that how does one person go down that line or that walk?

End up in an addiction whereas other people don't. Yeah, that's a big question. That's . It just one word answer probably is enough. It's . Yeah. I'll give the one word answer like, Same. Is everything else, Nature versus nurture. And I think, sometimes it gets a little political with that, where it's it's all trauma and adverse experiences.

The scientists like it's a biological, your genetics and that, and it's both. That's the thing with substances, it's, there's, it's like a Swiss Army knife of negative like coping skills that it helps with. It, A lot of times, like if people are in extremely stressful situations and that can mean a lot of different things in their life and they're gonna be more susceptible.

And I think those are a lot of the times, the husband, I'm not trying to like Genderize, this is just like what I get all the time, but it's yeah, husbands who are, using too much of Covid a lot, a lot of women as well, but. Yeah, so there there's the stress.

So there's the stress of the present, Then there's the stress of the past, right? Of the developmental traumas adverse. The more you have, in many ways you're more likely, but then it addiction is notorious for affecting everybody, right? It does not discriminate, right? And so you have a lot of people, let's say like myself, honestly, who didn't have a ton of like adverse childhood experiences.

So why the hell did it hit me so hard? And there's like the biological, and it wasn't even genetic, but in some ways it is. But I think there's certain, and people may argue this, like the personality types. That are gonna be more susceptible. Like for example, like I have found in my own personal observation, a lot of the folks who have these ongoing issues, especially from a young age, have adhd or they have some kind of neuro atypical thing going on, right?

Where they struggle with impulse control and in substances just do something different for. Because they have just a different mental setup where substances fit like a puzzle very well. So I think there's just some people, right? Take for my brother, he likes to have a good time, but he just, it just didn't hit him the same way.

There's just different elements of our personality. We have the same upbringing, same parents, a lot of the similar genetics. But for whatever reason, like I just went down that route. It was. There's damn near nothing I could have done about it just because of how I'm wired how substance is. It was clear from the young age that they affect me.

They do something different for me than someone else. One of the like anecdotes I use is, I say a healthy relationship with chemicals is like, this is something I do once in a while for. Where people go down the rabbit hole is when it becomes a tool for something specific, right? This is the way I cope with stress.

A lot of people do that. They have a glass of weight, and they're able to manage to a certain degree. But that's one example of this is the one thing, right? When you become reliant on it to, this is what I use to non-pay, pain killers, whatever. This is what I do to cope, emotionally with trauma from the past.

This is what I use is solely a means to have fun. I got nothing else that I do except this is what I rely on. Not just a, auxiliary tool to do it once in a while and you could just go down the line. But whenever you use substances for something specific, that's where it becomes a trap.

Yeah. Because, because then you have, the evil of tolerance, and I always showed you, so tolerance, right? Is the, it's the, I need more to get the same effect, but then when I stop doing it, It feels worse, right? Then I go into withdrawal, so then I need more, right? So whenever you start getting in that cycle, it is hard to break.

And some people find themselves able to break it and they're like, Gosh, I learned my lesson and I don't do it. And they move on with their lives. They're still in the same cycle as the, more chronic addict. So that's why it is hard a lot of times to tell the difference of what is an appropriate intervention, because I don't know.

These folks are in the same washing machine, right? I don't know which one is gonna be able to get out and not go back into it because it looks very much, Now there's some indicators that I look for that kind of give me a hint to it. But sometimes it is hard to tell, and that's why in the zeitgeist or whatever, it just that black and white, are they an alcoholic or are they not an alcoholic words?

The real question is are they a chronic addict or al is this going to be an issue? Ongoing, almost no matter what you do or not, right? I think that's a bigger question. Cause at the end of the day when somebody comes for an assessment, which is a really, one of the first steps you want to take, is at the end of the day, I'm just making a recommendation for different levels of care.

And that could be anything from, Hey, why don't you, Nothing really to, Hey, let's see me once a week and let's see where this goes. And we'll set up some goals and see how we do. And if we need more, we could just up it from there to, Hey, you need to go to detox right now. Cause your hands are shaking and I'm worried you may have a seizure.

So it really spans a wide, So the question is, what are you most appropriate for? And someone who's saying, Okay, yeah, I. Back in the using cycle. However, I've been to like 10 treatments before and I'm doing opiates. It's okay, we're not gonna do that. Hey, let's meet once a week and work on some of your goals.

It's we need, this is more entrenched and more chronic. I don't remember the original question cause I tend to go on rants, but Yeah. No, that's really helpful to give people an idea of. Therapy or what treatment options are out there. And I think a lot of us, we think of addictions, we think of addiction treatment facility or detox or rehab.

But what does therapy like, let's say you do an assessment and you decide, okay, this person meets a criteria that probably once a week for psychotherapy would be really good. What does that look like? What does that look like? That's a good question. I almost have a little formula that I do with these.

And one of the first things I do is I work with them on motivation, right? So really identifying what is your motivation to stop using and how do we enhance that? One of the ways we enhance is we talk about it more and really examine, why do you wanna do this? And. What are the positives you're going for and what are the negatives you're trying to avoid?

Cause it's important to always remember those because you know when the going gets tough and that substance is in front of you, right? Your mind has a great way of trying to convince you to do that immediate pleasure right now. So really trying to ingrain that motivation because it. Just, going over that line of I want to do this to then form a plan, right?

So then we come up with a plan, and part of that plan is identifying I use like a, I called like the stoplight model where it's like red, yellow, green, and the red is here is where I do not go. These are. Most damaging behaviors and it's basically the relapse. Or if I do this, I'm coming close to relapse or I step foot in a bar, but the red is drinking.

I am right now. I'm not going to drink the yellow. Here are all the things that will probably lead to drinking that I will, that I want to avoid. I may find myself in the zone, but when I recognize that, that's when I get out of the zone, right? These are all things that just help build awareness and then the green, are he probably the most important here are the positive, healthy.

Things that I wanna do, I, I wanted to get back into working out. All right. Alright. How often, then doing kind of the smart goals of all, how often do you wanna work out, right? How do you you wanna go on walks? Do you want to, even doing therapy that is an example of a agree here.

Here are the changes that I'm going to make. It could even be things like replacement behaviors, or you could do this with anything you do with smoking. All right, I'm gonna drink tea instead after a meal. So these are all things you could put, so we identify that because one of the biggest things of making any behavioral changes awareness.

Being aware. Cause all these things are exist in your head, but they're everything, everything in your head is floating back there, so you're kinda like, Ah, so let's get it on paper. Let's, have this visualized and have an organized plan. The third element is accountability, and that is where therapy comes in, right?

It's a great if we're meeting every week and every week we're gonna check in. I'm gonna be asking you about your little stoplight there and what you did, and when you do that, people are going to be more likely to, cause they don't want to come in and not do their homework. This is awkward right in.

It's like a lot of times how D B T works, where like you go in and it's if you have to do your thought chain analysis, if you had a self-harm incident or something like that. And it's no one wants to do the thought, it's annoying, there's that accountability and I try to get them to set up accountability in other ways, whether it's with the spouse.

But eventually the goal is that you could have a sense of accountability with yourself, but it always does help to have accountability in as many, I call it like layers of accountability. the joke is look, if in the most extreme sense, imagine if like I had access to your bank account, and not only that, so if you relapse, I get all your money.

Not only that, I'm gonna have a security guard. With you 24 7 at all times. And if you use, they have a cattle prod and they're gonna shock you right in the butt. , you're not gonna use. Give even more extreme I'm gonna kill you. Like so whoever that is, even like the most dire of heroin addicts Aren't gonna do it because they have this just insane level of accountability, but that's not realistic.

How can we find realistic measures where you have these incentives and maybe even disincentives incentives are more powerful. But setting up, also these layers of accountability so that you're just more likely to maintain that behavior. And especially at the beginning, that's when it's the hardest.

Our minds adjust pretty quick, to making changes. And then there's all sorts of ongoing complications of maintaining those changes, which is a little trickier. But so off the bat, those are like the first two things we do. Everything else is gets into therapy zone of, looking at core beliefs and learning skills of how to reframe negative thoughts and, all the greatest hits.

 get into therapy mode because one of the most important things is we need to set a foundation of, if you're. Actively engaging in like very problematic substance use. It's really hard to do the deeper work, right? , so it's like, all right, we're just gonna stop the pipe from just shooting water all over the basement.

We're just gonna patch it up, clean it so that we could work on the rest of the house. know, It's like I'm trying to remodel a house and decorate it, meet while the basement is just flooding with sewage water, right? Somehow it doesn't really. Work all that well, depending on how bad it is.

Yeah, so those are that's like the therapeutic model. And I try to teach it to therapists that aren't addiction because I think, as complicated as addiction is, therapists are afraid to touch it, right? Yeah. And I see why. However, I think for those who are in mild or moderate zone, depending, where maybe it's not as complicated, maybe just more of a negative coping pattern that if they could learn.

You know how to use something like that. Or apply it to other behaviors. They'd know that, they shouldn't be too afraid of it. Maybe takes a little practice, you have some consultation, but I really think every therapist could and should have some of those skills to be able to treat them mild to modern if they get someone more severe.

Just like anything else, like I'm somewhat, I'm like, I'm somewhat comfortable with everything. , O C D, but if it is like a primary and severe, there's some of those things where I'm like, I'm just not the best person for the job. Like I know what D B T, I know how to, I know what the tenants of, prolonged, exposure type stuff and I could implement that, right?

But there's certain things that do require a specialist, but it's not everyone because as from a private practice therapist, And this was one of the things that shocked me is I don't know who the hell was walking into my office. Kinda like being the general practitioner, like a small town, rural hospital.

Like I gotta know how to sew up and and sometimes like you, you just never know and it's shy. Cause I always thought oh, I'll probably get them less acute, maybe more depression, anxiety. The working well. No, you get some, like sometimes you're that front line, even though they're in your nice little office with the nice little decorations in the May.

They may be in like a really tough, complicated spot and you're like, Whoa. Yeah. So I think it's important for us, as therapists to have a general broad understanding of a lot of these, a lot of these things. And another reason too is just like there's not enough therapists and like I see a lot of therapists are like, and having anything like greater than like mild depression or anxiety, like the newer ones and I get that, but, maybe it's better to get some consultation and learn something.

Use this as a learning opportunity. But yeah, I think addiction, you just cannot avoid it. You can't just keep referring out and yeah, maybe you can, and but there's. So few of us and the specialty specialists, their schedule gets full. And the wait lists. Yeah. Yeah. And doing the social media work I do, I get to read tens of thousands of comments Wow.

From people who are. . Okay. Just out there, right? And they live in different areas all over the world. And one of the biggest issues is either I can't afford it or I don't have access to it. And probably a lot of people have access to it and they just don't know how to ac, they just don't know how to navigate the complicated system, right?

So few people are even able to get resources. How is therapists, can we. , stay in our lane but widen it at least a little bit. At least give it a shot. And like I've a client recently where he and I, really started to, they were really. Let's just call it an overactivated nervous system, right?

Where just, I dunno what they would use to call neurosis back in the day. I go, I love that term. I don't know, it's back. I think it's cause I'm a Jew and like that's in our, vernacular. I don't wonder what the Yiddish word is. But just really struggling with a lot of daily tests are really hard and and then we started to realize after working, it's this really seems a lot like O C D and not just regular anxiety.

And I was like, I could refer you to an outpatient program, a specialist, we're doing some good work, but let's give it a shot. I know at least a little bit about it. I'm a real advocate of things like workbooks. I'm like, why don't you just find a good five star workbook on Amazon?

Do it. We'll go over some of it together. We'll see if you can make improvements and if not, maybe we'll do a bit of an outpatient program or something like that if you're if you're not getting, quote, better, if you're, if your symptoms are not improving, just like anything else medical, we all have a treatment plan and we have goals, and if, objectively, if it's not working, then, let's, then maybe have you see a specialist versus just being like, yeah. Oh, absolutely. And I think addiction is that when that, especially new therapists don't wanna touch, like it's a scary animal almost, but I loved how you broke it down into the green light, red light or green light, yellow light, red light, like the stop light analogy. That is so think about. And I think you can apply that to a lot of other behaviors and things in mental health.

But just that motivational. Interviewing the stages of change and just goal setting, working with people that accountability, that you're a safe place and they have that place to go to every week. That's reassuring in and of itself. If I'm gonna have stress at work or in my relationship and my inkling or my impulse is to say, I wanna go to the bottle.

But to know, Oh wait, I'm gonna see my therapist this week on Thursday. Or, that will feel really good, especially when you start to get some of the positive reward of it, of just being with someone or feeling validated, feeling heard, and then you experience a positive coping mechanism and the offloading, it's Okay I can Distress tolerance increases.

Oh, positive reward here increases and it's not gonna be a one week thing. But just that beautiful relationship over time I think is so valuable. Yeah. And exactly. And I use that model for everything. I use that like every new client, I actually do the exact same thing. It just looks a little bit different cuz we all have, I call them internal boundaries, we, we all know about boundaries, which, which is okay. I'm setting a boundary with you or with my boss or other people. There's a big push for that. But I'm like, these are internal boundaries. These are limits that you set with yourself, and we all need to have them, and we all need to just.

To meet our goals, just push ourselves a little bit, right? We don't go over the window of we're just gonna, slowly try to expand what we're comfortable with. And so I use it for pretty much every just, I think it's beneficial, but for addiction, it's like a little, it's got a little bit more of an emphasis.

Sometimes it's life or death. But yeah. Yeah, exactly. So I think it is a good kind of wide. Tool that you could use. And you're right about the, like with the positive enforcement, usually, almost always. People get services, not because they're like, I want the positive. They do. They want the positive, but they're like, My ass is on fire.

, they come in and there's smoke, coming from behind them, And that is a, legal issue, And they're really feeling trapped in a corner. And that could be emotional too. They're like, I'm just fricking miserable. So they come in because of the consequences and the punish.

It's come for that, but stay for the positive thing, elements. And so what sometimes is a conundrum for people is, often whether I do anything or not, naturally the fire's gonna go out and you're gonna heal up a little bit. I try to, the interventions help move that forward faster.

But, it's like a, just like anything, like a crisis. Would Ram Manuel say, it's like never always take advantage of a crisis. Never let a good crisis go to waste, because this is an opportunity, it's a wake up call to make changes, because very soon, I tell 'em very soon your life is gonna start to like tilt back to normal.

But if you don't make changes, The crisis is gonna come again. If you don't fix the inherent issues you're gonna very likely be back here again. So let's change, make some of these changes now so that doesn't happen, so that you don't get another dwi. That'd be a great example of, Oh man, I got DWI and I gotta get an assessment.

I lost my license. It's cost me $10,000. I gotta blow into two. But then eventually you pay the money and your life goes back to normal and it becomes the new normal. And if you just keep doing what you're doing, It's very likely to happen again. So I think it's a positive. It's like the positive effects of recovery.

The rewards are what motivate people. Long time. The punishment gets you in the door, but it won't keep it. I There are some rare people who you know, gets so freaked out, or they just got brought to such a place where they just shut the door and they're done. They don't even have to make that.

They're just like, I'm. They, it's some people can do that. It's not the best plan for everybody to just be like, All right, you had some horrible consequences. You're good to go. And just remember those because our minds forget very quickly cuz our brains trick us. To take the reward that's right in front of us to self soothe now.

And it just becomes, it's that people like personified as like the devil on your shoulder. People call it slick, right? It's the part of your mind that says we need to take care of this thing now. And it gives you all these reasons why. And you wanna do it so bad cuz you know how good you're gonna feel, but then you don't think about how that's going to affect you.

It, and you're literally almost incapable of thinking about how bad it was before you put lipstick on the pig. Oh, wasn't that bad. That's the long term mental game. That's what makes recovery so hard in the long term and relapse so high often for people who have a significant amount of recovery and they're not necessarily craving it all the time.

They just I call it relapse of negligence. There was no fight, there was no passion. It was just like I used to always drink whiskey. But, and it got bad, but I never tried just drinking beer. And so any outsider who was your life was just an absolute mess.

Like, How could you even think to do this? But like when you're in that mental space, like you're basically in a space of mild insanity essentially when you're close to that relapse, depending on how bad it was before. But even people who was extremely severe, they come up with these anecdotes or whatever and justifications, rationalizations.

To open that door again to open the floodgate of here's how it's gonna be different this time. And some people can do that, right? It maybe works for a small percentage of people who are less severe, but more often than not, that leads people back into that same cycle cuz they forget how bad it was.

So I think that's why, that's why like certain programs that have accountability, things like AA. Other community support programs or even just doing like ongoing therapy for years, right? You remember, you talk, you remember how bad it is. You remember how good you know the benefits of recovery are that you've become so used to and then eventually take for granted, right?

That awareness piece, that's why people like often relapse. It's more about mental negligence and not a impassion, right? I call the other one a relapse of passion and that's the one most people think about, where it's like, Oh, I'm creating it all my boss, or so stressful I got broken up with and Screw it.

God, I'm drinking anyway. And that happens often in like early recovery where you just don't have the coping skills or just doesn't seem worth it because of how bad you feel, or your cravings are just so bad. But really in the long term, more people tend to relapse out of, the, they call it the mental twist back in the old days, back in the old AA days.

And the peculiar, they call it the peculiar mental twist. Brings people back after a long period of time So would you suggest someone, I know this is such a personalized question, but how often then would someone be in therapy? Could it be lifelong? Would it be weekly? Would it spread out? What does that often look like?

Or social support? Yeah, that's a good question. And I guess it depends on the individual about what they want about. So like typical, let's say, you're running the mill person who I think is appropriate for outpatient therapy to work on managing their chemical health. I like to start out once a week, maybe we do that for a few months.

Some people like to see me once a week for a very long time. Often we then go to every other. . Usually from there, there's not many people I see once a month, but there are some people I recommend that for who don't have a lot of other accountability. They're not in a community support program.

So sometimes with those people I think it's actually a benefit, knowing that you're gonna see your therapist in a month because people often backslide and the old behaviors, and if they come in, sometimes a therapist could be. , Hey I'm concerned, I could see this. And they're like, Oh, you know what?

You're right. I'm like, All right, let's get back. And sometimes it's let's, maybe as we get through this next phase or a crisis that came up or whatever, we can see each other a little bit more and then go back. So people who don't have any support or accountability, sometimes I would say honestly, I don't like, I feel like it could be a benefit to see someone once every six months.

Because of making a significant behavioral change to have any type of accountability in check, like a little tuneup, right? Yeah. How we do with our cars. I know what I look, I always like think of therapy like massage therapy, right? Cuz sometimes you like, maybe you really need it, like it's best intervention for getting your muscles worked on or whatever.

But every once in a while people are like I don't know if I need it. It's. . I don't always need a Swedish massage, but I walk away feeling better. And it's an element of self care. So there's therapy could serve different purposes. It doesn't always have to be like, I'm falling off a cliff and now maybe insurance won't pay for it.

It's like I like a good chat with someone supportive. But. I think they're just, yeah, there's just different benefits and different reasons people seek support services. And just that mental health support. So where can our listeners find you? You said you really like to put out social media content, which would be so helpful cuz just as you've been describing these different areas of addiction and kind of letting us into your world, it's so fascinating.

I've learned so much, so I'm sure our listeners would love to follow along with you and continue to learn more. I think that's such a beautiful thing to be doing because it permeates all of us and so we get to learn more and knowledge is power. Yeah, so my biggest platform is TikTok. And you can find me at Evan, the counselor.

So Evan dot the DO counselor. If you put that in, you'll find me. But also if you longer form YouTube content and then Instagram, I just post the stuff I make for other stuff. Some people just Don't like TikTok or don't dunno what the heck it is. Yeah, so you can find me on Instagram where I post some of the same content too.

But yeah, I try to do some similar like educational type content and, just try to make it entertaining and more engaging and me just sit and talk and, I do some I do a lot of comedy. On there too. The mental health comedy stuff. So check it out if you want. Oh, that's awesome.

Yes. I think that just normalizes it and it makes it less scary, especially anything addiction or substances can be really scary and taboo and stigmatized, so I love that you're putting this stuff out there. I love that you're using humor and just really, again, just thank you for describing it and being able to do that for us.

That's so beneficial. Wow. You may wanna check out my content before you start saying any good things. You may watch it. talking about our conversation today. I'm one of those people who don't have TikTok, but and I wanna open that can of worms. I love working with my younger university clients cuz they're like do you know what Instagram is?

Not that old, I'm a mom, , but TikTok, I don't know actually. Obviously I know of it, I'm just not on there. But I will, That's very common for a lot of millennials, Or business, TikTok business. But I think it's a, there's a lot of good stuff. There's some really good mental health.

I, I. Compared to any of the other social media, I think TikTok has the best mental health professionals making content. There's like a wide variety, and it's more palatable than like watching a whole YouTube video. There's probably, there's plenty of people who do it. I don't, I've seen some of them.

But with TikTok it's just so much more fun. Some of it is just like very educational, and if you download the app, it learns pretty quick what you like. So you could search for those hashtags and mental, and it'll start throwing all of us at you and you could see who you like of people, there's psychiatrists, there's, psych pharmacists.

There's so much to learn on there. You just gotta be careful cause it's a little addicting . But that cause honestly, the content is, That good. And it's not like super complicated. Produced stuff. It's some of it's just people talking, but some of the bigger creators have learned how to be engaging and grab your attention.

But you could also, but it's also some of it is nutritious where you're learning some real stuff. Yeah. And I think it incentivizes people. It's. If it's, if consuming this important, nutritious content is fun then. All the better. The more you're gonna learn. So I, so just like approach with caution.

But I think a lot of people, like everyone who gets on TikTok, they get addicted for a while, right? And it's kinda like that addiction thing, eventually they burn out. So it's just pace yourself with it. Cuz otherwise you're gonna just, it's gonna consume your life or be up to 3:00 AM then you're gonna burn out and just put it away forever.

But, just pace yourself with it. And I think it's awesome. Oh, that I've heard really good things. So I am considering checking. And again, it was so valuable to have you on today, Evan. Thank you. Thank you so much for coming on and sharing your story, your wisdom and expertise, and we really just are very appreciative of you.

Thank you. Awesome. Yeah, no, thanks for inviting me and giving me a little escape. And now it's Monday and I'm like, Oh God, what fresh hell am I gonna have to, Yeah. , it's, I love what you doing? I'm excited. Get back on the grind today. Awesome. Thank you again Evan. Our team will be in touch like when it's coming out and we can link to you and everything like that.

Yeah, let me know. It be cool and I could share as well and some of my social promoted a little bit awesome on website. All that good stuff. So yes. Thank you. So Evan dot the counselor. There you go. That's it. Perfect. Awesome. All right, thank you again Evan. Yeah. Thanks. Take care.