Addiction Medicine Made Easy | Fighting back against addiction

How to Help Someone With Addiction Who Isn't Ready to Change

• Casey Grover, MD, FACEP, FASAM

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What if the fastest way to help a loved one stop using isn’t pushing harder but stepping out of the “villain” role? We sit down with master addiction counselor and YouTuber Amber Hollingsworth to unpack a practical, compassionate framework that actually moves people from resistance to readiness. Amber explains why policing, nagging, and ultimatums create the perfect distraction from change—and how strategic empathy, active listening, and credibility open the door to real motivation.

We break the recovery process into simple, workable steps: stop being the bad guy, build trust by reflecting the person’s perspective, and allow the bargaining phase—“only on weekends,” “just beer,” “no more pills”—to serve as useful data rather than defeat. You’ll hear how to accelerate learning without triggering defensiveness, why a 30-day trial of sobriety is a powerful reality check, and how to prepare resources so you can act quickly when the “I’m ready” moment arrives. We also dive into separate-counselor models that lower conflict, how to align change with a person’s values and strengths, and the role of humor and respect in keeping people engaged.

We don’t ignore medical realities. From treating insomnia, anxiety, and depression in early recovery to using long-acting buprenorphine injections for opioid use disorder, we explore low-barrier tools that improve safety and adherence—especially vital in the fentanyl era. The goal isn’t to force a path; it’s to create conditions where the next right step feels easier than the last wrong one.

If you’re a parent, partner, or clinician looking for strategies that work in the real world, this conversation offers concrete scripts, mindset shifts, and timing cues you can use today. Subscribe, share with someone who needs it, and leave a review with your biggest insight—what’s one change you’ll make in your next hard conversation?


To contact Dr. Grover: ammadeeasy@fastmail.com

SPEAKER_01:

Welcome to the Addiction Medicine Made Easy podcast. Hey there, I'm Dr. Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years, I worked in the emergency department, seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started. This episode is on how to motivate someone to stop using drugs and alcohol. Let me give you the context on this episode. So I get random emails all the time from publicists saying, hey, don't you think my client should be on your podcast? And sometimes they connect me with an awesome guest, and sometimes I have to say that they are not a good fit for my podcast. So I got an email saying something like, hey, my client is a drug and alcohol counselor who specializes in helping people who aren't motivated to get sober change their mind and actually start wanting to get sober. And you can bet I wanted to have that person on my podcast. So this episode is with that person. Her name is Amber, and she is a drug and alcohol counselor. And this interview was amazing. I will be sharing this episode with so many of the families that I work with. Amber has worked out a unique approach on how to motivate someone, even if they are resistant, to want to quit drugs and alcohol. Here's the summary. First, don't be the bad guy. The family member needs to change their role from nagging their loved one about drug and alcohol use to being more supportive. Second, start building credit. The family member needs to feel that their loved one is on their side and trying to genuinely understand their problem with drugs and alcohol and support them. Third, let them bargain. People often, when they have an addiction, aren't ready to completely quit and often offer various approaches to make progress, like, hey, I'm only going to drink beer, not liquor, or, hey, I'm only going to smoke weed and nothing harder. The family member needs to allow this to happen so that the person with addiction tries different approaches, many of which will not work, and so they can start seeing that sobriety is the best option. And finally, the family member needs to be ready with treatment resources when their loved one is. So when that, hey, I'm ready to be sober moment comes, the family member is all ready with the right resources. This approach is amazing. I think Amber should publish her method so more clinicians can start using it. One final clarification before we start. Amber usually has the patient who has addiction and their family see different clinicians in her practice because putting them in the same room usually involves a lot of conflict. So her practice works with both the patient and their family, but the majority of the work is done seeing separate counselors to avoid that conflict. Fantastic interview. Let's get into it. Okay, I'm so glad to have you on my podcast today. Why don't we start by just you telling us who you are and what you do?

SPEAKER_02:

Sure. My name is Ambert Hollingsworth. I'm a master addiction counselor and a licensed mental health counselor, and I've been helping people overcome addiction for more than 20 years now. These days, most people know me from YouTube. I'm a YouTuber and the channel is called Put the Shovel Down, which may sound strange, but it's a recovery saying. It means you hit your bottom when you put your shovel down. You don't have to keep digging, you don't have to burn every bridge and lose everything. You can decide when you're done.

SPEAKER_01:

You said you were a master addiction counselor? Yes. What does that mean?

SPEAKER_02:

It's a national certification through NADAC.

unknown:

Oh.

SPEAKER_02:

So you can be like a licensed counselor in your state. It's just like a level up from that.

SPEAKER_01:

So let's start with your comment about put the shovel down.

SPEAKER_02:

Yeah.

SPEAKER_01:

I've not heard that. Tell me if you do you know any history behind that phrase?

SPEAKER_02:

My history with the phrase is one of my first jobs in the field is I had an intensive outpatient program for teens. And one of the teens used to say that. I think you heard it in a meeting. So you hit your bottom, you put your shovel down. And I feel like people hear that all the time. You have to hit bottom, you have to lose everything, but I disagree.

SPEAKER_01:

Interesting. Let's unpack that. Have clients that come to me for all different reasons. And I've heard people having high bottoms and low bottoms. So a person who has a high bottom maybe just gets a single DUI, makes a big change, and moves on. A low bottom would be somebody who maybe had an overdose or was homeless. Talk to me about how you use the idea of rock bottom in in your work as a drug and alcohol counselor.

SPEAKER_02:

In my work, the idea of rock bottom is I try to get people off of that track before we get there. I deal a lot with people who I would call like a functional alcoholic or addict. Some of them actually very high functional addicts and alcoholics. And so I work a lot with their families on how do you get through someone's denial who's in that situation? How do you get them moving towards change, which can be quite a task if someone's successful in other areas of their life, it's really hard to get them to see, hey, this really is a problem.

SPEAKER_01:

So I'm gonna cut to the chase. What's the answer? How do you get to them?

SPEAKER_02:

There's a there's a system. The first thing you have to do as the family member is you have to get out of the bag I roll because almost always what happens when you have an addicted loved one, of course, you're you're watching them make mistakes, they're changing, they're not themselves, they're ruining their life and yours too, probably. And so your natural inclination is to want to grab them by the shoulders and say, Wake up, what are you doing? And you start trying to get them to see the problem, and you're doing that very directly, and you start trying to catch them because they tell you that they're not doing it or they're not doing as much as you think they're doing it. And so you become like the secret spy, you get, I don't know, equipment, black lights or something in your purse, and you get this whole cat mouse dynamic going on. And that's a huge problem. And the biggest reason that's a problem is because as long as you're the villain in their story, they don't have to look at what's going on with them. It's like you're a giant distraction. And the reason I know this is because all my years of counseling people with drug and alcohol problems, if the family is playing the villain, that's the only thing that they will talk to me about. Like we cannot talk about anything else other than my wife or my husband or my mom or my sister or whoever it is. It's like it's the first, that's the first piece that has go. The most important piece is to not play the villain in someone else's story.

SPEAKER_01:

That's so funny because I heard you say the first thing you've got to do, and then I didn't understand the phrase. That's so fascinating. You have to stop being the villain. One of my patients this week, his wife brought him in and she said, I'm tired of being the alcohol police. Interesting. Okay, so that's step one. What's next?

SPEAKER_02:

So once you get out of the villain role or bad guy role, as I call it, you start to build credibility with your loved one. And I it's kind of like building credit if you wanted to buy a house and you need a certain credit score or something. You start building credit with your loved one. And if you're in the bad guy role, you got negative credit. So first we gotta get to neutral, right? And then the way you can build credit with your loved one is they wanna know that you understand them, which is different than you love them. They know that you love them. And sometimes that's annoying to be honest, right? It's they want to know that you understand their point of view because someone doesn't care what you think if they don't think that you get them. Like, for example, you may know your grandmama loves you, but you're probably not gonna listen to her opinion or follow her advice if you don't think she gets your situation. So you spend whatever amount of time it takes to help this person understand that you understand them. The way you do that is you use a lot of active listening skills, you look at things from their perspective, you use a lot of strategic empathy. That's what I do as a counselor. I just spend however many weeks it takes to just do that. And I just wait until I got my credit score where it needs to be. And then I wait for the right moment and then I cash my credit in. And then they're like, thank you, Abby, you helped me so much, instead of this whole, I'm trying to make you do something. When you have good credit with your loved one, they care what you think and they care about the relationship. And so this idea of if I don't get it together, I'm gonna lose this relationship is actually meaningful. When you're in the villain role, this whole if you don't get it together, I'm gonna leave, they're thinking, I wish you would. So it doesn't work, the whole like ultimatum thing.

SPEAKER_01:

Addiction medicine is a listening specialty. I do a lot of listening. So let me make sure I understand this. So you're saying step one is to go from not being the villain, and step two is to get credit with them. Essentially, it sounds like you're trying to remind them that you care and you're on their side.

SPEAKER_02:

It's of course it's that you care, but it's that you get it. Like what a counselor would do. Like I listen to you and I'm like, oh, it's like this. Oh, you're oh, this is what's going on. So you're just spending time completely understanding their perspective and mirroring that back to them so that they get that you get it. And then what you have to say is valid.

SPEAKER_01:

So it's listening, but being actually willing to accept their perspective.

SPEAKER_02:

Because we may not agree with everything that they think or everything that they do, but there's a piece of it we can understand. Like we could understand why someone might want to come home and have some drinks after work because they're stressed. We can understand why someone might want to do drugs at a party to fit in. Like we may not agree that's the right answer, but there's a piece of it we can empathize with. And if we can understand their point of view, it just helps them lower their guard down and be so much more influenzable.

SPEAKER_01:

So interesting. So I'm thinking in my own mind about my own practice. When I'm seeing a new patient, I usually ask two questions that are the most helpful. The first is, why do you want to get help? And to your point, if I hear my wife is annoying me, I know it's not gonna go well. So that's like you were saying, that spouse has to stop being the bad guy. And then the second question is, what does the substance do for you? How does it help you? And that goes back to your second piece. How interesting. I've never thought of your framework, but it makes perfect sense. Yeah.

SPEAKER_02:

Well, I think the reason why I'm good at dealing with people in denial, because my whole career, people that come sit in an addiction counselor's office don't usually want to be there. They're usually leveraged in by someone or they don't think they have a problem, or they're just doing it to get out of some trouble or something. And so I've had to learn to work with that. So when someone, it's the same question I ask. When someone tells me that, I'm like, good, you're in the right place. I'm gonna get you out of this mess. When I'm on your side, I'm literally like, what do you need? You need to do something? Let me write you a letter, we're gonna get you out of trouble. And then they see me as aligned with them. And now we can be a team and we can figure out this problem as a team.

SPEAKER_01:

Yeah, it's interesting. I do a lot of educating parents on how to talk to their kids about drugs and alcohol. And there's three situations we look at. The my kid's doing fine, I just need to teach them. I'm worried about my kid and oops, I found my kid using. And the advice I give the parents around the I found my kids using is to sit down and ask legitimate questions with genuine curiosity to try to understand them. Same thing, your same idea, different framework. This makes perfect sense.

SPEAKER_02:

Yeah. If you're working in this field, this is what you've been doing all these years. So I'm just basically teaching family members how to do this because sometimes you can't get your person to sit in front of a professional. It'd be great, yeah, send them over to Amber and you can do it for me. But what if you can't get them to see Dr. Grover or Amber, whatever? You're the only one. You're the front line. And honestly, it's not really that complicated, really. It's it's just against your instincts. But once you understand the principles of it and what you're doing, then you can help move that person along in their stages of change.

SPEAKER_01:

How do you navigate difficult history between a loved one to help them be able to start being genuinely curious?

SPEAKER_02:

If you got a lot, and you usually do, of like bad blood or distrust on both sides, one of the quickest ways you can get yourself out of the villain roll is just admit it. So if you can say, I've been doing a lot of thinking about it, or I went and saw somebody and I realized I've been handling this all wrong, and I have not been helpful to you at all. And I'm gonna rein that in. I've been trying to control it, I've been critical of you. Like whatever it is that they think you've been doing, you own it. Call it an accusation audit. Think of what they would accuse you of and give it, give them all the leeway, all you know, and use their words and say, you're right, I've been doing this and this, and that's not even helpful. And then they're all of a sudden paying attention to you, and now you got their attention. Now you have to consistently be different, but that's a good way to get them to shift faster.

SPEAKER_01:

I think I'm gonna have trouble articulating my question, but what's the most number of years you've seen a couple, brother, sister, parent, child, have the person with addiction, bad guy role make the positive change to no longer being the bad guy and starting to be on the person with addiction side? What's the quickest or what's the what's the longest period of bad blood before they started using your framework that you saw at work?

SPEAKER_02:

Oh my gosh, I don't know. Any number of years. Depends on how old they are when they come to see me. Like they could have been married 40 years. They could have been parenting this kid 30 years. It depends.

SPEAKER_01:

Do you find that there's like a certain amount of time of the bad blood years, if you will, that makes it harder for them to work with you and use your framework?

SPEAKER_02:

Yes, but it's not really the amount of years, it's the amount of hurt feelings and emotional damage more from the family member's role than from the addict's role. Like the family member has a hard time getting past their own hurt feelings to do what I'm telling them to do. And I don't blame them. It is completely unfair. And that's what I say. Everything I tell you is gonna be totally unfair. Let's just say it, but it's gonna work. I'm not about what's fair, I'm about what's gonna work. And this is what you want to happen. And I'm very directive because when people are in crisis, they're like, what do I do? What do I say exactly? Say this at this moment you're gonna do this, and it's gonna work. But it's hard to hold back all those things you want to say.

SPEAKER_01:

And is your practice more with families or with people with addiction or both?

SPEAKER_02:

Both. The way that I've done practice since I've been in private practice is I usually see the person who has an addiction, and I have other counselors or coaches who work with the family members. And instead of doing it all in the same room, we do it separately. So on the back end, I would have the family counselors working with the family members while I work with the person, and that sort of expedites the whole process.

SPEAKER_01:

Do you find that transition to being on someone's side is more complicated when, say, the person with addiction is a teenager and you're working with their parents?

SPEAKER_02:

I I think it it's not really any more complicated in that the strategies work just as well, but it is more complicated in that when you're minor, your person under 18 is doing things that are illegal, and then you feel like you have certain responsibilities as a parent that you really just can't quite take your hands off of. There's some complications with that. Just as far as like what's your liability, what are your responsibilities, and that sort of thing.

SPEAKER_01:

Because I find with my teenage patients, they come in with their parents and I play ref. Mom and dad are upset, and then the patient's upset, and then mom and dad are upset, and it's truly I am the referee.

SPEAKER_02:

That's why I don't put them in the same room. I can't do it. I hate it.

SPEAKER_01:

Interesting. I've not done that.

SPEAKER_02:

No, that's why everybody gets their own person. We call it lawyering. And I'm always the defense attorney. And so when I see one person, it's my job to get you out of trouble. What we need to do. And uh sometimes we'll meet all in the same room, but not until we're ready. And when we do, the family comes with their person. I go with my person, like literally, like you're going with your advocate. Because then you feel like you have someone on your side. Because if it's just one person, both sides are just trying to convince you to tell the other side that they're wrong. And I hate that.

SPEAKER_01:

100%. Yes, happens all the time.

SPEAKER_02:

Hate it, hate it. I'm just not good enough to do that kind of family counseling, I think.

SPEAKER_01:

So let me just make sure I get this straight. So you're saying that your model, first don't be a villain, next, get credit with them, works best when the person with addiction has their counselor, the family has their counselor, and then you all, when you all meet together, the counselors do basically the negotiation.

SPEAKER_02:

Yeah, and a lot of the negotiation happens behind the scenes, just like court, right? A lot of times the lawyers work it out. It might be like, I want my mom to quit reading my journal behind the scenes. We hash it out and we say, Listen, I need your person quit doing this. Listen, I need your person to understand this, and we kind of like help that happen. And these days, because I'm on YouTube and I teach families this on YouTube, like they're already doing it long before they ever even see us or anybody for that sake. So it's already like when the person gets to me now that the family's been doing that all along, they come in ready. They're like, Amber, got a big problem. You gotta help me. And I've been treating my family terrible, and I gotta stop doing that, which is completely different than like most of my career, which is I'm here because my wife made me, I'm here because, you know, the norm.

SPEAKER_01:

Yeah. Okay. So we've got step one and step two. What's the next?

SPEAKER_02:

Okay, so as you're building credit and you're not being the villain, your person is probably gonna move into the fancy word, be contemplation stage, but I call it bargaining. So before a person decides they need to stop completely, they're gonna try to cut it back or control it, and they're gonna try a lot of bargains. And as the family member, if you just understand that this actually is good news because it means they're trying to figure out what they need to do to change, but they're gonna try a lot of wrong things first. So I teach families, it's your job to help that go faster. You can't make someone skip that. And maybe they say they're gonna only drink this much or they're only gonna smoke that much or whatever. That's not true. It's your job to say, okay, let's try that. That'd be good. And then let that person fail. And then we move to the next bargain, next bargain. And that's how we get to the point of what old school recovery would call powerlessness. You're not gonna get to that, I gotta let go of this completely until you've tried all the things. And so we teach family members to say, let's try that. Okay, let's try that. Well, that doesn't work, let's try that, but if that didn't work, let's try this to help a person move through that faster. You can expedite it.

SPEAKER_01:

How long does that bargaining phase usually last?

SPEAKER_02:

I don't, that's hard for me to say. I feel like when people start using our strategies, I'd say within, I want to say for the most part, within six months to a year, sometimes faster.

SPEAKER_01:

Yeah, that makes perfect sense. So I'm just thinking about this with my patients. Interesting. Okay. Do you have your patients keep a written ledger? Like you literally write down the idea and it didn't work, cross it out just so they don't go back to the same idea before.

SPEAKER_02:

No, because they will go back to the same idea before. They'll try it a few times because what will happen is they'll say, let's say I'm just gonna drink beer, not liquor, or something like that. Or I'm just gonna smoke weed, I'm not gonna do cocaine anymore. It doesn't matter, whatever the thing is. They'll probably be successful at that for a little bit, and then they'll fall off the cliff. And then they'll think, I just gotta go back. I was doing really good. So they'll try it more than once. So it's not a matter of, okay, try it, check it off. It's let me try that again. And you gotta give people room to do that. But while they're doing that, I plant some seeds. I say, yeah, let's try that, then that'd be good. Say a lot of times people end up figuring out that actually easier to do none than a little, but it's really different for everybody. So let's try that. If it doesn't work, don't worry. We got plan B, C, D, E. We're gonna figure this out. So that way when it doesn't work, they come, they don't have an issue coming to me saying, I tried it, it didn't work, or it worked for this long and then it didn't, because we're just problem solving it together. And then they come to the conclusion that it really is easier to do nothing than a little. Because I plant these seeds, I say, no, like even if you can pull it off, is it really even worth it to drink two beers? What's that gonna do but make you thirsty? And so we have these fun conversations along the way. I'm sending these, this could happen to you, but I'm not saying this will happen to you, I'm saying this could. It plants a seed and then they figure that out fast.

SPEAKER_01:

And how do you support the family member who wants immediate change to be okay being patient?

SPEAKER_02:

I just tell them that they couldn't want that all day long, but as if they're trying to force it, they're slowing down the process. And I'm just if they just look back at their own experience, they're gonna know I'm they're gonna know it's true because they've been trying that before they got to me for a long time. So I'm like, you're just slowing it down. We could get to this faster.

SPEAKER_01:

So it almost seems like by trying to rush it, they go back to being the villain.

SPEAKER_02:

That's right. But it's in patience, is what it is. It's I want them to figure it out faster, but there's a process of figuring it out. And I also teach them how to look for the winds that things are actually moving along differently, and then it helps the family tolerate it. So, like I'll say, when your person comes to tell you, I'm just gonna smoke on the weekends, and then we're two or three weeks in and they're smoking on Monday and Tuesday. I don't want you to be upset. I want you to be like, thank gosh, because we gotta prove this theory wrong quickly. And then I'll say, whatever you don't remind them and tell them they said they were only gonna do it this much and they need to do it this much. Because the whole pulling it back thing is never gonna work anyway. So you want not to be upset when that happens, but rather be like, okay, good. Okay, good. Now, like they're learning faster. And then you tolerate it better because you see it more as movement rather than as they're not trying or they lied or they're never gonna figure it out. You see it as, oh, that that's what we need to happen.

SPEAKER_01:

Do you teach the family member specific scripting of, hey, I see you're smoking on a Monday. It sounds like our plan didn't work. What's next? Do you teach them how to not get upset and be able to, again, build credit, maintain credit while they say, hey, this didn't work?

SPEAKER_02:

Sometimes it if I'm working directly with them, it depends on their loved one and what I know about their situation. If that relationship could tolerate that, or if I know that relationship, if the person is just extremely defensive and would just get super mad. So I would case by case basis about whether you brought it up and how to bring it up.

SPEAKER_01:

How does it go when someone's life is on the line because of their addiction? Let's say somebody has advanced cirrhosis from alcohol, and maybe we don't have a year before their liver's gonna give out.

SPEAKER_02:

In that case, you're not dealing with someone in denial. That's a harder case. I always say dealing with people in denial, it's not that hard. That's dealing with somebody who's just given up. If you've got advanced cirrhosis, you might be minimizing it to someone else out loud, but in your head, you know. And so that's actually harder, I think. When I'm talking about denial, I'm talking about like literally this person does not know. Not they're denying it to you, of course they're doing that, but like they're denying it to themselves. When you're dealing with someone who's super far in like that, like into stage four, like to that level, they probably know the issue there is probably more they're telling themselves something like, just screw it. If I'm this far, or I'm never gonna get better, or that's just who I am. Like, that's a different line of thinking, I think.

SPEAKER_01:

Usually let me just see if I can process that. I'm thinking of a case where a gentleman just seemed completely oblivious to the fact that he was going to die of hysterosis if he kept drinking and he eventually just stopped seeing me. Yeah, interesting. So it sounds like this works best when there isn't an urgent health matter as a consequence of the addiction complicating the situation.

SPEAKER_02:

This is the technique to get someone out of denial, even if that's the case. I just find that usually if that someone's that far gone, they may be denying it to other people out loud because they don't want to hear it. But there's a level of knowing, I think. But regardless, this is the thing that's gonna work. Even if this person's gonna die in six months. Coming at it another way from a family member perspective might not work. If you're in a situation where someone's like overdosing a lot or something like that, you might want to do like an old school type of intervention. That can work with someone who knows they have a problem but can't stop or just has given into it or something like that. Because when you force someone like that into treatment, sometimes, you know, when their brain clears up enough, they decide to get sober. I don't have a problem with that. Like sometimes these people just need to get sober long enough. But if they truly do not think they have a problem, I don't care how long you force them in there, if they're not done with their bargains, they're not done with their bargain. And I know it's scary because it could be like super obvious. It's it's just the way the psychology of it works, in my experience.

SPEAKER_01:

And let me ask a clarifying question. So is your model specifically around getting people to admit they have a problem, or is it to motivate people to change, or is it both?

SPEAKER_02:

Both. They can admit it or not admit it. The point is for them to decide to do something about it. And so it depends on how stubborn headed they are, you know, what the dynamic of the relationship is. Because what family owners don't know is actually they've probably been trying to solve this problem for a long time, but they haven't told you that because they haven't admitted it to you because they don't want to be backed into a corner and they're not sure if they can do it, and they're not sure if they want to do it, and they don't want to say, I'm trying to stop. They'll secretly try to stop because they don't want to hear it from you.

SPEAKER_01:

Makes perfect sense. Okay, so we talked about not being the villain. We talked about building credit, and we're talking about bargaining. Tell me about how the bargaining phase of the process wraps up and segues into the next bit.

SPEAKER_02:

Because eventually you figure out either this doesn't work or it's too much effort to make this work. That's what I do a lot of talking to people. How much energy do you have to do thinking about trying to keep this under control? And then you're planning and you're scheming, and so they just eventually figure out it's not worth it or it doesn't work. And then the next thing I do, if a person is still not all the way there, then what I'll do is I'll have them do a trial sober run. And I try to get them to do at least 30 days because you feel worse for the first two or three weeks. So that's not a good sober run because you don't get a good take on what being sober is, you get a good take on what being a withdrawal is. So I'm like, I could be wrong. I think you're gonna feel better, I think it's gonna be easier. Let's just test. After we've done some bargaining, try to get them to do 30 days, or if you can get more than 30 days, it's even better. But I feel like we got to get to 30 days for them to start feeling better. And that's the key because even if they go back to using or drinking after 30 days, if they've experienced it and we've set the stage right, now they know what it feels like over here, what life feels like over here, and they have a much better comparison. So they probably almost certainly will go back to using after 30 days or 60 days, however. And then they're gonna immediately find that they're right back in the same situation. Now the dots start connecting so much better.

SPEAKER_01:

So, do you find that people sometimes after failed attempts come to their own conclusion? I'm ready for sobriety. And on the flip side, if somebody just keeps failing, it's your job as the counselor to say, why don't we just try being sober and see what happens? Yeah. Yeah, it makes perfect sense. Yeah.

SPEAKER_02:

Yeah, it's just a learning process. And it's really just helping people move through that learning process. And the biggest key is trying not to make someone defensive because that just slows everything down. And so once you know where they are, you can figure out how to not step on them. You can step around them.

SPEAKER_01:

And do you ever get someone who when you suggest a trial of sobriety, they say no? Oh, yeah, sure. What do you do?

SPEAKER_02:

I'll say okay, whatever they're wherever they're at, and I'll put it out there, even ahead. I'll say this doesn't work, we can try that. And they may skip around, but eventually they come to that and they'll try that. And and I'll set the stage, I'll say, don't feel I always tell them the truth. You're gonna feel real bad for a week. That don't count because you're in withdrawal, and then this, so that they they have a realistic expectation of what that's gonna be like. And then as all this is going on, I'm planting these little seeds in their head about what it feels like to be sober, like sober sober. I'm like, oh my gosh, so much easier. You don't have no complications, you have more energy, and so I'm like subliminally putting these in there. So they start to see it differently. You know, they want to start to see the substance more accurately.

SPEAKER_01:

How much medical support do your patients need when they start getting sober?

SPEAKER_02:

It depends. Like sometimes they need detox support, depending on what they're using. Sometimes they don't need detox support, but sometimes they need help with depression or anxiety or some other kind of issue. So I would say pretty frequently, but less they're drinking too much for a long time, I'll say, I want to at least see your doctor and talk about something for sleep or something just to get us through this period to make it doable.

SPEAKER_01:

Yeah, the majority of medications I prescribe are mental health medications. Insomnia, anxiety, depression, PTSD, all of that comes out when the substance goes away.

SPEAKER_02:

And sometimes people say, Well, that's cheaty. I'm like, that's ridiculous. I'm gonna do whatever it takes. I'm gonna be this thing. What do I need to do? Like that's you literally like pulling all the tools out of the toolbox.

SPEAKER_01:

Yeah, that that strikes a nerve with me given I'm a physician. Here's how I describe it to people, right? Addiction is using substances to change how you feel, and the goal is to feel good and not need anything. Medicines, substances, and medications are like a bridge.

unknown:

Yeah.

SPEAKER_01:

Help the transition work better and you don't need them forever. Because a lot of my patients tell me, like, okay, I stopped the cannabis, but I don't want to be on Lexapro for forever.

SPEAKER_02:

Yeah, I don't want to be dependent.

SPEAKER_01:

Yeah. Yeah. So that's usually how I frame it. Yeah. Is medicine facilitates the process. Okay.

SPEAKER_02:

Honestly, it cracks me up when you get that. And you get it a lot. I don't want to take a medicine. I'm like, and you're putting what in your body? It's just, it's kind of it's total cognitive dissonance.

SPEAKER_01:

My favorite. I have one page. I just love her. She's so funny. And she was so afraid to take any of my meds. She has horrible PTSD. Was using fentanyl and meth. And, anyways, her dealer laced something horrible in there. And she looks at me, she goes, Dr. Grover, my drug dealer is so unreliable. And we had a laugh about it. And then finally she started taking her meds for PTSD. And I saw her this week. She's like, Dr. Grover, I feel so much better.

unknown:

I know.

SPEAKER_01:

Yeah.

SPEAKER_02:

I know you've got people pouring all these like poisons in themselves, but they don't want to take an antipressant. I'm like, Yeah. And I use a lot of humor. And sometimes I just joke with them like that and just help them see it funny.

SPEAKER_01:

I laugh with my patients all the time and it really helps. Yeah. Yeah. Okay. So we've working on bargaining. What's the path from bargaining to the next step?

SPEAKER_02:

You have to go through all those bargains. Then you sometimes people just go from bargaining to okay, you're right, let's just be done. Then sometimes people do the 30-day period or the 60-day period. They will go back after that. If they're telling you I'm just going to do a sober period, dry January, so work time, whatever it is, they will go back. And so I try to help the family member be prepared for that so that they're not freaked out. What we're trying to do is just get them to see what life is like when you don't have to be on that merry-go-round, when you're not running on that treadmill, when you feel better and you think clearer. Because when you're doing a trial period, sometimes you're just trying to get them to see the difference. And then when they go back, they're going to see it more clearly. Because when they go back, they're going to tell themselves, okay, I'm going to drink again or I'm going to use again, but I'm not going to do like I did before. I'm just going to do a little bit. So they'll be back into the bargain. And then the bargain won't work. And the good news is it won't work very quickly, it won't work. And so the truth just becomes harder and harder to not see. And so that moves people out of denial.

SPEAKER_01:

Okay, and then once they're out of denial, what's next?

SPEAKER_02:

Then I'll say, What do you need to do to get sober? And I'll let them tell me. And they may say, What do you think I should do? I don't know what I don't find that it's about telling people how to get sober. And most people they may try some different things as far as staying sober. They may do a little bargaining with that. Maybe I don't like this or like that or whatever. And that's okay too. But I try not to be super pushy on how people get sober.

SPEAKER_01:

I joke with my patients all the time, and they'll have an idea of what they want to do. And I said, you know what? If you told me, Dr. Grover, when I put mayonnaise on my left ear, I am sober. What do you think I would tell you to do? And the answer is put mayonnaise on your left ear because it works. Yeah, exactly. Truly to your point, it sounds like your work is let's motivate people to get ready for change and be ready to accept what they need to do to get sober. And then the process of working with someone like myself or whatever program you work with, it just becomes easier because they're motivated. And then, yes, I totally agree. Everyone's ultimate path to sobriety is different.

SPEAKER_02:

Right. And it once you get someone who decides that's what they want to do and they're gonna do, they'll figure that out for themselves. In fact, they've probably already known the whole time. They just hadn't decided that they wanted to do that. And I can give people tips on how to manage a craving or basic stuff, but I don't push people down any certain path. There is a there is another piece that I probably haven't elaborated on, but a lot of what I do is I look for this person's sort of natural gifts and strength and I focus on seeing that. Like when I say you have to help someone understand them, like I see them like, oh, you are like the master. And I start planting these seeds about all the things that they're missing. And we're talking about that all along. And then I do a lot of talking, it's like you need to use your superpower for the good.

SPEAKER_01:

That's almost like contingency management is giving them some positive affirmations to work towards.

SPEAKER_02:

And it has to be true things, like I have to like see them and hear who they are and be able to reflect that to them. And then they're like, You're right. And then they just get excited about it. One of the things I teach family members to do is to decide what is your person's values. How do they want to be seen by other people? How do they see themselves? And instead of trying to tell them, You're a terrible father, what you say is I've always appreciated how you've put priority in the kids. You're reminding them of their values. That creates that dissonance, and they start to see the difference.

SPEAKER_01:

Interesting. One thing that I say a lot to my patients is they'll start after about three to four months of sobriety being like, hey, I think I want to get a peer support specialist class, and I think I want to be a drug and alcohol counselor. And this is something I use a lot, and it I get goosebumps every time I say it. But addiction is a disease of shame and stigma. And my patients have done some horrible things. And what's amazing is when they transition from living with addiction to recovery and working to help others, all those skeletons in their closet now become their superpower.

SPEAKER_00:

That's right. Yeah.

SPEAKER_01:

And it's the coolest thing to watch when they realize like the fact that I used to do this could help people. And I'm like, yes.

SPEAKER_02:

Yeah. I heard somebody this past year say, and I hadn't heard it before, they turn your mess into your message.

SPEAKER_00:

Ooh, that's like that. That is great.

SPEAKER_02:

Yeah. No, totally. Some form of purpose has to come in, whether it's I want to help other people or there's bigger things in store for me. But it's that purpose piece, so important.

SPEAKER_01:

Yeah. What uh what's your success rate with this approach?

SPEAKER_02:

I don't know because I don't measure.

SPEAKER_01:

Anecdotally?

SPEAKER_02:

People that come see me usually get sober. Reason is because my focus isn't really on trying to make them get sober. My focus is making them have a pleasant experience. If they like me, they'll keep coming in. And if they keep coming to see me, I'm gonna get you there.

SPEAKER_01:

Yeah, it's just I've said that so often. If someone's not ready to get sober on the first visit, I'm like, you know what? Let's just book a follow-up. I'd love to see you again. 100%. If they like the experience, they come back. Yeah. Our practice, there are five physicians and I think eight peer support specialists. So these are all folks who lived experience. And addiction is a very traumatizing disease. A lot of my patients have difficult homes or abusive family members. And sometimes we just tell people, like, just come hang out in the waiting room. Just come hang out with us. And yes, you are spot on with that to try to make them have a good experience and feel respected is so important.

SPEAKER_02:

Right. And they feel safe. They know you're not trying to push them. And then I build the credit score as we go along. And then I just basically wait till they get themselves in a mess. And then I'm like, oh, maybe you should try this. They're like, yeah, let's do that. I'm gonna get out of trouble. And then I like I said, then they're like, oh, thank you so much. Versus feeling like someone made them.

SPEAKER_00:

Hmm. I want to unpack that. I want to get you out of trouble.

SPEAKER_01:

How does that usually land with your patients?

SPEAKER_02:

It depends on what kind of trouble they're in. If they're in, let's say they have a D UR or something, I'll say, Let me write a letter to your lawyer saying you're coming, you're compliant, coming every week, you're working, you're doing all these things. Great. If they're in trouble with their spouse, that's easy because I got the family counselor on them. Let me fix that for you. Like, whatever it is, if there's something that I can help make better for them, I I do.

SPEAKER_01:

Is that usually what you open with in your first meeting with a person? I think you said that I'm you said, like, hey, I'm Amber, I want to get you out of trouble. Go ahead.

SPEAKER_02:

Oh, I just say, Hey, I'm here on be on your side. Whatever happens, I'm your advocate. So you I'm not the principal, you I'm not against you, I'm your person. They're there to be on your side. So I set it up that way. Sometimes it takes me a minute to figure out what that something is that they need help with. Sometimes it's pretty immediate and urgent, and then sometimes it may just come along the way.

SPEAKER_01:

Do you have a particularly memorable case of where this worked really well in a family that was particularly frustrated or at wit's end?

SPEAKER_02:

I see it a lot, especially when I I used to deal a lot more with like teens, kids still living at home or young adults, like college kids and stuff. And getting their parents to back up off of them is super helpful and they're super appreciative. But I'm funny about it. I'm gonna say, listen, I'm gonna make that happen for you. In fact, actually, the family counselor's gonna make that happen for you. So, but I'm just gonna tell you a secret right now. You're gonna think that they're just oblivious and they're not even paying attention and they're like fine with it. Let me tell you what's really happening. That family counselor's over there giving them a strategy and they're just waiting and letting you mess up. So I'm just telling you, they're just gonna let you figure this out the hard way. So fair one it. And they're like, okay, great.

SPEAKER_01:

In the era of fentanyl, when the risk of overdose and lace drugs is so much higher, have you had to change your approach?

SPEAKER_02:

I don't know that I would change that approach, really. If someone is in that phase, I might talk to them about um a buprenorphine medicine, a suboxone, something like that. Just depends on where they're at. But I don't know that approach would be different. I know that there's an urgency that's there more. And I wish you could make it faster. This is the fastest way to get there. Like it really is. It doesn't feel fast enough, maybe to the family members, but I'm like, this is the fastest.

SPEAKER_01:

Yeah, I guess maybe it was a read-my-mind question, but I think about someone using cannabis, really can't overdose on it. Sure, you can get sick. It's going to cause mental health symptoms over time. But we have some time, we have some breathing room.

SPEAKER_00:

Yeah.

SPEAKER_01:

But with fentanyl, it's just so urgent. Here in California, we've gotten plenty of these fentanyl analogs, acryl, fentanyl, acetyl, fentanyl, paraflora fentanyl. I'm sure they're in South Carolina too. But it just feels like the stakes are so much higher in the era of fentanyl. And I wasn't sure if you had to change how you do things just to help communicate that urgency.

SPEAKER_02:

I think that the family already understands that urgency. The person knows what they're doing and they know that it's risky. So it's not like I can say you're playing with life and death. When someone's that far into addiction, there's passively suicidal anyway. So that whole this is gonna kill you thing is just not that powerful because there's this part of them that's like sometimes wishes they wouldn't wake up. They may not be actively suicidal with a plan, but they're miserable and unhappy and trying to not be sick all the time. And in the back of their mind, it wouldn't be the worst thing. So that whole like trying to press, you're gonna kill yourself. I just haven't found that works, even though I want to do that because it's scary. I just don't know that it is effective.

SPEAKER_01:

Yeah, it's funny. When I was in my training and I trained at a very good institution, I did my residency at Stanford in the emergency department. We would literally write, you need to stop drinking in their discharge instructions. And oh, I'm such a good doctor. They didn't teach us anything.

SPEAKER_02:

I told them to stop.

SPEAKER_01:

Yeah, yeah. My very lovely and very intelligent spouse and colleague, Dr. Reb Close. We've been married for 18 years. We've been practicing addiction medicine together for three or four years.

SPEAKER_02:

That's really cool.

SPEAKER_01:

Yeah. So she did emergency medicine. I did emergency medicine. Between the two of us, 15 years of medical education at UC Land Stanford. We got an entire hour in 15 years of training on addiction.

SPEAKER_02:

Wow. That's crazy.

SPEAKER_01:

So, yes, we've learned all this after the fact and gone through the American Board of Preventative Medicine's practice pathway for addiction medicine, and now we're both certified. But yeah, for years I just told people like you need to stop using. And that's what I thought was what they needed. And clearly that was not the case. I just wonder if there's some signal around fentanyl specifically, just doing maybe some psychoeducation on specific risks just to let them know the urgency, but in a supportive, empathetic way.

SPEAKER_02:

If I'm talking to someone who doesn't know that, then I probably would. But I haven't ran across someone that's using that kind of drug that doesn't know that already.

SPEAKER_01:

I guess that's a good point.

SPEAKER_02:

I might do a lot of education with their family and I might get them to get an Arcan and I might do some things like that, and I might talk to them about Suboxone or something and say, hey, like I know you're stuck on this four-hour treadmill and that's miserable. And I might work that angle of saying, man, this would stabilize you. This would make it where you could go to work and you wouldn't have to like constantly be stealing or hiding or you're spending all your money. But I don't know, that's a different technique.

SPEAKER_01:

Okay. So in other words, people know the harms, and part of what the family members do in getting credit is to acknowledge that their loved one is intelligent and understands what they're doing and they need to work on finding the why.

SPEAKER_02:

If they're 14 or 15 years old, maybe they don't. I don't even know about that. I if you're that far in, but you may be like, whatever, it's not gonna happen to me. It's not that you don't know it. So I tell families, do not send no medical article to your person about this is your lungs. Do not send, do not do it. Because that's it just and I don't do that either. They know that.

SPEAKER_01:

On the flip side, do you have the loved ones send maybe information about addiction or brain science or new treatments as a way to be supportive? Hey, what do you think?

SPEAKER_02:

Not until the person is expressing some sort of change talk. And depending on what sort of change talk, I tell the family members I train them to be having some resources in their back pocket and like finding ones that their loved one will go for. And that could just be a podcast, that could be a book, that could be anything, like a friend that's in recovery, and to wait for the right moment to play that card. Because if you play that card too soon, someone's in denial and they don't think they have a problem and you're constantly talking to them about going to treatment, you've destroyed your credit rating. You're just an idiot who doesn't know what you're talking about. And then everything you say, you're just overreactor. So I encourage them to find resources that the person will go for. If the person's not religious, it needs to be a not religious one. If their person's an outdoors one, it needs to be an outdoorsman and be waiting, sitting on ready till they get their moment. And then say, and then I teach them to say, I don't really know if this is for you or not. I don't know. I thought you might like it because it's outdoors. I call it the leave it on the coffee table method. Someone's like more likely to look at it if they don't feel pushed.

SPEAKER_00:

That is a beautiful pearl right there.

SPEAKER_01:

Okay, is there any part of your approach we haven't gone over yet?

SPEAKER_02:

Those are the basics of it. That's the big outline.

SPEAKER_01:

And did you come up with it yourself?

SPEAKER_02:

Yeah, trial and error, figuring it out. Because when you go to counseling school, I guess you get more than doctors. We got a course on it, but the course entails go to three 12-step meetings and come back and report to us what it was like. That's it. And they put the disease model curve up on the whiteboard.

SPEAKER_01:

That's it. Have you published this like in a book or a scientific article?

SPEAKER_02:

No, I'm thinking about writing a book. I have an online course called The Invisible Intervention. I have a little workbook, but I haven't decided if I want to go the writing route. I'm I do better talking.

SPEAKER_01:

So Yeah. Thus, thus YouTube and podcasts. Okay. As we get to the end of the hour, is there anything else you wanted to add that we missed?

SPEAKER_02:

I don't think so. I just want to say I appreciate the work that you're doing.

SPEAKER_01:

So, yes, I'm very proud. I got a minute to brag. We have a five physician addiction medicine practice in little old Monterey, California. And it's great. Yeah, we can get people in the same day. We have four pillars to our medical approach. It's kindness and respect, it's low barrier to entering treatment. It's really emphasizing the role of peer support and those with lived experience, supporting a person wanting to get sober and then using long-acting injectable medications. So the way I say it is let's say you're on Suboxone, you're on it three times a day, you've got to make what over 900 choices a year to make sure you take your meds. And once we get you on a once-a-month injection, you just have to come see me 12 times. Yeah.

SPEAKER_02:

And how easy is it to talk to people into doing that?

SPEAKER_01:

It's an interesting question. So same thing that you were talking about is trying to understand the why. I mentioned what do I do in my first appointment? What makes you want to change? And for a lot of people, it's my health. I lost my kids. I'm going to face jail time. And I really look at it, again, back to my man is on the ear joke. What for them feels easiest? Some of my patients are super diligent. I prescribe it, they don't miss a dose. All of us are humans. Some people really struggle with remembering medications. And so some people hear that there's a once-a-month shot and they're like, oh, thank goodness, it'd be so much easier. And they want to go for that. Others, to your point, we try not doing it and it doesn't work. And I'm finally like, okay, we're if we're here in the next month, I think we should try the injection.

SPEAKER_02:

And it's a good idea. The bargaining working up to it. Same thing, same thing. Yeah.

SPEAKER_01:

Yeah.

SPEAKER_02:

So do you find that people, because one of the ways I sell, I don't do sublica, but I sell people on the idea of sublicate a lot, is I'll say, if you ever decide you want to come off, it's so much easier to come off of subplica than it is Suboxone. And then I explain all that to them. Maybe you don't need to come off. But if you decided you wanted to, people say that they can slow down on this and come off without feeling anything.

SPEAKER_01:

You are correct. I do it all the time. We give them four to six shots of sublicade. It builds up in their system. There's a depot of it, and then they don't kick. It is unbelievable.

SPEAKER_02:

Isn't it? I know. And once people like can start to think about that way, they're like, yeah.

SPEAKER_01:

Totally. Usually my conversation with them is look, let's get you on Suboxone. I promise I can get you off of it, and it's no big deal. And when they hear that, they're like, okay, I'm ready.

SPEAKER_02:

Yeah. I love it. My my experiences is that most people that are in our field use these same techniques, but sometimes we don't have words on them. We just know we just do them. Like because we've just been doing them forever. I think teaching YouTube or talking to families has forced me to have to figure out what is it that I do? Can I put some names on those steps or whatever? But you inherently figure this out.

SPEAKER_01:

Yeah. And part of why I have a podcast is one of my patients will be like, Dr. Grover, what do I do? And I'm like, wait, I have an episode for you. And then I just email them the podcast episode, they'll listen to it. And then it's almost like I can get work done with my patients in between our visits by having podcast episodes that they can listen to.

SPEAKER_02:

And I think you can get work done even more because when you're telling someone something face to face, their walls are up a little bit because they're just not sure and they feel pushed. And when they're just listening and they just know you're talking to the world, their walls are down and they actually absorb it better that way, I think.

SPEAKER_01:

I would agree. Yeah. So, Amber, if someone wants to learn more about your work, where can they find you?

SPEAKER_02:

Best place to find me is on YouTube. Put the shovel down. Whether you are a person thinking about getting sober in early recovery, you have a loved one who needs to think about it. We have every kind of information for every angle.

SPEAKER_01:

Fantastic work. I will be sending this to so many of my patients' family members as soon as it is live. So, Amber, I have to say thank you so much for coming on my podcast and teaching me.

SPEAKER_02:

Thanks for having me. Appreciate it.

SPEAKER_01:

Before we wrap up, a huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction. And a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses. To those healthcare providers out there treating patients with addiction, you're doing life-saving work and thank you for what you do. For everyone else tuning in, thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together, we can make it happen. Thanks for listening. And remember, treating addiction saves lives.