The Future Complex Case Management (Part 1)

Complex case management sounds like paperwork until you see what it really is: the difference between a client staying engaged or falling through the cracks. We bring together a roundtable of experienced leaders in addiction treatment and recovery to talk candidly about what “complex” looks like now and why it keeps evolving. We get into whole-person care, family systems, trauma, and the real-world barriers that show up the moment someone tries to step down in the continuum of care. 

We also dig into the clinical patterns we’re seeing more often, including bipolar disorder and suicide risk in high-performing clients who have built an identity around holding it all together. The conversation turns to substance trends that are reshaping treatment planning, including high-potency THC and the growing concern about psychosis and repeat episodes, plus kratom and how it’s being marketed as focus and stress relief. These aren’t abstract talking points; they change how we assess risk, stabilize the nervous system, and coordinate longer-term support. 

From there, we talk denial as a survival strategy, how stigma keeps people from naming trauma, and why some environments, including parts of church culture, can unintentionally encourage spiritual bypassing instead of honest help-seeking. We close with practical, actionable ways clinicians and programs can improve outcomes now: earlier collaboration, warm handoffs, involving families and outside providers sooner, and building teams that include peer support. If you care about trauma-informed care, co-occurring disorders, and better care coordination in addiction treatment, this conversation will sharpen how you think and how you plan. 

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Transcript

Welcome And Panel Introductions

SPEAKER_03 0:00

All right, well let's go ahead and jump in. We're recording this. This is gonna be a uh a podcast as well. And so um we're gonna go ahead and get started. We may have some people, we have about I don't think 23, 25 um register to be a part. And if people jump on as we go, that's great. Um but if not, we're just we're just gonna have a conversation um and uh talk about what we were we're just mentioning before we started recording, what we feel like is a very, very important topic in this in this field. So before we do that, I want to go around and kind of let you guys just just introduce yourself. Um we have some in my opinion, we have some some legends in in the field here and really honored to have a really incredible, not just I'm not just saying it because they're my friends and I love them personally, but they they actually are um incredible thought leaders and experts in this in this space in this field. And so um who do I want to pick to go first? So you you'd probably rather me introduce you than have to introduce yourself because I know the humility that's around this this table right now, but um I guess I'm gonna pick on my man Ty. Ty, I'm glad you're a part of this today, man. You're you're one of my favorite people on the planet. We met the first time we met was at a recovery rally, and you were taking photos, and you just exuded joy. I was like, this is one of the most joyful guys. I want to be his friend, and then you know, probably about four years later, here we are, we get to work together. So, Ty, thanks for being here. Why don't you introduce yourself?

SPEAKER_01 1:30

Oh well, hello everybody. Thank you for the warm introduction, Drew. The warm handoff, which I'm sure we'll get talking about later. Um, my name's Ty or Tyrone Medic. Um, depends on what day of the week is by which one I go. Um, I'm the head of case management for Valiant Detox, um, and I work under the organization of Valiant Living. Um person in the recovery space as well. Um, and as Drew mentioned, um I'm a part of various recovery communities across uh Colorado, one of them being advocates for recovery Colorado, where they throw the largest um recovery rally in the state, um, where last year we had 6,000 people in recovery gather um all in one space to celebrate what that looks like and to access resources and to just you know break the stigma. So yeah, that's who I am. Um, and yes, I love to smile. My mom paid for it many years ago, so I have to flash it a lot.

SPEAKER_03 2:28

That's great, that's great. Um, let's let's pitch over to Sims. I think I think Michael Sims, the first time I met Michael Sims, I was uh a client at Valiant, and I think maybe he was sticking needles in my ear. That might have been my first experience with Sims, or it probably was an intake call. But um yeah, Sims has been on the Valiant Living podcast uh, you know, uh I think a handful of times now. Um, someone that I I love to quote often and just well well respected in this in this industry and space. So, Sims, tell us a little bit about who you are and what you're doing now.

SPEAKER_04 3:03

Um absolutely thanks, Drew, and I really appreciate you inviting me on to this. So, yeah, I'm uh Michael Sims. Currently, I'm the chief operating officer for All Points North. Had the pleasure of working in a number of amazing treatment centers, including Valiant Living, you know, for about five or six years. And uh I'm a therapist just by training. So I'm a licensed clinical social worker, licensed addictions counselor, I'm also a CSAT, certified internal family systems, uh, just recently become licensed as a natural medicine facilitator. And as Drew so eloquently put, um, I am an acu detox practitioner. So the auricular acupuncture as well, you know, anything to really help people to um help regulate their nervous system and engage with treatment. I'm a big fan of and proponent of. And yeah, I've just been in this field for over 15 years, a huge proponent of really doing this complex, deep clinical work that's so important. And I think, you know, a lot of times uh case management doesn't get the understanding that it really needs, because that is the glue that holds this all together a lot of times, that keeps treatment moving from one continue level of the continuum to another. So really excited to be here and uh be on this panel with all of you.

SPEAKER_03 4:25

So yeah, yeah, I think you described that better than sticking needles in my ear. Maybe that's a more eloquent way of saying that really works. I was skeptical, but it worked, man. I slept like a baby after all that, so it was it was good. Appreciate you. Sherry Young actually was just on the Valiant Podcast dropped yesterday. Great story with you and your your daughter Julie and your recovery story. But man, you've been in this this industry many years. I feel like it's the you know, one degree of separation from Sherry Young. Everyone knows Sherry, Sherry knows everyone. It's like in just an absolute rock star, so well respected in this industry, leads right fit, um, collaborative consulting with her daughter, Julie. They've partnered up, which is really special, and um great friends, great partners uh with Valiant. Sherry, why don't you give a little introduction to who you are?

SPEAKER_00 5:21

So thanks, Drew. Um, I think the reason you get to know, you know, you only get to know so many people in this industry um if you live long enough. So, you know, I've been in the industry for 20 years. I was a college professor prior to that. Um, I have 28 years of recovery. And, you know, as we talked about in the podcast yesterday, um, my daughter uh got sober uh eight months after I did. So we have shared this recovery journey just like we shared the chaos and confusion and craziness of addiction, uh, which in our family was intergenerational. So I come to this field as a clinical educator and consultant, and I come alongside treatment centers, um professionals, individuals, and family members. And my goal is to really provide support and um resourcing for them to be able to take those next steps of hope and healing, um, whatever that might look like. So we're out-of-the-box thinkers, we don't have any cookie-cutter approach. And so I am delighted that we're gonna be talking about complexity because it just uh it's so relevant today. Thank you.

SPEAKER_03 6:53

Thanks for being here, Sherry. I I joke with Sherry on the podcast that whatever whatever heaven, whatever this afterlife looks like, there's gonna be a long line of people lined up to talk to Sherry and say thank you for helping me get on the on the right path. So and then last but not least, my my great friend, also my boss, that's those are unrelated. We'd be great friends even if she wasn't my boss. We Dr. MD and I get to partner on a lot of stuff these days, and it really is a gift to me. Um, the more I hear her speak, the more I'm like, man, that there is this a deep, deep well of not just information and obviously incredibly, incredibly smart, but a deep well of care. And, you know, the way you you treat people and care for people is is really wonderful. So Dr. MD is kind of the brainchild behind this whole round table thing that we're doing third Thursday, because you know, and I won't speak for you, but I know you just deeply believe in collaboration. This is something that's important. And I will say, as you get ready to introduce yourself for Jay Hurley and Paul and Samantha Taylor, those who are on, we want you to feel like you're sitting at the table with us. I can unmute you, you can ask questions. This isn't a come and just, you know, hear, although they've got great things to say. We want to hear what you have to say. We want to hear your questions and your comments. So please feel like you're you're here a part of it. But Dr. MD, introduce yourself.

SPEAKER_02 8:13

Hi, so uh I'm Dr. Stephanie MD. I'm a cleansal clinical forensic psychologist. Um, so my background has some legal, some criminal aspect, and then definitely that clinical psychology, which is what led me to looking at addiction first and foremost. Um, because I realize a lot of the times we're criminalizing things that are a medical diagnosis and um and we need to do better, right? So, how do you how do you do better until you step in it yourself and take some action? Um, I developed these roundtables because I have a firm belief that I I am, I never want to be the smartest person in the room. So I always try to find people who are smarter than me so that I can gain knowledge from, so that I can share information with, so that we can become greater and stronger and we can do better work in this field. So um I am so grateful to Michael Sims, to Sherry. You are just as Drew said, for me, a well, right? Like you are sometimes my well of knowledge and experience and connection. Um and Michael, you have just always kind of been really consistent for me. Um, even when, you know, I was at uh the Meadows and you were here at Valiant. Like he, you were just a consistent person. I always knew what I was gonna get, which is so great to have on a therapist, right? And even just a colleague. Um and Ty, oh my gosh, you guys, I can't speak enough about Ty. Like we talk about the difficulties of getting people into treatment who have money, who have resources, who have the support, who have family. Ty literally pulls people off the street. And I'm not kidding you, who have like no resources, no money, no family, no support. And and builds a network with them in a way that they feel seen and heard. And and and that is so like for me, that touches my heart so much because that that's a population that can get forgotten about because there is no, you know, there is no mutual give in that. You give a lot more than they do. Um, and so I value that so much. And Drew, uh, yes, I agree. I think I I would be your friend even if we didn't have to work together. Um I I I love your family, I love your passion, I love, I just love everything that you have become in your recovery and the man that you have outlined yourself to be in this recovery process. I think it's a model and an example for others of where you can really make some changes wholeheartedly, like the inside versus just that mask that gets worn on the outside. Um, and you are a prime example of, you know, recovery is not a diet, it's a lifestyle change, right? Like you've got to live it every single day. Um, and you're an example of that. Um matter of fact, everybody on this thing is an example of that. So I feel very blessed to be a part of this, and I'm so grateful that you guys are joining us. So thank you. Yeah.

SPEAKER_03 11:18

Thank you. Thank you. That's that's kind. Well, let's let's dive

Defining Complex Case Management

SPEAKER_03 11:21

in. Enough, enough of the love fest. If you can't tell, there's a lot of love on this on this call right now. Um, Kenneth, thanks for joining us. Glad you're here. Um, please jump in with questions and comments. Um let's just set the context because we've we've got about 45 minutes or so to go through about probably a week's worth of material. And so we'll we'll we'll just jump right in. But when you hear the the the phrase complex case management, let's just set the context for the conversation. What does that actually mean in today's environment? Sims, I want to just pitch to you first to kind of get us kicked off. Yeah, I know. I had to choose somebody because you guys would all defer to one another. So, you know, and and please, as we're doing this, don't be polite. Jump in, interrupt each other. I mean, jump in and with your comments and questions. Don't wait on me to call in.

SPEAKER_04 12:06

Yeah, absolutely. No, thank you, Drew. And you know, when I hear like the term complex case management, um, I really think about this movement towards seeing the client in their entirety, really understanding all the different aspects of who the client is and where they're coming from. You know, I know this field has changed over the last 15, 20 years. For a while, it was like either substance use or mental health. And now it's you know, co-occurring and polysubstance use and polypharmacy and process addictions, family systems, trauma. You know, I love the quote by Gabor Mate that says, like, the question isn't why the addiction, but why the pain? And I think this is actually about like looking at a person much more in this complexity, not zeroing in on maybe what these symptoms of like their mental health are, but actually what are the causes, how we're getting to the bottom of this. And with this case management piece, how are we actually like helping this continuity from you know these higher levels of care, stepping them down with the same clinical understanding, with the same alignment to really get the best outcomes for people.

SPEAKER_03 13:16

So I love that. When you said that, what came up for me is when I when I sat down in my intervention before I got to treatment, the interventionist looked at me. The first thing he said after I'd been my whole world had been turned upside down, he looked at me and said, How long have you been in pain? And I thought that was the kindest, most empathetic thing to say. Because I was I was expecting everything from how could you, what's wrong with you, you're an added, whatever, and just looked at me with such tenderness and said, How long have you been in pain? And that that really resonates with with what he just said. Sherry, what's coming up for you when you when you think about complex case management?

SPEAKER_00 13:51

Yeah, so I I think in terms of family systems and you know having experienced intergenerational, you know, trauma and um addiction, mental health issues. Um, you know, I I mean, like that's my go-to, you know, I assume that, you know, everyone has been wounded in one way or another. Um, you know, typically it's in uh often it's inadvertent, sometimes, you know, abuse is intentional. Um, but it's all people in pain. And so, Michael, I'm so glad that you, you know, gave us that quote from um Gabor Mate, because um that's the core. And if we can look at the core, then all of the tentacles that come out, whether it's you know, the way that that pain manifests itself in psychological um you know symptoms or physical and medical symptoms, um, you know, in uh uh you know, any any kind of manifestation, whether it's addiction, mental health, um, you know, trauma and attachment, it seems to me to be, you know, one of the core places to really look.

SPEAKER_03 15:24

Yeah. Ty, you you're in this, you're in the weeds of this day in, day out. I mean, what if from your perspective, what what do you have to add from from what they've said?

SPEAKER_01 15:34

Yeah. Um so you just touched on the big stuff, but uh I think underneath some of this stuff, especially for some of the the clients that I work with, um, there's also housing problems. There's legal involvement, there's multiple providers that aren't being spoken to. You know, we're doing the handoff, and it's like, here you go, here's here's your thing now. Um and the complexity is as you just said, it's not the diagnoses, it's coordinating all the moving parts in a way that keeps the client stable and engaged.

SPEAKER_03 16:05

Yeah, so good. MD, what are you what are you seeing more now that we weren't seeing five to 10 years ago in this space when it comes to complex case management?

New Clinical Patterns Changing Care

SPEAKER_02 16:15

Oh man. Uh Sims and I were talking about this last week. Um, there's a few things, right? So um, you know, when we're looking at mental health, I'm seeing a significant rise in bipolar uh disorder. Um, and since I do mostly work with men, I'm seeing a significant rise in that bipolar with men who have some form of identity image management attached to it, because they're high-level performers. Um, and with that comes a high level and a high risk of suicide. Um, we as Valiant, we've lost somebody in that category last year. Uh, no, this year, a couple months ago. Um, because when that mask comes off or that mask is taken off by somebody else and they're not ready for it or they don't have the structure, this brain disease, right? This bipolar kicks in and it makes permanent decisions for temporary situations. Um, and so for me, that's such a huge thing because a lot of the times when we're looking at life or death, I know people talk about it all the time when it comes to substances, fentanyl and benzodiazepines and alcohol. Like this is life or death. But honestly, so is mental health, so is process disorders, so is intimacy disorders that are, they're all life or death, right? So we've got kind of that dynamic. And then the other dynamic Michael Sims and I were talking about was, you know, kind of twofold. This THC that, you know, marijuana did used to be the thing that was grown in the backyard, right? And and didn't go back to its roots of a hallucinogenic. But now that it's like governmently engineered and we can change the structure of the THC, we're seeing such a high proponent of psychosis. And that can go two different ways, right? Like it can be a psychosis that is there forever because this person had a predisposition for schizophrenia or um psychosis in their family. Or it's something that really, in my view, has been jacking up the young brain, causing some psychosis. And maybe they weren't predispositioned for it. And so we can we can get the psychosis to go away. But anytime they touch THC, it doesn't even matter how much that psychosis kicks back in and stronger than ever, and they're risking themselves of never being able to get rid of that in the future, right? So it's like there's these two things that I've seen really pop up. And the last one I would say is maybe um Kratom. You know, this this new infatuation with Kratom. And I don't know about you guys, but for me, you guys, I'm seeing um high performance college students going into these smoke shops and sometimes these just circle K, right? And they're seeing Kratom advertised as like a stress relief, a self-care, uh build some more um like concentration, be able to concentrate better, have more focus. And and they're getting sucked in and now they're becoming addicts when I'm not sure that would have ever been the case before. So, like for me, those are kind of like the ones that I see most prevalent today. But I want to open it up because obviously, you know, Michael could be seeing something different. Ty, you can be seeing some Sherry, you could be seeing something different. Um, but those are kind of the primary things I've noticed recently.

SPEAKER_04 19:43

And yeah, I just want to add, and thank you for bringing that up. I mean, the marijuana has been incredibly interesting to follow. In fact, some of the research that I'm seeing with like marijuana use in adolescence leads to like a three time greater risk of suicidality over the course of the next 30 years. Um, we're seeing a lot of changes in the profiles of substances that people are using. And um really a lot, like I've seen a lift or more of people who might be struggling with bipolar disorder one or schizophrenia or other devolutional disorders, OCD. I appreciate you bringing it up the piece because like I think the field is even changing some of the language around psychosis, as we were talking about the other week, that we're so used to talking about substance-induced delusions. And as you said, like we're seeing a lot of the field moving towards is this substance revealed delusions? Was some part of their genetic marker turned on that this is going to be like a lifelong um psychological problem that will need to be managed, that will need to be treated differently. Um, depending on like I think the classic thinking was, oh, well, they were on meth for a couple days and then, you know, they're fine now, the delusions have gone away. But really, understanding that um, you know, when people have these psychotic episodes, they're much more likely to have another. And this might be a revelation, especially with younger people, that will take lifelong management or longer-term management. Um, so the complexity and understanding these cases, I think, um, is getting more and more important. And this is what have led to, you know, multiple treatment attempts and bad cohesion between providers that Ty alluded to. So yeah, well said, Dr.

SPEAKER_03 21:33

Yeah, well what are the factors that make a case truly complex?

What Makes A Case Complex

SPEAKER_03 21:39

I mean, we kind of alluded to it some, but well, just for clarity, what what are those factors if if you were to say this is, you know, maybe standard treatment and it, but here's a complex case. What does that look like?

SPEAKER_00 21:51

So can I just pop in on this one? Um you know, it's not a diagnosis, and I don't think that there's anything in the DSA. That identifies this as a psychological difficulty. But what about denial? So I think we are a nation that lives in unconsciousness. We pull ourselves up by our bootstraps. When the tough gets going, I mean, when you know the going gets tough, the tough get going. We handle it, we manage it, we deny it. And when I talk to people, I mean, I remember talking to one young man and he said, Nope, um, there's there's never been any trauma in my life. And as we talked further, he revealed that last year his brother committed suicide. And I circled back with him and I said, That regardless of what your relationship was or wasn't with your brother, that's traumatic.

unknown 23:03

Yeah.

SPEAKER_00 23:04

So, you know, I you know, I'd love to have uh, you know, my colleagues weigh in on that one.

SPEAKER_03 23:12

Yeah. I mean, what came up for me just real quick while you guys are thinking is you know, helping in some ways to to redefine some of the terms and get people to see, like I, you know, I'll say when you when you mentioned that you know the suicide and the trauma, and some people just kind of whether it's denial or they don't have a name for it yet, they don't know that's what it is, or they normalize it. Again, for me, I'm going in of you know, 40 years in the church, 20 years full-time vocationally, 20 years as a pastor's kid, sitting down and someone says, You're an addict and you need to go to treatment for 90 days. And I'm like, what? Like, I had no context, I had no framework for addiction or that what I was dealing with could possibly be an addiction. I just thought that's how the world functioned and all those things. So I I love what you're saying. But yeah, you guys weighing in on what Sherry said, I think that's that's a good point.

SPEAKER_02 24:09

Hi, do me a favor. Why don't you tell us uh from the these you have a different population than what I think uh especially me and Michael deal with on a daily basis, right? You have a little bit of a unique population. And I know when I was dealing with more homeless people and and uh there were different complexities, right? And different denials. Um, the trauma thing was a big thing in in not recognizing what is trauma versus what just as normal life events for them to go through because they've gone through so such horrible things their whole life. They're like, well, all of these things can't be trauma, right? So it's just life. I'm just managing life. Um but yeah, so tell us about your population and what you've been seeing in that.

SPEAKER_01 24:52

Um so it varies. Um we have a pretty diverse population at our detox facility. Um you know, some of the people that we interact with, it some of their traumas are are just right there, you know. Um, and you know, whether that could be the loss of a child, you know, um, or both both in life and also to another system um with men, you know, for at least in my experience, um, men are very much so in denial around a lot of things. You know, we're not we're not talking about our emotions, you know, we're not talking about how things affect us, you know. Oh, my dad, my dad, that's just how my dad was, you know, that's okay, you know, or you know, I'm this is only my 47th relationship. It's not the relationships are not the problem, you know. So those are issues that come up during discussions, but then we also deal with the with other underlying things is uh the housing that I mentioned, you know, oh, we lost our home at some point in time, and you know, I'm the breadwinner, so I'm supposed to be the one to fix all this, and they're not able to. You know, those are some of the things that we deal with, along with the legal involvement. Don't don't get me started on that one. But when somebody's caught up in the system, yeah, you know, from 18, 20, 25 years old, and they're still in the system at 45 years old, there's all sorts of underlying traumas that come from that as well. And those are a lot of the people that I deal with. Yeah.

SPEAKER_02 26:26

Thanks, Ty. I love it. Because I think, you know, as Sherry was saying that I hear that time and time again, Sherry. Every time I get on the phone call with a guy, is like, okay, so what kind of traumas have you experienced? And I've had to change my wording. I can't use the word trauma, right? So instead, I'll talk about um what life events stand out to you, right? Like both good and bad. Because I want to know them both, right? Because I get to see the resiliency in these, in these really amazing things that they've been able to do despite their environment, their trauma, their mental health, their addiction. Um and then when I go through the bad, I come up with that. Like, well, my dad committed suicide when I was eight years old. It's like, ooh, no, no trauma, huh? Um, or I mean, my mom and dad were both alcoholics, they divorced. I mean, they kind of used me as like the go-between. It's like that's trauma, too. So there's a piece of me that feels like there's still a lot of stigma for men to be strong and to just kind of, I mean, the theory was when I was a kid, it was pull up your big boy pants, right? And let's get this done. It is, it's like um, it's just a resiliency to push through. So if I acknowledge this as a trauma and I put a label on myself that I've been traumatized, I'll always be that person instead of acknowledging like this is just an awareness. This is a piece of me, this is part of my story, but it doesn't make me who I am. So it's like having to weed through that social expectation of what a man is supposed to look like and what they're allowed to and not allowed to talk about or acknowledge or um or feel. Right. So I love that you brought that up, Sherry, because that I mean that's that's consistent. I would say almost every single phone call eigen on for a consultation or for potential admission. That's that's a guarantee. Very rarely do I have somebody say, well, I have this really significant trauma in my childhood. And if they do, it's because they've been doing outpatient therapy for like five to 10 years and they finally realize, like, oh, I actually need to get off the field. I need to like really care for myself, right? Not just once a week, but every day I need to engulf myself in this culture. Um, but I'll notice like if they say, Oh, you have this trauma, I'm like, who have you been doing therapy with? Because I know you've been doing therapy that just didn't come out of nowhere. So um, yeah, yeah, absolutely. Thank you, Jimmy, for bringing that up.

SPEAKER_04 29:05

I think that is an important thing. I would add, I mean, I I love what everyone's saying, but one of the things that I'm like a signal for me that complexity is really part of this is I'm seeing more and more clients, and we've seen this for a while, but who have multiple treatment episodes, um, you know, without durable recovery. And, you know, a lot of times it's like, you know, what are we not understanding? You know, what do we need to dig deeper on? Um, like, is there motivation there? Like, what is the reason that we're seeing this person come in? And you start seeing clients actually build resistance to treatment, like treatment becomes the barrier, and they're less likely to engage, less likely to try new things, or less likely to follow the continuum of care that we know actually works. And so, I mean, that's always one of those strong signals I follow to get really curious about like what are we missing? And you know, to me, like treatment episodes, even if someone returns to use or like cycles back through mental health symptoms, it's not a failure. Like, there's data there, like what was working, what were some of the strengths, and how can we shift these things to really help people be successful and to try to regain that motivation? Because I do think that's where shame and trauma all come together, and they're you know, they speak the language of the covery. I need I know what I need to do, I just need to do it. It's like, whoa, you know, there's probably more we need to understand. So yeah. Yes.

SPEAKER_03 30:33

So

Denial And Spiritual Bypassing

SPEAKER_03 30:34

good. Well, I want to turn to the chat real quick because we're getting some really great questions over here, and I want to bring that into this conversation as well. So thank you, Paul Kenneth. And I just I'm a little slow, I just realized who Jay Hurley is. So I'm really glad to have you on today, too.

SPEAKER_02 30:50

For those of you that don't know, Jay Hurley is Sherry Young's daughter who did the podcast with her.

SPEAKER_03 30:55

So just business partner, and I just I'm I'm a little slow, guys. So I apologize, but Julie, it's really great to have you on and would love to um have your voice as a part of this as well because you you're you're a great uh thought leader in this field. But uh I want selfishly, I want to hear what you guys Paul asked a great question, and I want to hear what you guys have to say about this. What what would this round table, what would you say are some of the biggest denials that the church is needing to deal with?

SPEAKER_00 31:26

Well, don't get me started.

SPEAKER_03 31:28

Well, I thought the same thing, Sherry. I was like, I'll I'm I'm like over here, like, you know, please put me in, Coach. Put me in, Coach.

SPEAKER_00 31:36

I love that. And you know, I mean, I was just thinking back to all the things that you know Sims and um you know uh Dr. MD, you know, talked about. And you know, so there we've been talking a lot about overt trauma. There's also covert trauma. And um one of the terms that you know I've become incredibly familiar with, um, particularly through my own years of experience um in Christianity is spiritual bypassing. And that loops back to the denial, you know. I mean, like um, if Jesus is the answer to everything, um, you know, that's a bypass. And so it prevents me from really having to look at the hard reality of what is literally going on. And um, and you know, and then asking for help is really difficult, you know, um, in those Christian communities because, you know, if we're the model Christian, you know, we're we should have it together. So there's, you know, there's all of that, but you know, and I was thinking, you know, Ty, about the other end of the spectrum. So there, you know, there at one end of the spectrum, there's the homeless without resources. And then there's the high performing, you know, professional who has grown up in a family where both mom and dad are perhaps also high performers and preoccupied. And so never got you know the attention, never truly has ever been seen and so you know, moved into their own forms of perfection, performance, you know, and achievement. And you know, you know, one day may wake up and go, oh my god, I'm like an empty shell. So I think we're on to some really critical themes. And thank you for that question, because um, you know, like any, you know, like any uh, you know, system or organization, you know, there's good and bad. Um I think we just need to, you know, continue to ask these questions and live the questions. Like Rilka said, you know, live the questions. Perhaps in some distant day, we'll be able to live our way into the answers.

SPEAKER_03 34:22

Yeah. And I'll just jump in real quick because I could spend the rest of the time on this question and I don't want to, but I will say, Sherry, I agree with everything that you're saying. Spiritual bypassing was the first thing that came to mind. I know, Paul, you're I know you're familiar with that term because of just in your PSAP uh work. And you know, the the two things that come to mind for me is I think being in the church, I was taught to that feelings are bad. Don't feel your feelings, give it over to God, and that's the spiritual bypassing thing. Well, that that created um addiction in my own because I if I don't feel my feelings and I don't know where to go to get my my needs met in a healthy way, well, I'm gonna turn to something to cope and to deal. And so um that was a big part of it for me. And then I think the second thing is, especially in in most churches, is spiritual, but it's also honest confession. I mean, when I read through scripture, it looks more like a 12-step room to me than most of our churches with big stages and lights and haze and all this stuff, because you know, Jesus literally said, confess your sins to one another so you can be healed. And so we wonder why there's not more healing going on in the church, is because it's almost like God even delegated healing to say, hey, if you will tell Ty what you're going through, and there will be attunement there, which happens in a lot of 12-step rooms, you will actually find healing. It's not go into this quiet chamber or it's not sit in church and not know anybody and just hide. It is honest confession about what you're actually going through. And and unfortunately, most churches aren't psychologically safe enough to come with your honesty. They don't know what to do with it. And so most people stay very, very hidden. And so, um, but Paul, I cannot wait to have follow-up conversations uh about this with you. I can tell you and I are gonna be really good buddies. Um, I want to get to what Kenneth is saying here. Sims, did you have something we were gonna say on that?

SPEAKER_04 36:10

Oh, I was just gonna throw, you know, I've I've had the pleasure of like working with a lot of um, I mean, Chris, like, you know, the church, that's a big, that's a big, you know, wide thing. But, you know, I've worked with a number of ministers and pastors and priests over my time. And and one of the things like just to I'd like to speak to on this question is, you know, I think it's like acceptance that there is a problem that a lot of times the church really needs to contend with. Every other professional organization in the United States, like with physicians or pilots, like have a way for people to get treatment and come back. I love some of the studies that Harvard did with physician help programs that with like monitoring over five years, 87% of people return back to work and 85% of people find sustained recovery. So many times I've I've worked with um you know pastors or ministers, um, and there's no way back, you know, like they they kind of get lost in you know their recovery. It's they've made a they've they've made a mistake, um, their addiction is overtaken, and you know, I think it does a disservice to to the church a lot of times. So I just wanted to kind of name that I think would be great is if they were able to match some of these other professional organizations that help people get back to where they need to get to, and you know, people devote their life to this, just like a doctor, just like a lawyer, just like any other of these professions. So yeah.

SPEAKER_03 37:41

That's really beautifully said. I feel like it's one extreme or the other. You either you have some big implosion and you're back in the pulpit that next week in our culture and don't deal with it, or you're sidelined and disqualified permanently. And all the men and women that I currently would want to follow spiritual direction and get spiritual direction from are usually like, eh, I'm not going back into the system. I'm like, no, we need you. You're you're actually being honest and showing like I I want to follow you because you've been through the stuff, you know, and they're like, nah, I don't need it, I don't want it. And so, anyways, that I feel like this is a whole nother this is I want to go, I want to just go to all go there on all of it. Um, but thank you for saying that, Sims. I think that's it was really good for me, even personally, to hear you say that. That's really, really beautiful. Um, I'll go into Kenneth's questions here and then want to get to

Collaboration Across Levels Of Care

SPEAKER_03 38:32

yours, Julie. And I love this. This is I would rather get to your questions than all the questions I have written down because we want to make sure this is helpful for you. But Ty brought up an important point regarding collaborative care. How are you all handling care collaboration across different care levels? Which is great. That was actually my next question, anyway. Um, and how are you integrating technology to make care handoffs smooth? So, Ty, since your name was brought up on that, we're gonna let you go first on that.

SPEAKER_01 38:59

Um, well, uh handling care across all levels. So right now, I would say that the way I see case management, it tends to be in a bubble. You know, somebody comes to us and we're focusing on where do we get you next? How do we we're already discharge planning, we're looking for the exit, you know. Um, and some organizations that I work with, um, especially here in Colorado, especially Medicaid-based type programs, um, they're they're getting really good about having multiple people together. Um, and so when I when I send somebody to a program, you know, yes, we're doing the paperwork and all that other stuff, but you know, we're we're doing the warm handoff. And then those programs themselves, they have therapists involved, they have case managers, they have peer support. Peer support, I think, is is a totally underrated service. Um, because those are people who have also been in the deep already. And so they understand that when someone's bringing up, you know, the, you know, these these points are things that I bring up constantly because they're something that I see often. But, you know, the housing instability, the family, the job, you know, um, resume writing, like these little things that add up to a person feeling like, oh man, I can do this. Right. The team has to be there in order to support it. Um you know, I work with a sober living that offers multiple people to wrap around someone when they show up. You know, here's your therapist, here's your your dentist, here's your um, here's a list of job opportunities for you that that that work with what you are. Wow, sorry, I gotta turn that off. Whoa.

SPEAKER_03 40:49

If you're just listening and not watching, that was amazing.

SPEAKER_01 40:52

Ty somehow triggered fireworks on his screen, which is but I'll be honest, you know, when I dish when when I'm working on discharging people, you know, I would love to stay with somebody for six months. I would love to stay with somebody for a year and walk them through, you know, the life experiences that they need help with. Um, an organization that I recently came along with, um Whole On Health, um, they I think this is going to be a game changer for a lot of people. Um, they've built a whole system where they contract out with peer support doctors, therapists, um uh the whole care team. And it's accessible on your in your phone. Um, and they've built it out so when you are reaching out to your therapist, there's some some notation that goes out to the rest of the team. So everyone is aware that you know, you had a really hard therapy session. Everyone is aware that you're getting something checked out, you know, at the doctor's office without going into all the details, but everyone is aware. So that way the next person's like, hey, how'd that how'd that thing go? You know, do you want to talk about it? You know, your peer support specialist is like, now that we got the doctor's appointment taken care of, and now that you're seeing a therapist, let's talk about the housing piece. Let's talk about that warrant that you have out for yourself right now. Let's talk about all these layers that need to be addressed in order for you to feel stable enough in your life to to achieve some some long-term sobriety because all of these pieces were things that were affecting your ability to focus on, you know, this goal.

SPEAKER_03 42:34

Yeah, yeah. Long-winded. That was great. I want to ask just a quick follow-up to that. Um, uh, how do we how do you determine when a client needs a higher level of coordination or care? Like when you're talking about moving collaboration, different levels of care, like how do you even identify that? Like, hey, what if you know, this standard approach isn't working, you need something different.

SPEAKER_01 43:00

Um as basic as it sounds, oftentimes I like to sit with them and ask them, like, what do you need right now? You know, because oftentimes as a case management, we're we're in this, you know, I need to get you in, I need to get you settled, I need to get you there. And oftentimes we don't sit down and ask them, what is it that you need right now and how can I help you achieve that?

SPEAKER_03 43:25

Yeah. That's great. Sims, what do you see in your line of work when it comes to that? Because you're working across a lot of different levels of care.

SPEAKER_04 43:32

Yeah, no, absolutely. And you know, I mean, we we have used technology to like automate records requests to to move files from one to the other, but it's actually like I think the most effective thing with a lot of these cases is that collaboration piece. You know, one, accepting that case management is clinical work, um, they are just as important as many other parts of the team. But one of the things that I that like all points story. Does that I love as I've been on there is they do these treatment team meetings at day 10, at day 20, at day 30, that has like the psychologist in there, has the therapist in there, the case manager, the family therapist, but also the client and the client's family. Interesting. All together in a room for like an hour to talk about like where we're at, where we're going, what the recommendations are. And I think that is where like this collaboration always needs to be everyone needs to be on the same page. Um, I see triangulation, and that's the signal I follow. And hey, we need to bump up the complexity and the support on this. When like families are getting upset, medical providers aren't understanding what's going on. When you start having static outside of the system, um, it's when you know, like we could have the best technology in the world, but the solution is just let's all get in the same room and talk about this. You know? Well, I love that.

SPEAKER_03 44:57

I will say from from the client's perspective too, like it it brought me a lot of comfort knowing that I had many different voices from different, like I had a team of people helping me. So it was like, even if one person, like, say me and my therapists weren't necessarily like on the same page, I still had a case manager and I still had Dr. Martin, and I had, you know, family, like, so there's a bunch of people seeing from different angles. So it actually helped bring me a lot of peace, saying, hey, this isn't just what does one person think I need, or you know, or someone who's actually talking with my family and saying this is where they're at and what they need. And so I think that team approach, I love the idea of getting a client and the family in the room too, because it just makes you feel a part of the process. And you actually have a team of professionals helping you navigate this. It's actually super, super comforting. Anything else on that from you, Dr. MD, you're sharing?

SPEAKER_02 45:55

Well, for me, I think um the hardest part and where we as treatment facilities are still not um maybe as good as we should be, is communicating with other facilities, right? We've all learned now how to communicate with our our own staff, our own company, our own, right? And sims, we do the same thing, right? Like we get we do a weekly staff meeting where we hear from housing, we hear from you know the medical providers, we hear from therapists, from family, we hear from our wellness director. What does it look like when he's out on experientials, right? Um, but where we, where the disconnect happens is there's not one universal technology that every treatment center uses. So it's not like we can just say, hey, we know you're going here. We're gonna go ahead and just transfer this over to your, you know, electronic medical record system and and uh and here's all the information, right? And I think that's where Sherry jumps in, it's been so helpful for Valiant. I know she's been extremely helpful for APN, is like, okay, we have a client who either is coming towards the end of their stay, or you know what? They've had some increase in symptoms since being with us and they need a higher level of care. They're no longer in an appropriate spot. We reach out to Sherry and we're like, Sherry, hey, like this is what's happening. This is the case conceptualization, this is what we're seeing from the whole person. Can you help us find the right spot for this person? And can you help us coordinate that care so that it goes as smoothly as possible? Um, so for like for Valiant, Sherry's been a godsend because there are times where you know we can't hold their hand all the way next to the next level, but she comes along with us and helps us do that.

SPEAKER_03 47:35

Yeah, I love that. Well, let me let me jump into this other question here that that um Julie

Trauma Lens With 12-Step Recovery

SPEAKER_03 47:42

asked. I think it's really, really good. I read through it. It's she says, hello, many 12-step focused treatment programs with co-occurring disorders emphasize sobriety first because of concerns about cognitive capacity early in recovery. Could you all speak to how a trauma-focused lens doesn't replace the 12-step model but actually supports it? Specifically, I'm hoping to highlight that some people simply can't access the tools yet. When someone's nervous system is stuck in survival mode, they're not resisting recovery. The client's psychologically unable to use this or not unable to use the skills. Trauma-informed stabilization helps people become able to engage in 12-step work more effectively, not instead of it. Would love to hear perspectives on integrating both approaches and how you discern first things first. Well, first of all, Julie, I love the question. I also I love your answer. I think you you really did a great job, you know, speaking to that as well. Um, but yeah, what would you guys say about that?

SPEAKER_00 48:42

I'd just like to say that's my daughter.

SPEAKER_03 48:47

For those just listening and not watching, Sherry is beaming with pride. You know the fireworks that came on TIS screen? Sherry's got her own fireworks going right now, just as I was reading Julie's Julie's comment. You guys are are a great team. But yeah, jump in, weigh in on on this, because I think that's I think that's a really, really important question and distinction.

SPEAKER_00 49:07

So I'd like to just say you so I actually um got sober in the rooms of Alcoholics Anonymous. And I um went to a meeting a day for the first year that I was sober. And I chose to do that because and I went at six o'clock at night because you know, I replaced my other kind of happy hour with the meeting. And um, you know, sitting in that meeting was really challenging for me. I had been a college professor and it was like it just seemed so simple and so, you know, didactic and you know, um, you know, there were days that I was coming out of my skin, but you know, the regulation of sitting in that meeting. But at 10 years sober, I found that what I had done is replaced the alcohol with work. And I was working with startup businesses, and basically I was still completely an adrenaline junkie, and that's when I started doing the trauma work. I wish I had been exposed, you know, to the drivers of my you know disease earlier. Um it takes what it takes, and I wasn't. But once I began to um explore, you know, the why, you know, like why did I feel the need to drink in the first place? Where's the pain? Um, as you know, Michael said earlier, um, that's really when the healing, um, I remained sober, um, I you know didn't have to experience relapse, but you know, I was still living addictively. And you know, when I began that, you know, that core work of healing, what drove, you know, my addiction, um, that's when I really began to experience relief and transformation and you know, moving out of management strategies into acceptance and you know, true joy.

SPEAKER_03 51:32

Yeah. Yes, Sims, you look like you had something you wanted to add to that.

SPEAKER_04 51:37

Oh, no, I I just agree with what Sherry's saying. And I think like, thank you for the question. I mean, it definitely seems very like polyvagal informed, like really kind of looking at our nervous system and getting in that central vagal state. But I think that is the importance of really understanding like the interplay between like substance use and trauma. Um, I love from the polyvagal lens that we talk about, like we learn to co-regulate with our parents, with our mom, with our caretaker before we learn how to self-regulate. And a lot of times, like from a trauma-informed lens, like taking part in these 12-step programs is learning how to co-regulate again. So then we can start to build that self-regulation. I think it comes from like a misnomer that people think trauma work is like EMDR or like reprocessing or reliving all of our heart trauma. Um, Bessel Vanderkoel talks a lot about like that bottom-up and top-down work. And I think when we look at like some of these 12-step programs, when we look at um recovery, like, yeah, probably is not a good idea for someone to come in just fresh out of recovery and do like EMDR, put some paddles in their hands, but to help them to learn how to emotionally regulate, how to state shift from one emotional state to another emotional state, um, is in perfect alignment with you know, the 12-step pause when agitated, you know, um, act as if, keep it simple. Like these things all are in alignment. And I think we may get, you know, some of the programs might get a little, oh, we don't do trauma work yet, we don't do this. Like it's all trauma work, it's all recovery work, and and we're building towards the same goal, and you have to treat all of it the same time. Um, and and sit with the client in the comfort that they're not going to get all of the immediate gratification at the same time, you know, through this process.

SPEAKER_03 53:28

So well, I'm glad you said that because I I'm reflecting back on my time. And and when I was at Valiant, they we we also went to 12-step meetings as a part of our you know early on. I hated them at first. That was my least favorite part of the program. I hated going to 12-step meetings. First of all, I was already exhausted from therapy. Then it's like, now you're gonna drag me to this, you know. But as I progressed through the program, I it slowly started to change where that started to become some of my favorite, because that was a place where there was peer connection and sharing and honesty. And so if it would have been like, well, no, just do this or do that. So I I loved the both and approach. And depending on where I was and in my progression, I had different views. It wasn't that I didn't like the therapy anymore. It was just the the 12-step started to make more sense to me as to why I was there and the benefit of it. Um, and I know we only have a few minutes left, so I'm gonna skip around. And Dr. MD, we we may have to make this like a two or three parter, because I think I got to five of my 22 questions on the on the list. So, but I do want to jump ahead to um practical application.

Practical Takeaways And Closing

SPEAKER_03 54:29

You guys have shared so many, so much good stuff, and we still have time if there's a comment or question, if anybody wants to throw that in there. But I want to jump ahead because I did want to talk about where systems break down, what effective case management looks like. We still have all that to get to, right? But let's just jump to practical application just for the sake of time today, and then maybe in a future conversation we come back to those. But for clinicians, um, what can we do today to better support complex cases within the current system?

SPEAKER_02 55:01

Well, I'd say for me, um and Michael Sims and Sherry Young have already talked about this, but looking at the whole person, right? We need to stop looking at the addiction as being the problem or the issue. Um, instead, it's how do I look at a human being and recognize that they're an individual person with their own specific unique needs, experiences, goals. And then, you know, like Ty said, what how can I help you and what do you need right now? So for me, it's just the the application for a clinician is finding out what this person's goals are because those are important. Nobody's gonna buy into something that that is not part of their goal. Um, because we're asking them to do a lot of really tough things, right? So it's like, hey, what's your goal? And how do we take one step or two steps closer to this goal with your unique individual health, body, spirit, mind, concerns, family, um, and get you closer to that goal. That's my goal. I want to take one or two steps closer to your goal, and then I lay out what that looks like for them, right? Because this is how I think I can help you get to your goal. What do you think? Right. And are you willing to do this work? And if they're not, then we've got to come to some form of compromise. It's kind of like we talked about at the beginning, right, Sherry, where you just can't cookie cutter it anymore. It can't be one of those facilities, either, you know, you jump on the bandwagon or you don't. And if you don't, then you're out and we just let go of you because that's just re-redefining, revalidating these things that they feel about themselves, anyways, which has led them to addiction. So for me, it's listening to a patient, applying the the steps for sobriety and recovery and healing, but being able to identify how these steps are going to get you closer to this, your goal, right? Your goal in life.

unknown 57:00

Yeah.

SPEAKER_00 57:01

I think one of the core recognitions um of transformation for me was when I was able to see that my drinking was a solution before it was a problem. And I think a lot of treatment programs, people come in and they're presented, they say, This is a problem. But no, that whatever you were doing addictively saved your life. It allowed you to continue to survive. And we know that survival is always unconscious. So then our job as treatment you know providers and treatment consultants is to help them become conscious about the things that they were formerly unconscious about.

SPEAKER_04 57:59

Yeah. Well, the and I would just add, I mean, I I agree with everything Dr. Indy and Dr. Young and everyone has said, but you know, one thing that like practical applications that I've seen is like as the treatment industry, we need to involve like other providers and the family and everything so much sooner in this process. We should be gathering collateral, talking to the outside providers from day one, talking to everyone because these clients don't exist in isolation, and that happens so much in treatment. But um, you know, like we have to realize that a lot of these cases are real complex, and the the answer might not be in the room. So, you know, how do we how do we get there? You know?

SPEAKER_03 58:42

That's so good. So good. Well, guys, we'll end it there. Thank you so much, Ty, Sherry, Michael, Stephanie. You guys, uh amazing. We just barely scratched the surface of what we could be talking about. So this is this is gonna be an ongoing conversation. You know, thank you to everyone who joined us live today for your participation and engagement. You made this conversation so much better. And we'll continue to do this every third Thursday, same time. We'll be showing up, having conversations, lend your voice to this. So really appreciate it. Everyone have a wonderful day. Thanks, panelists. Thanks, everyone, joining us. God bless you guys.

SPEAKER_04 59:15

Bye, everyone. Bye, thanks.