Addiction & Recovery Conversations with Brett Lovins
Real stories. Honest conversations. No judgment. This podcast dives into the raw, personal journeys of people navigating substance use, recovery, and everything in between. Whether you’re sober, sober-curious, or just looking to understand the human side of addiction and healing, these stories offer insight, hope, and a reminder that no one is alone in this. Guests include advocates, Recovery Friendly Workplace experts, HR professionals, healthcare providers, musicians, family members, and friends—each bringing their unique perspective. We also explore how businesses can create Recovery Friendly Workplaces (RFW), breaking stigma and building real support for employees and their families. Since most people spend two-thirds of their waking lives at work, we talk about the critical role workplaces play in recovery, well-being, and changing the conversation around substance use.
Addiction & Recovery Conversations with Brett Lovins
Comprehensive Healthcare - SUD Division Chief in Yakima - Jon Schlenske
What if everything you thought you knew about addiction treatment was rooted in outdated thinking? After 26 years in the substance use disorder field, Jon Schlenske brings a perspective that challenges conventional wisdom while offering genuine hope for those struggling with addiction. Jon is Division Chief, Substance Use Disorders and Integrated Services at Comprehensive Healthcare in Yakima, WA.
This conversation traces Schlenske's journey from grassroots case management to his current role leading Integrated Care at Comprehensive Healthcare. His experience spans treating pregnant women with opioid addiction at Vanderbilt to developing hospital diversion and outreach programs.
At the heart of our discussion is a powerful reframing of addiction as a legitimate disease. Schlenske explains how it meets all the clinical criteria of other diseases – it has symptoms, it's progressive, it involves withdrawal, and it can be fatal. Yet society continues to treat those with addiction differently than people with cancer, diabetes, or heart disease. This stigma creates barriers to treatment while adding unnecessary shame.
The conversation doesn’t shy away from uncomfortable truths. With only one in eight people maintaining sobriety six months after treatment, Schlenske questions why outdated approaches remain dominant despite poor outcomes. He makes a compelling case for medication-assisted treatment, emphasizing how pharmaceuticals can provide the stability needed for deeper healing.
Perhaps most powerful is Schlenske's emphasis on hope and human connection. Instead of focusing solely on complex modalities, he suggests that recovery begins when we treat people with dignity and address the trauma that often precedes addiction. The path forward requires not just better treatment but a shift in how society views and supports those battling substance use disorders.
Whether you're struggling, supporting someone, or just trying to understand, this episode offers insights that could change how you think about recovery. Listen now to join the conversation about building more compassionate, effective paths to healing.
Comprehensive Healthcare
Jon Schlenske on LinkedIn
Other useful links from Brett:
- Sober Curious Consulting - Brett's Recovery Friendly Workplace consulting business.
- Brett's YouTube channel
- Washington Recovery Alliance - building the capacity of the recovery community to advance substance use recovery and mental health wellness by catalyzing public understanding and shaping public policy in Washington State.
- Recovery-Ready Workplace Toolkit - providing information, tools, and resources to help employers from all sectors—government, for-profit, non-profit, and not-for-profit—effectively prevent and respond to substance misuse in the workforce from the Department of Labor.
- Data on SUD in the US (2022) - from SAMHSA (Substance Abuse and Mental Health Services Administration). Link to my favorite PDF for statistics.
- Addiction 101 - it’s not a moral failing—it’s a treatable illness. Get the facts about this misunderstood medical condition from my friends at Shatterproof.
So we have a mutual friend and you came to that Rotary speech that I did in Yakima and we met there and I think we both I felt like we had a nice rapport and stuff and I was like we should come on the podcast, and so the way I like to start these I think it works well is just to give my guests the opportunity to introduce themselves to the audience, and in this case, me as well, because I know not much about your work other than there's a strong overlap with what I care about. So would you be up for introduce yourself, john?
Speaker 2:Absolutely Again. My name's John Shalinski. I've been in Yakima about a year and a half Been in the SUD space. This is my 26th year in a variety of different settings and a variety of different roles. It's been tremendous sort of going through such a long period of time, of changes and modalities and philosophy, so I do think that I can talk a little bit about that because it has been a long time.
Speaker 2:We came to Yakima from Nashville where I was a senior director at Vanderbilt University Medical Center where I was overseeing a program called Project Firefly, which an extremely forward-thinking, innovative program at Vanderbilt, where the whole nature of the program was treating pregnant women that were addicted to opioids. The results were incredible NICU stays decreased and stigma decreased and these women got love and hope and arms wrapped around them. It was just a really magical experience. My wife and I are originally from Spokane. I was CEO at Spokane Treatment and Recovery Services for 15 years. We developed a lot of really unique and cool programs, particularly in the world of co-occurring disorders, subacute detoxification, hospital diversion, outreach, things of that nature. I've been a CEO at a Rural 29 mental health clinic in southern Minnesota. We were there for a few years, enjoyed that experience and then we landed in Yakima. We were recruited to come here.
Speaker 2:While we were in Nashville we really had a hope and a desire to get back to Washington State where our family is. We felt a bit disconnected and this opportunity came our way and we jumped on it. Been here at Comprehensive Healthcare for about a year and a half as Division Chief of Substance Use Disorders and Integrated Care, so really have my finger in everything SUD here at Comprehensive and we're a really sort of massive agency. We employ roughly 750 people. We're in five counties. We have every modality, from outpatient to inpatient, to co-occurring, to ENTs, to PAC programs, iddt programs, family programs you name it, we provide it.
Speaker 2:I believe we're the second largest nonprofit behavioral health center in the state of Washington behind Sound over in Seattle. That's a little bit about me. I have a master's degree in addiction studies with a focus on behavioral sciences, undergrad in business. I've been a Washington State SUDP since 2005. So just it's kind of all I've done. So I'm excited to talk about whatever you want to talk about, because I think it'll be a unique perspective in terms of strategies and growth and what we've overcome as a system and maybe things we could probably improve.
Speaker 1:Love it. Well, I didn't realize the breadth and length of your experience in this, John, so I don't even know where to start because I've got so many questions.
Speaker 2:Fire away.
Speaker 1:Yeah, so you're in Yakima, the Palm Springs of Washington, yes, yes, and so that's my hometown, as you know, and my brother lives over in Spokane, and so Molly and I lived over there for a while, so we're Eastern Washington. Upbringings right? Yeah, that's right, and so I think a really interesting first question would be what led you to have an interest in this? Tell me about your interest or how that led up to this work.
Speaker 2:Yeah, you know, really there was some happenstance involved. I was working with kids way back starting in like 96, 97. We were in Spokane and back then, um, advertisements for jobs were in the newspaper and I would scroll the newspaper pretty much daily and an ad was in the newspaper, uh, for a program in Spokane called the detox enhancement program. That was housed at community detox services, which when I was CEO I rebranded it to Spokane Treatment and Recovery Services, but back then it was Community Detox had family systems issues due to alcohol and other dynamics. So it always intrigued me in terms of the why and the how and really the enormity of it. Again, I didn't have the education or the background to really dive into the whys, except I knew from experiences that it was extremely painful and people were dying and I was just intrigued by the complexity of it. Number one. Number two I was intrigued by the stigma even back then, why we treated this population so uniquely different than other sick people. So I wanted to get involved. I had no experience with SUD when I answered this ad but for whatever reason, they called me in for an interview and I ended up getting the job and this program was really tailored towards taking folks out of psychiatric institutions, putting them in a different environment that we had for them, and then over a period of 60 days we would do a deep dive into their experiences, really provide intensive case management work and social support, evaluation and really over a 60-day period, try to reintegrate them into the community without returning back to a psychiatric institution. So it really was, I think, one of the first integrated care models in Spokane that really proved to be extraordinarily effective.
Speaker 2:From that point I just sort of worked my way up in that agency, culminating as CEO. So I really did every position, from the grassroots case management stuff to clinician, to clinical director, to CEO. So really that was like having to climb that way taught me so much about every level of care and really why folks are within those levels of care and what we needed to do as an agency to truly help. So that's what led me into the field. We all have stories, experiences that maybe trigger the unique desire to work with folks that, from my perspective, are cast aside probably way too much. They're marginalized, they're stigmatized and really in those moments that was my focus is how can I get folks to look at this disease like we look at other diseases, and that's been my goal throughout.
Speaker 1:Well, this is one of my favorite topics and there's a couple things in there that I'd love to explore with you a little bit, especially somebody like you that's seen a lot right, and especially where you just described. You've seen a lot, you've experienced a lot. One of the things that I'm still working my way toward understanding about how to talk about it, and particularly when I think about advocacy, is the disease model, in particular for family. So you know, I've done a fair bit of looking into this. I'd love to give you a crack at talking about the disease model and because some people are resistant to it you know that right and then the family in particular can be particularly resistant to it because of the symptoms, if you will, but that's a word that I've just interjected, that may not be appropriate. So I'd love to hear your thoughts on addiction or substance use disorder as a disease.
Speaker 2:Sure. Symptom is a great word because it has a direct correlation to every disease and I think that's where I'd start my when I speak about it in front of large groups. It's really let's take it down to the fundamental, elementary level and let's talk about it In terms of does it have symptoms? It absolutely does. Is it progressive? Without a doubt. Is there withdrawal symptoms associated? Without a doubt. Is it potentially fatal? Without a doubt. That's describing cancer, that's describing diabetes, that's describing heart disease. That's really describing every potentially fatal disease that we suffer from. If you break it down in those elementary frames, that's exactly what a disease looks like and that's the disease model of addiction from my perspective. If you look at the criteria of a disease, this fits that box perfectly. It goes untreated. That's potentially fatal. The progressiveness of it is not unique to any other disease. I think, when we speak about the disease model of addiction in society, the difference between this disease and all other disease, I think, is that there's still an element of just stop or you're making this decision. You made this choice. Now you're not afforded all of the other things that may need to get you better, because we kind of view this as a disease. The American Medical Association says it's a disease. The American Psychiatric Association says it's a disease, but as a society I'm not so sure. We still think of it as a disease.
Speaker 2:And really that's my number one focus every day when I get here and do community work. It's how do we get people to look at this like all other diseases? And until we do, I don't know if we can appropriately treat it. Number one, but number two I think stigma is going to take people back out and keep them out because they're fearful of coming forward. So we can get super scientific about neurochemistry and genetic disposition.
Speaker 2:We can get super scientific about neurochemistry and genetic disposition, but if you just frame it to folks, hey, what do those things look like? And is that any different than any other disease that we treat? Now? It's not. And why do we look at it that it's so different than those other fatal diseases? If it goes untreated, and why do we tell people with this disease that they just need to stop? To me that's nonsensical, illogical and very dangerous. So really we can get into the roots of what the disease model looks like. But for me, and when I talk to families, I really I frame it that way, and I like them to explain to me how this is any different than those types of things.
Speaker 1:Well, let's keep playing in this for a little bit longer. Let's do it so in your line of work, then. You've already said that you're talking to family members. That's something I hear from people that have tuned into my work of interviews and whatnot. I've had a lot of family members reach out to me and say it's really been useful to begin to understand this through that lens, which is great, right, but I want to propose this and get your thoughts on it.
Speaker 1:I had no idea that I potentially had a disease, right. I, like most, just figured it was a willpower issue and I, you know, tomorrow I'm going to get this right, and the next day and the next day and all the things that I have have have marshaled over the years that I've been useful. To me, this one spot seemed to be, and all I did was continue to berate myself. So, while you're talking to the family members, you know how effective have you seen it to propose that idea if you have to the sick person, and have you ever seen lights go on when they say, whoa, hang on a second? You mean, it's not just that I'm a bad person with, you know, no willpower. Can you speak to?
Speaker 2:any of that. Yeah, I think it's our job to get the lights on right. I think that's the motive I think unique to family systems. There are so many consequences wrapped up in practicing addiction, and family members tend to focus on those as they should. It's scary, it's painful, it's uncertain, it's dishonest. That's what we do when we're active in our addiction, and it's hard to get a family member to let go of that. So I think there's a healing process.
Speaker 2:Before we drop the big bomb of this is what your family member has, I think you need to process through with family members how they're feeling, what they've suffered, how it's impacted them, what they're looking for their family member to get through help or care treatment. I think the mistake we make, though, is that we sort of direct families that they need to be supportive and we don't give them time to heal from their pain that they've experienced being involved with or loving somebody that's inflicted with this right. So I always try to include them from that lens. Give them an opportunity to process, let us know exactly what's this journey been like, and really also what's this journey been like and really also, this can be a kind of a courageous service delivery. It's also giving. When I do couples work, it's you know they come in and they tell these horrific stories and you know Joey's been to treatment six times and I'm sticking around. I don't know how much more I can take. They need to have permission. They don't have to stay, but if they do, they need to be fully educated on what the loved one's suffering from, from a medicinal perspective, from a disease model perspective.
Speaker 2:And I think when you can arm a family member with that, however long that may take for them to heal from all of the things that go along with this, I think that's when you move the needle, all of the things that go along with this. I think that's when you move the needle, but you have to do it in a way that gives them permission to be very clear with their pain, because I think most of the focus goes on the addict and getting them better, which is the way it should be. But we can't dictate how the family member needs to feel and I think that's the big mistake we make. Like he's here getting help. You need to sort of get over it. He's getting help, you need to sort of, you need to forgive and forget and understand, and I don't know if that's quite fair to the people that have already employed or deployed all of these supportive techniques over sometimes decades, because they just love that person.
Speaker 2:I hope this is making sense, but I think it has to be sort of an equal mix of. This is what the family needs, this is what the practicing addict alcoholic needs, and then, at the end, how do we marry that to a path forward in terms of this is really what you're signing up for for an indefinite period of time. You're going to have to do your own independent work to stay healthy. You're going to have to do your own work around the anxiety that goes around. Hey, when is the other shoe going to drop? I've heard all of this before and I think that's all common and I think it's actually logical, but I don't know if we spend enough time with families anyway. So what we like to do here is we like to devote a lot of time to those family members, because that's really going to be the person support system anyway, and they need just as many tools as the practicing addict alcoholic does If they're not married that way, it simply doesn't work.
Speaker 1:Man, there's so much here, so you talked about, you know, helping the family, and just recently I've had more conversations about this concept. And do you know Rich Jones, by chance? Is that a name that's familiar? I do not. Okay, anyway, he was talking about the effectiveness of working with the family members, independent of the person afflicted with the condition, and how often the person who's with the disease gets curious about what's being said, and that's often. Is that your experience too? He said that was commonplace.
Speaker 2:It's extremely common and I think that's from a place of insecurity and uncertainty and fear and, yeah, that's super common in family systems work throughout, yeah.
Speaker 1:Yeah, so let's just say that the, what are we going to call it? Patient? What would the word be?
Speaker 2:What would the we use client here or yeah, client yeah. I think that's just a minor form of destigmatization if we use the word individual or client consumer. I think patient just implies that they're and they are sick. But I like to humanize them at every opportunity I can.
Speaker 1:I love that and I always think through the lens of when I was in my active addiction too, the kinds of words that would have thrown up a red flag Probably if I was called a patient. I would not feel comfortable with that. So I'm glad you said that, yes, sir. So let's set the client aside for a moment and you're working with the. For whatever reason, I'm going to keep going with this. Perfect, and you have this opportunity to let's just say you've only got a short period of time and you know, earlier in this conversation you talked about sort of the checkboxes of a disease that make it a disease. Let's go a little bit into the brain chemistry. If you're talking to that family member who's either listening on this podcast right now, or that you're talking to, what are you going to say to sort of reveal this idea that Joe or Susan or whatever is suffering from a disease? Can you do that, john?
Speaker 2:Yeah, I take them through all of the things we've discussed Again, we break it down to a very elementary level. I let them interject. Again. They're coming to us filled with pain and uncertainty and fear, so you have to take sometimes it's a slower process and you need to give them time to ask their own set of questions. The other thing, though I think in that regard we need to be realistic about what they're going to absorb anyway, based on the experiences that they've been through for the last 10, 15, 20 years.
Speaker 2:I think at times we get them in these rooms and we're so eager to help and make folks healthy, or give them an opportunity to make themselves healthy, that we need to understand that this is going to take some time themselves healthy, that we need to understand that this is going to take some time. So that's the first thing. I tell the family that if you stay with this and this isn't up for debate I tell them that your loved one suffers from a disease that's potentially fatal and what you've seen over the last 20 years are a bunch of really acute symptoms that have culminated, for whatever reason, to now. We're going to stop. We're finally going to look at this and try to get better. You're not going to sway that family member into a space of happiness and reprieve by session, even six. So to me it's going in kind of little sections. Starting with I'm not going to debate this with you. This is absolutely a disease. If you don't believe me, you can go do your independent research or you can look at what the American Medical Association says about this, or you can go compare it to any other potentially fatal disease and then you can come back and sort of give me your feedback and we'll go from there. I've had really good luck with that approach because it's very simple. I think, like I tell my clinicians sometimes, in this space we have to do simple better. It's such a complex disease and we fill it with evidence-based practices, which is great, and we use all of these big, massive words and we dive deep into science and medicine and all of this stuff.
Speaker 2:At the end of the day it's really about instilling hope in another person. If you do that just a little, I mean it doesn't even need to be a lot. But if you can take someone who's been hopeless and lonely, who have self-stigmatized themselves, to feeling that they're not even worth sobriety, then we're not doing our job. Our job is to instill hope and optimism and love, and you're part of and you're not broken. You're sick and you know what. You're not your addiction either. You're Brett and you're an alcoholic. Billy's Billy. He has cancer. Janie has heart disease. Why would we treat Brett any different than the other two? And until, unilaterally, as a system, we figure that out, I don't know what kind of progress we're supposed to make.
Speaker 2:Because it's really about hope. It's about acceptancelusion, and this population doesn't feel that. They don't feel that anywhere. They're scared to self-disclose things. It's 2025 and we have sick people that are scared to tell people they're sick. That's our issue, that's society's issue, because the cat's out of the bag. This thing will kill you dead, it destroys families, it destroys kids, it's destroying communities as we speak. So I think at times, we need to dumb this thing down and make the singular focus from a clinical perspective into instilling hope in people that don't have any, and, from my experience, when I've been able to do that, folks have gotten clean and sober.
Speaker 1:Yeah, hope is a thread that runs through this work. It shows up a lot and again, thinking back to my time in active addiction and I think about Well, it's hard to say, you know, it's hard to go back and tell a different story, because I live what I live and that's what I bring to this conversation and every other one. But I have a suspicion that the way I would have listened to you right now would have been with tremendous resistance and because, for a couple reasons one, I wanted to keep and I like to use the Gollum term the precious. I wanted to keep the precious by the fact that, just like Gollum, it was killing me, but I wanted to keep it. And second, you know I would have called hooey on anybody that said to me I need hope to deal with this disease.
Speaker 1:The only time I could really get there, john, was about eight beers in the first little wave through there, where I would have the courage to start to think about this from the perspective of.
Speaker 1:Okay, you know, now I can start to think about this safely. I couldn't do it before I started because of the symptoms of heart rate and you know the anxiety and anticipation and the cravings were ramping up and then past about eight or nine beers. I'm not going to remember much of that. So there's like that was my window of exploration of my situation and I wonder sometimes if this kind of information would have been available to me and easily available, because I'll add that would that have made a difference in me recalculating my current situation and the possibility that when somebody says they need help current situation and the possibility that when somebody says they need help, maybe there's something to that. Right, some people come to want help with enthusiasm or the opposite of enthusiasm but desperation. Right. But I don't think that would have been me. I'm not sure that I could have been convinced that I needed help. So that's a lot and anything in there you're up for talking about.
Speaker 2:Yeah, I think in terms of goal disposition, I think hope is probably where I like to get everybody to go, but I also understand that that's not going to start day one. They're going to be angry. This thing's filled with guilt and shame and we leave shrapnel in our wake when we're practicing and I think we take people for granted. It's not the most honest disease, I think, instilling in the person in front of you that you are battling the only disease that every single second of every single day is trying to convince you that you don't have it, which is unique from all the other ones. And how are we going to live with that, because that's not going to go away. And how we combat that is elevated self-esteem and self-forgiveness, decreasing self-stigma, being willing to genuinely apologize to the people that have supported you thus far, that are signing up to be a support system, moving forward, all the while understanding that every second of every day, you're going to have to deploy coping skills and thinking tactics in an attempt to defeat a disease that is trying to seep in to convince you throughout the day that you don't have the thing. And to me, that's where this is the killer right. It's like cancer man. People will fight, they will go through rounds of treatment, they will do whatever they need to do to get better. Really, that's across the board. Now, with this, though, because of what I just said, they consistently kind of go through the stages of change from pre-contemplation Now they're in contemplation. That's what I'm depicting, and at every stop, what is that alcoholic or addict going to do to combat that? That's really where we begin.
Speaker 2:I've probably detoxed 35,000 people in my career. I've had folks that have come to me crying that they wanted to stop and couldn't. I've had folks come to me and say you know, I don't really have, I don't want to hear anything. You have to say my delivery doesn't change, it's your welcome here. When you're ready, I'm here. Those types of statements they don't hear often. So good clinicians are going to say the things that they don't hear often. But also, when you're in front of an addict or alcoholic, you need to understand they're going to absolutely know if you're not being transparent and if you're being dishonest and if you're being a phony and if you're not going to practice what you preach. I've had many people that were resistant, that didn't want to hear that, and that's fine. That's what, in a lot of ways they're supposed to say. You know, there's acuity levels to this that we don't talk about either. We just sort of throw everyone in the same peach basket and say, get better. Well, everyone lands in those seats for different reasons.
Speaker 2:Adverse childhood experiences are a common thread with 99% of the people that I treat Horrible childhoods and divorce and abuse and trauma, sexual abuse, physical abuse and then they get to a point, sometimes at an even young age, they would just rather live life not feeling anything, but then the natural consequences and the secondary consequences come in and that feeds it. Now I'm getting in trouble. Now I have to self-medicate that. And now my family's on me and I don't know what to do. Now I have to self-medicate that. So now we have a grocery list of things we're self-medicating about.
Speaker 2:When the beginning of this journey started, when your dad started beating you up, well, let's talk about that. Or is it more important to go into a room and really be told things that you really already know? We already know them. So I don't think we devote nearly enough time in treatment inpatient or outpatient really diving into when did this start and why did it start? Because I know people that I've treated. They didn't have that opportunity, they had to hold on to that and then they reach 17 or 18 or 19. And again, we don't pick this thing. This thing picks us.
Speaker 2:And if you have these experiences where you just want to be numb, really for the foreseeable future, it doesn't make sense to me at that point to look at the person and say you're an alcoholic. Well, no, kidding. Let's talk about what's caused you pain for 15 years. Let's talk about processing what your mom or your dad may have done to you, or how you felt when your family was disconnected, or how you felt the first time you were kind of ostracized or stigmatized.
Speaker 2:Folks don't get better unless they process those types of things. They just don't. Those things don't go away. So I think we need to sort of get back to more of that type of dialogue when they come in for help, as opposed to immediately just diving into you're an alcoholic. We're going to combat that. These are the things you need to do. It's going to fall upon deaf ears, unfortunately, because they're still in massive amounts of pain. I hope that answers the question, but that's what I like to do generally speaking, and people think of that uniquely. Some folks say well, we shouldn't talk about trauma until they're six months into their recovery. We don't want to pick those scabs until they have a clean and sober support network and a really firm recovery base. The sad reality about this is about one out of eight that complete treatment make it six months, so why wait?
Speaker 1:We don't have time, let's go there for a second. So you know, you brought in the example of the person with cancer and you brought in you know that in this case they're willing to do treatment, et cetera. I'm going to speak from the layman of what I think society thinks treatment is for active addiction, and then I'd love to get your two bits on it if you will, so love it. So this is what I think society thinks and this is what, growing up, you go to treatment and then you're better. And when you have a return to use which is a term I'm getting used to relapse is the more common one. But if a person returns to use you just said one out of eight just a second ago Wow, that's tough right, that's a tough thing. The stomach right, think about that For everybody.
Speaker 2:Think about that yeah.
Speaker 1:So when you set people up with the hope and expectations and whatnot, first off, there's a lot in there, john, have at it.
Speaker 2:Yeah, thanks for asking the question. This is probably what I'm most passionate about, and maybe it's a hair on the controversial side, or people don't want to hear it, or whatever it may be. Our outcomes have not improved. Our treatment outcomes have not improved. I'm a data and outcomes. I think those are vitally important to the work we do every day, because it really takes the subjectivity out of it, like this is really what's going on.
Speaker 2:And then when you mix, like for-profit treatment centers and non-profit treatment centers, and that philosophy is completely fragmented and different, the motives are different. Right, they all sort of say the same thing, but it's not the same thing. I know that very few people in this country that enter inpatient treatment and complete stay clean and sober. The average adult in our country enters inpatient about five and a half times before they attain the six months. That's a mind-blowing thing and we continue to do it the same way. So and I'm not saying me here, us, here we absolutely provide integrated care and we look at the whole person and we expect recidivism. We expect people to return to use, unfortunately, and we're not going to cast them aside if they do return to use, unfortunately, and we're not going to cast them aside if they do. But really the structure in our country, with about 95% of our inpatient treatment centers being 12-step based, with really that premise being kind of all or nothing if you relapse, you kind of fail. You have to start over now and to an addict that maybe had two and a half years now we're going to take them right back to, I'm not worth it. I'm less than I told you. I was a failure. I told you I couldn't do this, when we know that this is a remitting and relapsing disease and we can't. We want everybody to get it the first time and live a happy, healthy life, but the data simply doesn't suggest that that's the case and we still do it the same way throughout our treatment system. So when we talk about when we're in front of an addict or an alcoholic and we go through the cool definition of insanity speech and it's doing it, we all get that. Well, that's kind of the treatment system. We're doing it the same way and it's not really rendering good results. And I really believe that because it's so not individualized, we throw 60 people into a big room and we all tell them the same thing, when every single person is unique and different in terms of why they got there. So I am passionate about kind of changing that and looking at why.
Speaker 2:The data is the data. What are we doing? That's disconnected from other diseases where they have solid efficacy and good outcomes, and why do we continue to think the way we thought back in 1939? We've evolved. We know that it's much more complex now. We know that people probably the data suggests are going to have a relapse or two or three.
Speaker 2:I don't know why we're shocked anymore and I don't know why we're still fear-based. I don't know why we're shocked anymore and I don't know why we're still fear-based. I don't know why we would punish that person. I don't know why we say things like you just weren't ready. What does that mean? You need to go do more research. What does that mean? But that's where we're at. That's where we're at it's.
Speaker 2:You have like 30 or 60 days to figure out how you're going to get better and escape something that has harmed you physically, emotionally, spiritually and mentally and all the people that care about you the same way for say 25 years and in 30 days. For say 25 years and in 30 days you're going to be better. To me, that's absolutely a logical thing and if that's our expectation, then of course, we're not going to see the results we want to see as a treatment system, because it's an unrealistic expectation. I think we can plant seeds, we can educate, we can let people heal, but in 30 days, I think it's really about really thoroughly getting people to understand that they're inflicted with a disease. This is why, talking about the experiences that led them there and maybe, hey, intermittently, how are we going to? When you leave treatment, what are you going to do on a daily basis if you want to continue to breed hope within your life? That's treatment. It's not making someone so scared of this thing that now that they're terrified and scared, they're going to stop, because death is not a deterrent with this. It's not.
Speaker 2:Fentanyl's proved that People know that that's absolutely on the table every time they ingest and they still ingest. So, to answer your question specifically, I think the last deep dive we did on the data you know, it's, I think, one out of six and a half and multiple treatment attempts and lots of relapses and that could be budgetary constraints and you know we really don't know any other way of doing it. But, like I tell people, I think that, like, the first 10 days of treatment should be individual therapy and building a human connection with somebody that you trust, that you believe in, that's going to listen to you, because they haven't had that ever, hence that's why they're there Now, if you can build that human connection, now we can talk about this thing specifically and how it's specifically impacted you and how it's going to specifically impact your family, and what we're going to do specific to your experiences, moving forward so we can combat this thing to the best of our ability.
Speaker 1:All right, I want to say something here around this idea of hope and getting well, so I'm going to tell a little bit of how I have thought about that on the far side of this, and then I'd like to share my experience of what being well looks like. I always use this, almost every podcast. I've used this metaphor. If I would have come across this podcast, I would have snuck in to hear it, I would have made sure the door was closed, I'd be listening for anybody at the door and I would have potentially listened to this, and so that's just true.
Speaker 1:When I think about what well looks like and this is what I'd like to propose to you there are some things that are very, very palpable, logical, paintable, and I'm going to put the big dog on the table. No more, and I'm going to resist the allure of using the F word here no more cravings. So anybody that doesn't understand what addiction is they likely don't understand this concept of cravings. I'm proposing that this is this is this is to set you up to swing at this one, john. But when I got over those cravings, uh, it was huge and that seemed to pop. Not only did that seem impossible, I couldn't even get my head around it. The logic of it didn't make sense. Like I've used this metaphor before, it's like living next to a waterfall. I only know that sound, that's what I know, and that that could be turned off, and suddenly I've got a different thing going here. But man, that's the big dog to me and it doesn't. So take me where you want to take me on that deal.
Speaker 2:No, you're right. I think I've heard that many, many times. When someone literally woke up and, for the first time in 10 years, didn't have a compulsion to drink or use, at that point they felt free, they felt hopeful, they felt well because they didn't have the compulsion, the preoccupation, those thoughts didn't dictate their entire day, week, months, years. What I'm going to drink again, how am I going to drink? How am I going to hide it? What am I going to lie about? Am I only going to drink Tuesday and Thursday this week, but the game's on Sunday? Am I going to be able to negotiate with my wife that I told her I wasn't going to drink on the weekend? But damn it. This weekend's going to be able to negotiate with my wife that I told her I wasn't going to drink on the weekend, but damn it. This weekend is going to be different. We're going to have a discussion and I'm going to set my limit at six beers. And damn it, because I'll tell you when you drink and use if you're inflicted. It's a big boom. It's a shift that no one has, because we're chasing homeostasis in a different way than everybody else and no one's going to understand what we're doing. But we seem to think we know where we're going. We don't. And then we start to resent those people that say hey, brett, you said you weren't going to drink on Saturday. Well, honey, the Mariners are on and I didn't know they were playing. Well, I'll only drink four. That's all compulsion, that's all preoccupation, that's all cravings. Cravings don't last very long and what I tell people is those cravings, as we live life, can also be correlated and associated with things that happened to us 15 years ago, 20 years ago, and it's a reminder. Now I got to drink and it's a reminder Now I got to use which is why I think opioid treatment programs and MOUD, suboxone, naltrexone.
Speaker 2:The positive outcomes within those programs are unbelievable because they're taking medicine to alleviate what you just depicted. They're not having those intense cravings anymore. They're not waking up every day with a $200 a day habit, not knowing what they're going to do. They're able to take medicine and get stable, continue down their road to recovery. They can be dads and moms and employees and colleagues. We still have people thumbing their nose at those types of programs. Well, correct me if I'm wrong, but most diseases and things that people get when they get sick, they take medicine. With this thing it's like, well, you can take medicine but you're not really clean. Yeah, but they're alive and now we have time.
Speaker 2:So I've shifted my thought process over the last 10 years that we need to really take a look at that, that the addicts and alcoholics that come to us to get the medicine stay clean and sober and the ones that don't don't. To me that drives home the disease model of addiction. They are getting pharmaceutical help in the form of methadone or bupe or whatever it may be I go talk to. And number two we have probably the most brilliant addictionologist working here that I've ever met, and I worked at Vanderbilt, which says something. Dr Jillian Zuckerman is probably not probably she's the best addictionologist I've ever been around, and it's because she understands this stuff on a level that very few people do, because she understands this stuff on a level that very few people do, that you need something to stop that cycle of crave, that cycle of preoccupation. Or they're either going to die, get arrested, end up in an institution or we'll never see them again. And the example she's setting in Yakima should be the example that everyone follows in terms of how you treat people. And I follow her lead on anything MOUD, because she's brilliant and I agree with her that medicine helps this disease and we're so fearful of it outside of, like OTP centers and mobile medication units. Mobile medication units we have a big enough sample size now that I mean opioids have an 88% relapse rate.
Speaker 2:Folks on methadone and suboxone that decreases substantially and then they garner hope because they don't feel terrible, they're able to go do productive things, they're able to reconnect with their children. I mean, people have this misnomer that if you take methadone you walk around with a zombie. The reality is you don't even know people are on it. So we have this subset population that gets this service that stays clean and sober and I don't know. Hazleton today may have 300 people in it and 10 will make it a year. So I think we need to look at maybe marrying those two things too. Mortality rates are decreasing because of MOUD. Communities are getting better because of it.
Speaker 2:People that historically are dying aren't if they get into these types of services. But I've become super passionate about this because I see the outcomes every day and we see them come in broken and fearful and near death and to your point. When we can just decrease the cravings and the preoccupation. You're going to look at this thing differently because now you're not as sick and with a lot of this, from my perspective, medicine could help probably anything in this regard to just give people the chance to stabilize and talk about the things that led them there. And that's a really hard conversation to have if you're in session with somebody that just wants to drink. So I don't know if that answered your question, but we have to look at that differently now because it's helping so many people.
Speaker 2:It's not the easy way out. They still have to do work but they're not dying. If they're on methadone they're not dying. If they're on suboxone they're not dying. If they get sublocate injections, they're just not. And, remarkably enough, with people like Dr Zuckerman, they're getting better.
Speaker 2:And in that program we're talking about probably the hardest drug to stop, certainly not the most dangerous. It's treacherous the physical withdrawal symptoms, the emotional which, everything. So I think my experience at vanderbilt in that regard, because all of the women were on suboxone, the engagement rates were through the roof because they they felt okay think. I think we need to take a good hard look at all inpatient treatment centers and see, man, if we medicated people just enough to alleviate that preoccupation. How much better would the results be. I don't know if we'll ever get there because it's such a controversial thing and I don't know why it's disheartening, because at this stage in the game I think we know enough about this thing that medicine works and it can buy that guy that has no hope. Enough time to get in front of somebody that they can make a connection with, that can may move the needle, and to me that thread needs to be pulled early.
Speaker 1:Man. So much in that. So the first time I became aware of medicine M-O-U-D. Define that real quick for our listeners.
Speaker 2:Medicine for opioid use disorder.
Speaker 1:Yeah, the first time I heard about these drugs that could curb cravings was I was going to a regular AA meeting and I had I would. I like to go have breakfast with people. I found that being around people that can understand what it's like is useful to me, and I think it's. I think that's a really really cool thing and most of us are kind of cool. So I'm just, you know it's like. You know it's like you think these are going to be a bunch of. You know they're your people. If you're listening to this, they're your people. We're in there, we're laughing and stuff, and and we're we're experiencing life together.
Speaker 1:Anyway, I like this guy and I had breakfast with him and he was a helicopter pilot for the military and he let me know that his treatment program they required him to be on and that was the first time I'd heard of it and I was like how is it possible? I've been sober five years and I've never heard of this? I think it's. Is it naltrexone for alcohol? Well, I thought, well, that would be good. So, alcohol, I thought, well, that would be good. So, so and and anytime I get somebody who's comes to me and they're early, I always say make, get your, get your physician on board. You need a team and I'm just a knucklehead, you know but get your your primary physician to at least have a conversation about that and they and they can advise you. I'm not going to advise you, but I've done that. I've seen a few people use it and it was super useful to them, 100%.
Speaker 2:Yeah, it works. It just does, and I don't know why we're so resistant.
Speaker 1:Yeah, well, and that's, and that's when I look at this and and you know, we're, we're, we're wading into some waters that you know it's going to get some people's backs up and I'll just be that, I'll be that voice for right now. You know you're just empowering, you're just enabling them. You're changing from one drug to another. They're still high. These are the things that people think and say right, do you want to speak to any of that? Because there's probably plenty there.
Speaker 2:It's well. Number one, you're absolutely right. It's said often and again I think it's just a philosophical indifference, which is okay. Everyone's kind of entitled to their own opinion about this. But for those of us that have had a front row seat for a long, long, long, long time, we're kind of tired of the old way not working With other ailments mental health issues, physical ailments, whatever it can be.
Speaker 2:New things, new treatments come into the marketplace often, or whatever. Acid reflux or depression or heart, I mean, it's standard, it's always continuous improvement, it's always what can we find better? And we throw massive amounts of capital at these things and really with the hope that they can maybe take some medicine that will keep them alive or include you. You're not really clean and sober. You're just switching from one drug to another. You're not doing it the way everyone else did it, which is not only illogical but again I think it's dangerous, because for some folks there's not another alternative and that part of it isn't looked at enough from just the folks that don't know enough about it. We have folks that come into our opioid treatment program, that have been to treatment a dozen times, that just they're super acute and they can't stop, and they know more about addiction than me. I mean, they've sat in all the rooms and they've gotten all the curriculum and they've had 30 or 60 days and all of that, and then they get out and not much is different, right? So I would tell the person that says that, yeah, you can own that opinion, but I'm of the thought that I kind of don't want that person to die and that's probably the next step for that person. They've proven that treatment doesn't work. Traditional treatment doesn't work, for whatever reason that they can't string a bunch of sobriety together. They really don't know what recovery looks like, being told all the things that you have and what you're going to have to do to fix it, all the while, again, all those traumatic experiences that you suffered prior that led you there are very rarely addressed.
Speaker 2:But now we have all this great medication that we can give to people under those circumstances that meet criteria that can really alleviate those thoughts. And now all that does is provide us a little time to get in front of that person and do real work. Now they're going to absorb this stuff. Now they're not going to have one foot here and one foot out there. They're not going to feel like a failure because the first time in 20 years, they actually don't crave alcohol. Do you know how big of a deal that is? Like that's a huge deal. But that thought is, I think, why we're in the situation we're in, why stigma is still so high and why it's now a political issue and blame game. And all of this Medication works.
Speaker 2:And if it's going to help an addict or alcoholic stay alive, I don't really care what you think. If you don't think that that person would benefit, when you know that that person's probably going to die, I think you need to take a good long hard look at your motives. Why are you doing what you're doing? Number two really our thoughts and feelings about this individually shouldn't come into the clinical space anyway. It's what will that person benefit most from and at that point, what are we going to do next?
Speaker 2:And medication we see it all the time downstairs here. People come in, they get started on methadone, suboxone and I will tell you, their life dramatically improves. That's not cheating, that's not taking the easy way out. They still have to carry and harbor all the experiences that the other guy has. Unfortunately, they're just addicted to a drug that's going to kill them, and I think it's important to note. Alcohol is going to kill way more people this year than fentanyl, and it's really not even close. So if we can institute a medication to save that guy's life, then, man, I think we have a duty to really take a good long hard. Look at how that, why that's the wrong thing to do If that makes sense.
Speaker 1:A thousand percent and I and I just a little plug. I don't know if you know this, but Dr Zuckerman has been on my podcast. She has an episode. So big plug for her, that episode, and for your, your, your group. So if somebody in Yakima or you're all over the East, washington, right.
Speaker 1:Ellensburg, sunnyside, yakima Walla, walla yeah we're all over, yeah, and I think we've done a good job here. I'd like to think that what we've just this conversation we've had has made it the complexity that's appropriate. And then I'm going to throw one more thing at you, and then you take us out the door. How's that sound?
Speaker 2:Yeah, absolutely, if you're done with me.
Speaker 1:So, when we think about wellness and I just shared one of the things that I think is true, especially somebody early on, and we explored the pharmaceuticals that are available to help with that big one the truth is my truth, and I think you're going to concur and add something to it is this thing is incurable, that I have, and it's chronic, just like a lot of other diseases, and so, in my case, though, it seems impossible to me right now that I would potentially return to that oblivion. I hang around with enough people that do this. I put on my lucky socks, john, I hear you. I hang around with enough people that do this. I put on my lucky socks, john, I put on my lucky socks. I do things that I've done for years, and I don't really think about it too much because I have to be in recovery.
Speaker 1:So somebody that's new to this is thinking well, wellness, and here's the thing. It seemed like a Grand Canyon. It really wasn't. I got over the Grand Canyon, and now that I'm there, I do things to protect my recovery, because I've seen enough examples of one swig of beer and I don't know what happens, right. So that seems like because I'd like to leave with some hope, like I'd love to leave with this idea that we're not worth being cast aside. There's a lot of us and a lot of us don't even speak about it because of the shame and stigma in society. I'm one of these loudmouths, so hopefully that maybe helps somebody that it is possible, john, over to you.
Speaker 2:It's absolutely possible. I think what I would say to all your listeners who ever may listen to this moving forward is we need to stop that behavior. We need to wrap our arms around this population. We need to support them. We need to increase access. We have to stop judging. We have to stop stigmatizing. That's the worst thing you can do to an addict. It sometimes can be the final nail. We really need to take a good long hard look at why we feel this way about them anyway, when I say they just society in general, why we think they're less than because they're inflicted, and really what gives you the right to treat them differently because they're inflicted? We have to stop the nonsense.
Speaker 2:I thought at this point fentanyl may sway some of that, but it really hasn't. I think fentanyl has been a huge strain on the healthcare system and people are really scared because we can't keep up. But the stigma is still there, the marginalization is still there and to me, my great fear is is what is it going to take for folks to really give this group a break in terms of they deserve to get better and heal just like everybody else? Er should welcome them with open arms If they come and reach out for help, be empathetic. Don't be judgmental If they suffer from a co-occurring disorder and they present really acutely on the mental health side. Don't treat them differently, don't browbeat them, don't marginalize them. They want to get better and to me, we can talk and talk and talk about again evidence-based practices and techniques and treatment centers and philosophy, but until we start treating these folks like human beings, I think the fight is going to go on and on and on. So I just encourage everybody if you know an addict, alcoholic, or you love an addict or alcoholic, I think we have a duty to lead by example and treat them like they're good people, because they are. They aren't what they have. Yes, we do some really silly things when we're practicing and unfortunately, some people do some things that they can't come back from. But all in all, if you continue to put one foot in front of the other, someone's going to step up and support you. But it has to be the collective and I think we need to shrink this philosophical indifference and gap to really cast a wide net of hope for these folks, not rambling or on a soapbox, but like we really have to step on a step up our game as people and as fellow human beings and wrap our arms around these folks, because that's what's going to change things. It's. It's not fancy treatment centers, it's. It's. It's not that because they're, that's the easy part, and I hope people don't take this the wrong way.
Speaker 2:But inpatient treatment isn't terribly difficult. You're told what to do, you're told where to go, you have plenty of support. You're in a bubble for 30 or 60 days. The focus is on you. The work starts the day you leave and if you think you're entering a society where you're going to be stigmatized and you can't speak freely about the disease you suffer from, to me that's where people start getting that preoccupation back and we can't have people living in fear to share about their experience or be fearful to tell people yeah, I'm an alcoholic and I'm a proud alcoholic. Yeah, I'm sober today. I can't talk about tomorrow because that's really unhealthy for me. I don't really feel comfortable talking even about what 11 o'clock is going to bring and you're not going to understand that. But I'm an alcoholic.
Speaker 2:People don't have that freedom. Like you and your group, I think you really have to be intentional with who you seek out and who you bring into your circle. But some of the folks that we work with, they don't have those people. They don't have a car, they don't have family, they don't have homes. You know what they deserve. This, too, they all do. So let's figure out how we can sort of be lockstep with helping everybody that suffers, not just the people that can afford it, not just the people that have good health insurance, not just the people that can pay for these long stays. I think we have a duty to help all of them, and if we attack it with that vigor, I think we'll make an impact, because they deserve it.