Bridging the Gaps: Reimagining Opioid Recovery
A podcast where we confront disparities, challenge outdated approaches, and reimagine a future where opioid addiction treatment is equitable, accessible, and effective for all communities."
Bridging the Gaps: Reimagining Opioid Recovery
Navigating Harm Reduction, Healing, and Trauma
The narrative surrounding opioid recovery is changing, moving toward a more compassionate and understanding approach that prioritizes harm reduction over abstinence. Join us as we explore the complexities of addiction, trauma, and healing with experts in the field who share their firsthand experiences and insights. In this engaging episode, host Joanna Rosa leads a heartfelt discussion with a panel of harm reduction specialists, counselors, and community advocates. Together, they unpack the stigma that often surrounds addiction and emphasize the importance of building trust and empathy in treatment.
Listeners will gain valuable insights into how trauma impacts not only the individual struggling with substance use but also their families and communities. The discussion reveals how addressing these underlying trauma narratives can facilitate better recovery outcomes. We explore how cultural differences play a pivotal role in shaping responses to treatment and emphasize that understanding an individual's story is crucial in meeting their unique needs.
Reframing the traditional views on addiction treatment, this episode encourages listeners to embrace a person-centered approach rooted in empathy and compassion. We challenge the outdated narratives that prescribe an all-or-nothing mentality around recovery. With powerful stories and professional insights, our guests illustrate the transformative potential of harm reduction strategies in creating inclusive and effective recovery pathways.
As you listen, we encourage you to reflect on your perceptions of addiction and consider how you can contribute to reducing stigma within your own circles. Join us in this vital conversation about rebuilding lives and healing communities. Don’t forget to subscribe, share your thoughts, and leave a review!
Welcome to Bridging the Gaps Reimagining Opioid Recovery, the podcast where we confront disparities, challenge outdated approaches and reimagine a future where opioid addiction treatment is equitable, accessible and effective for all communities. This is Joanna Rosa, a dual licensed therapist, and I'm interested in chatting with community members about the intersections of well-being, recovery and living our daily lives. On today's episode, we'll be talking about harm reduction. In a world that often thrives on shame and judgment, we want to shift the conversation towards empathy, understanding and healing. We'll explore how these harmful cycles can perpetuate systemic disparities and why it's crucial to create spaces that not only educate but also empower people to break free from cycles of harm.
Speaker 1:This episode is about dismantling harmful stigmas and offering a new lens, one that fosters growth, healing and true social change. Stay with us as we challenge old narratives and work towards a more just future. Joining us in the discussion is Mr Sam Simmons from Sam Simmons Consulting, dr Koo Pham from Cook Community Clinic in the Phillips neighborhood, ian McLoone, co-founder of Expanse Minnesota, and Bobby Gass from the Red Door Clinic. Hi everyone, thanks for joining us today on Bridging the Gaps, and Bobby Gass from the Red Door Clinic. Hi everyone, thanks for joining us today on Bridging the Gaps, reimagining Opioid Recovery. Would love to start with a roundtable of introductions.
Speaker 2:Tell us who you are and what you do in community. My name is Ian McClune, I'm a LPCC, ladc, and I have a clinic called Expanse Minnesota, and we've got a couple locations one in Minneapolis and one in Spring Lake Park where we do harm, reduction-oriented addiction, psychiatry, psychotherapy and a novel form of psychedelic psychotherapy, and then I work with folks in individual therapy as well Cool.
Speaker 3:Thank you. Hi, I'm Bobby Gass she her pronouns. I work at Red Door Clinic downtown Minneapolis. I'm the lead harm reduction specialist there. At our harm reduction program we also offer medication for opioid use disorder like Suboxone, and I've been working in harm reduction professionally and in community for the last 13 years.
Speaker 4:Good morning everyone. My name is Koo Pham. I'm a physician. I work at the University of Minnesota and also at Koo Clinic, which is a community health center. In a Phillips neighborhood clinic I take care of a variety of different folks. A lot of my patients do have use disorders, so I do addiction medicine and then hoping to do a little bit more telemedicine mobile health care coming in the coming future.
Speaker 5:I'm Sam Simmons and I am a behavioral consultant and licensed chemical dependency counselor, currently semi-retired, so I only do training and lectures at this time. I have a background in chronic pain as well and I specialize in dealing with trauma around issues with men, black men in particular.
Speaker 1:Wow, thank you. So tell us, how did you get started in harm reduction?
Speaker 3:I started in harm reduction at a non formerly known as the Minnesota AIDS Project, and it just made sense to me when it was kind of explained to me, because it's about meeting people where they're at and not coming in with any judgment, just compassion and love honestly, and I got to see firsthand kind of the transformative impact that that approach has on people's lives and I just got followed that way ever since.
Speaker 1:Nice Sam, what about you?
Speaker 5:Well, I mean, when we talk about harm reduction, I'm probably not as active and have never really been that active, because it doesn't fit. Hasn't fit that well in the Black community. We've just started to talk about harm reduction in the Black community within recent years. But I can, when we talk, I'll talk more about why that I think I believe, why it's been a little bit more difficult to do in the black community over these years.
Speaker 1:Yeah, Thank you. That's an important point to bring up, yeah.
Speaker 4:Yeah, I actually want to recenter the idea of harm reduction, because when I practice harm reduction, it's part of my primary care practice and I think what we I see harm reduction is being patient centered and community centered, not the idea that we are only meeting them where they're at, but really understanding their story too and being adaptable and flexible to that story, because the world changes and it's hard for a lot of folks. But if I'm able to listen to a person's story, then I can really work with that person and really take care of them to the core of what their philosophy of life is. And so when we talk about different racial groups or marginalized populations, I might come to a place of thinking this is the way I should do a treatment. This is what I learned in the books, but it's different for each individual because they have such different barriers or ways to celebrate and have joy in their life too. So I try to reconnect with people around. Harm reduction I really talk about that's just a good care for people.
Speaker 2:Yeah, 100%, I totally agree. I think we don't consider blood pressure treatment, harm reduction, we don't talk about insulin for diabetes as harm reduction, it's just care right. But we also don't approach those diseases or illnesses with kind of an all or nothing approach. You're either perfect, in which case the treatment's working, or you're failing, and it's all because of you. And so, yeah, I too I think I came into the field with a pretty, I think, experiential bias towards 12-step recovery and kind of just only knew about that.
Speaker 2:And then I entered grad school and one of my first courses was with my now friend and mentor and business partner, paula DeSanto, and she taught this kind of really loving, person-centered model of meeting people where they're at, not dictating the goals as they must be coming in the door, or even requiring total abstinence as a starting point for entering treatment. But you know, coming up alongside a client, figuring out what is important to them and helping them dictate the goals that they want to achieve, and in that way, I don't. You know, it's kind of disappointing that we have this split between harm reduction and the rest of care that you know it exists in addiction world but it doesn't really exist in any other branch of medicine.
Speaker 3:Yeah, I'd like to add on all this that my introduction to harm reduction came through a sexual health lens, and so, you know, when I'm out in community testing people for HIV and just interviewing them about their sexual habits, sexual behavior I want to find out what their self-directed goals are around sex and safer sex or just staying healthy, and then my only job is to help them meet their self-directed goals and, like others have said, it's about listening to their story, centering the patient, and not I don't know what's best for them. They do, and so how can I help them reach their goals as safely as possible, and that is harm reduction to me, yeah.
Speaker 1:Could we talk about the all or nothing that split, that dichotomy between harm reduction and abstinence? What are you seeing in your work with that all or nothing?
Speaker 2:as a field as people, to impose or impress upon people an idea that they're either perfect and everything's great or they're failing. You know, there's this concept called the abstinence violation effect, right, it's this idea that somebody maybe somebody's you know quitting smoking or quitting doing dope and they're counting their days, they're feeling really good, Things are moving along well, and then something happens. Whatever, they have a bad day or they just decide they want to hang out with some people who are using, and then they use a little bit, and then this idea of like, oh shit, now I've messed up the way and have a big, big, you know, much bigger episode than use episode than they otherwise might, and I think that you know that really is common. My approach is certainly to use those experiences as an opportunity to learn, to find out what happened, what went wrong, and not beat yourself up just because you weren't perfect.
Speaker 1:Yeah, absolutely Sam.
Speaker 5:Culturally in our community. Our response to especially chemical use and some other things is all or nothing.
Speaker 1:So that whole idea of harm reduction you know, because I've been in the field for over 30 years.
Speaker 5:So I remember when harm reduction was only at like one program in Minnesota and that was over on Nicollet Avenue and I forget the name of the program that existed at that time and it was primarily white middle class folks, right. And when you think about our community, especially because parts of our community have a high religiosity and very judgmental and so that whole idea of not staying clean, it gets judged and folks outside the community don't always understand that it might say you know pressure. Well, it shouldn't be that way, that kind of thing. One of the reasons I stopped practicing is that because you know in our community we have a lot of you know everybody can relapse, but relapse was high with that population and my view of why that was high is we weren't talking about trauma, right, and our community, different levels of our community, our whole existence in America has been based around trauma and so we don't incorporate the trauma in our culture so much that we don't even know between trauma and non-trauma.
Speaker 5:So you get me sober Now. I got to deal with all this stuff in terms of what I was medicating, because medicating yourself is high, a major part of chemical use in our community. I remember my dad had problems with alcohol but I used to watch him come from work and you got this 46-year-old man working at a factory got a 21-year-old white boy calling him boy all day. He can't afford to lose his job. He comes home and if he didn't get his Budweiser when he got home it was hell to pay.
Speaker 5:Okay, so we can talk about chemicals, but when we talk about addiction in the community, especially if you attach it to trauma, it also is alcohol, drugs and food. All three of those areas are very major health issues we're down to diabetes and you know and food issues and issues around trying to manage your emotions in terms of alcohol use, and we can look at violence and that kind of stuff and having a community that's fairly in parts of the black community that those problems are not. Nobody really cares about those problems unless they seep out of the community. Okay, and so that attitude, so the seed that now in our community we're talking about harm reduction is a plus, but still if we're not really trying to address that overall historical trauma, racial trauma, you know young kids who out here hurting folks and stuff will talk about when we get home, we go back and drink and we think about because later on.
Speaker 5:They feel the guilt right and see violence is actually a drug in itself as well. Okay, so I commit to violence. Later on I started thinking about that. Now I got to you know.
Speaker 1:I got to use some chemical to deal with that, that guilt that's left in me.
Speaker 5:And so you know I could go a minute but I'm not. But that's where I'm at at this particular point.
Speaker 4:I mean that makes so much sense because the issues that people face is more than just on and off Right, it's more than black and white, it's not a light switch and it's so nuanced right. And I think in the medical field what we do is we do these studies and we say success, failure, success failure, and put these in two groups. But there's so much in between, right. And then I'm asking for people to do the success, what I view as success, when that person just maybe they just want to be happy for whatever they're experiencing in life and being nuanced is important for me to really understand what their trauma they're experiencing, if they have a home, if they have access to food, all these things they're trying to do just to cope with life in general, just to survive. Then I'm saying to them it's like, hey, if you're using drugs done, I can't take care of you, you don't get it. It's way more complicated than that.
Speaker 1:Absolutely. I saw a lot of head shaking when Sam was talking.
Speaker 2:What came up for you. Well, one thing I'd love to talk about, or ask everybody about, is I've been kind of um, my paradigm has shifted a little bit. Uh, thanks in in no small part to um Dr Carl Hart's most recent book, Drug Use for Grownups, where he makes the point, I think is really salient, that the urge to alter our consciousness, the desire to get high, is innately human Right in an endeavor, the you know we've been altering our consciousness since probably before civilization existed, and you know so, for you know, probably hundreds of thousands of years. And and to me that's kind of a foundational aspect of harm reduction is getting away from the judgment of substance use as bad. Now, obviously, the folks that we serve, their substance use has gotten, their relationship with substances has gotten to a point that it is causing harm, to a point that it is causing harm. But it's something I go back to often in that you know it's not inherently wrong to want to and to enjoy getting high.
Speaker 5:I agree, and so when I used to do more treatment, I would tell folks that when I used to use cocaine, I enjoyed using cocaine and my coworkers would start frowning. I can't believe you said that in front of clients Because it's real. Okay, I liked getting high. The only problem I had with getting high was the consequences. Right, eventually the consequences caught up, otherwise I would have stayed high because, you know, like I said, I like it. Okay, so, being real, and that's you know, because I would say those kind of things with clients, you know they gravitated towards me a lot of times, which was a problem Because we can talk all day about the actual folks doing the work and their attitudes in terms of how they deal with clients and how they deal with clients from different backgrounds. Or, you know, I enjoy hearing folks say listen to where they're from, but also being able to listen to them from and also understand that. You might not understand, right, you know so, but yeah, that's enough.
Speaker 3:I appreciate you bringing up trauma as being such a huge part of drug use, especially in the Black community and communities of color.
Speaker 3:Every day I work with primarily Black, brown and Indigenous clients the vast majority are living outside and indigenous clients the vast majority are living outside, and so they are experiencing many overlapping traumas, from historical generational trauma to the trauma of living outside, trauma with law enforcement being rejected by family, and it takes a lot for someone experiencing all that to even come into a clinic, because then there's medical trauma as well, and so many people who use drugs are shamed in medical settings, let alone someone who's living outside. People just don't want those kinds of people in their business. So really what my approach and the approach of my team is to start by trying to heal trauma just on an individual, personal, relational level. You know, the first thing when I see someone is to welcome them onto my couch, offer them some hot coffee or some water and some snacks and just start there, and I think that taking the time to build a relationship and trust and try to heal some of that relational trauma or trauma with the medical system goes a long ways.
Speaker 1:I appreciate everyone speaking to the fact that there's three themes that I'm hearing right, we have judgment, shame and trauma, and so part of this podcast's responsibility is to talk about that from a cultural perspective, right, because we really wanted to focus on what are the experiences that not only us as practitioners but our audience can take away from in having a different awareness of how other cultures experience substance use. Can we talk about the trauma a little bit? Because, sam, you brought that up earlier and I think for me what was sitting there is that, yes, there is this cultural trauma that's happened, this generational pattern that we've taken and that's calcified like as culture, right?
Speaker 5:Well, you know, like I said, my current work that I'm probably more known for is my work around trauma, but typically with Black men in the Black community, partially because, you know, we focus on systems. Systems are raggedy. Okay, they're going to be raggedy. They're going to be raggedy now and they're going to be raggedy later on. My focus is okay, so we'll give that a given, but how do you deal with the trauma in your life and how does that show up and how does that show up in your personality? So, if we talk about African-American trauma, and I'm real clear.
Speaker 5:I'm really focused on African-American trauma, of African African Americans who have American slavery in their background and see and it's something that neither folks in the community or outside the community are that comfortable with because it makes folks uncomfortable, which is, you know, being uncomfortable is not a problem, but if I'm going out my way to make you uncomfortable, to make myself feel good, that's abuse right. But feeling uncomfortable is not a reason not to listen to people and not to hear their piece. A lot of the clients I deal with have no clue on what trauma is, Because we've been living trauma.
Speaker 3:Then think about this 246 years of slavery.
Speaker 5:Then they say you're free. What are your example? Your example is the perpetrator. So I try to imitate the perpetrator, try to outdo the perpetrator, incorrect at this particular time, and I really don't care. But the issue comes down to is my existence has been how do I navigate trauma Over time. What we get credit for being resilient, which I have a problem with, because nobody's supposed to be resilient for no, 460 years and not learn how to thrive. And you can't thrive when you continually do the same behaviors. Okay, but those behaviors had a place, you know. Give you an example.
Speaker 5:We talk about soul food. Soul food is a trauma response. We took whatever was given, we made it taste good, we made it good and then folks say well, if you're going to be healthy, you got to give it up. And the first response we get is now you took something else from us, not, not, can't see past the fact that maybe you might need to modify that. Maybe this understand what that's from. So some of what we call culture is nothing but a trauma response. You know it's like why are we so parts of our community, so high on what we wear and how we're seen? Is because we don't learn a surface response to being here in America. All we know is when we watch the perpetrator, we try to imitate them, do everything, keep our kids in order so they don't. And then I have to raise my kids in fear, and then I get questioned about that at the same time. So I don't understand.
Speaker 5:And so if I don't understand, my trauma is one of the things about the clients once we get them to understand what trauma is, and that being black doesn't mean you've got to be traumatized, because sometimes we'll say you're not black enough if you have it too easy. And so we don't incorporate it, and it's out of emotional survival. We don't incorporate the trauma into our lives and build our lives around the trauma of living in America that keeps popping back up. Okay, and so that's the internal, so how?
Speaker 5:does that trauma affect my relationships, my relationship with my family, my relationship with the community, how I see myself overall and my relationship, most of all, with myself and chemicals? And see, and I don't just stay focused on chemicals, because all of it's very destructive Chemicals, violence, food Okay, it's the gratification of any type. So narrowing it down with just the chemical piece has really been one of the things I stepped back from, because even when I was doing work, I was doing work right around the edge of the crack era which we haven't recovered from, by the way, okay, of the crack era which we haven't recovered from, by the way, okay. And in that whole thing around that crack era is, how does that show up in family?
Speaker 1:and community and it still shows up Right.
Speaker 5:And how does that show up in my relationships with each other, my relationship with my kids, my relationship with myself? Right? And think it's you know this is the way we do things, but that's where the power is at With you. You know we can stay focused on systems. But it's good to stay focused on systems because then I don't have to be accountable systems because then I don't have to be accountable.
Speaker 5:It's always good to be focused on something you have no control over, because then you don't have to change and you don't have to look, and then our inability and I'm going to make this statement and move on is that one of our biggest addictions, I believe in the Black community, is codependency, even more so than even chemical dependency, our inability to disconnect when we need to. That's disconnect from family, because family won't let us. If you start being sober, your family will turn on you and I know that's in other cultures. But I'm real clear I'm pro-Black, not anti-anything. Okay, it's like, oh God, you talk about Black people, well, what am I? I'm a-black, not anti-anything. Okay, it's like, oh God, you talk about black people, well, what am I?
Speaker 5:I'm a black man and so everybody else gets to talk about their own people and have no question. So even when I try to do what's right, then you got to question what I try to do, what's right. So you know, that's why I come off as the grouchy old man, because I don't care, because you know, again, that whole piece around, what does that look like in normal, in my environment? And the one thing I was going to say because I almost forgot, because I'm old and then I'm old is I learned about that, you know, when I was doing treatment in the 90s or late, early 2000s, young men be sent to treatment. They didn't have no chemical problem, they just went, they just used the system, so they didn't go to jail. You know what they had a problem with? They were addicted to drug selling. Being a drug dealer is a personality and it is a position in the community.
Speaker 1:You know when I was selling drugs.
Speaker 5:I was uncle big when I wasn't selling drugs, I was just in the street. Okay, now I'm somebody, I'm big. Walk in the club, everybody moves sam. Walk in the club. Folks tell me get out. So that whole feeling important, any means necessary is another addiction in itself.
Speaker 4:Yeah, gosh, I'm processing what all you're saying, sam. That's a lot. Now, as you were speaking, I was thinking about the refugee community that I take care of and how they see trauma, and then the multi-generational parts of this too, from elders to the youth, the youth living in a very different environment from their traditional home, yes, and how shame really is part of their, their trauma issues too, and the kids aren't able to talk about what they're feeling, and so what they're coping is using drugs, right, and often it's not even for them getting high, they're just wanting to get away from all the hard stuff they're experiencing. But they can't share that with their elders because they feel so shameful about it and often, as a provider, that may not be part of their culture. I can't understand those pieces and I struggle to hear about those stories. And so, as you're talking about the story of the drug dealer and the power differential of that and what that means for folks, gosh, that was powerful for you to share?
Speaker 1:Can we talk about the cycle between shame and addiction? Because that's another piece that I'm seeing and in my work I've seen people use shame as a mechanism right for change or punishment, penalizing, and I've known individuals who've gone through treatment where they were penalized for relapse. They were penalized for not showing up in that space. In a certain way they were penalized using like behavior contracts, attendance contracts, increased time if you're not following quote, unquote the rules. So I want to call that out there too, because, sam, you bring up a great point about. There is a cultural way we show up as Black people, yet in those spaces you can't be that.
Speaker 5:Well, you can't be that even within the community, though, see, my focus is really more so. How do we have to show up in the community on top of how we have to show up outside the community? Right, and both of them are very different. You know in how we have to show up for that right, and both of them are very different. You know in how we have to show up for that right. And you talk about shame.
Speaker 5:Shame has been used to keep us in order ever since the beginning, and we even use shame in terms of how we punish each other within the community big time, because when you're a people from the beginning to being told that you were less than and that you don't deserve anything, and then all the pictures show you as raggedy and dirty and you have been a vital part of building what we call to be America on your back, and then then, on top of that, then, watching immigrants come in immigrants come in right and appear in our appearance seem like they're doing better than we have, since we and we've been here longer brings up a whole, nother unnecessary problem, right, and I'm glad when you brought up the thing about immigrants I've worked in this immigrant.
Speaker 5:They come with a trauma, right, and then you've got the trauma of being here. But the other piece is is one of the things I want to bring up to immigrants is being real clear that when we're talking about African-Americans, we have to be real clear. An African immigrant is very different than an African-American. Okay, an African immigrant came to America with a plan.
Speaker 5:Nobody comes to America with a plan to be a slave, right, and so when you come with a plan, there's certain things you can ignore that I'm not emotionally able to ignore Because in my gut, my gut and soul, historical gut and soul, is still waiting for America to tell me they're sorry and it ain't happening, okay. We're still waiting for them to say they're sorry and it ain't happening, okay. We're still waiting for them to say they're sorry. You know, it's just like being in any kind of perpetrator, victim situation when you grow up in a child, a family where you've got an abusive father right, and over time some of us just start imitating the father because we think that's the best thing to do. And over time some of us just start imitating the father because we think that's the best thing to do. And then you imitate that and then you tell your young people that they've got to be three times better than your white counterpart to be successful. And then, when you are successful, then that counterpart. Now you've got to deal with the curse of excellence because the counterpart can't stand you being excellent. Okay, so now you've got this new generation, which what I call I have to deal with triple consciousness, and what we mean by triple consciousness. Double consciousness is how I have to show up in the white community versus how I show up at home, triple consciousness is how I show up in the white community and how I have to show up differently in different black communities.
Speaker 5:And we want to be surprised why we see an increase in suicide in our young people in the black community, which has been unheard of in the past. Right, because the pressure we put on our kids to to be successful, because we raise our kids in fear, we raise our kids in fear. We raise our kids in fear when you worry about your child walking out the door if they're going to make it back either. It'd be one thing if you probably was worrying about, if you depend on your community, worrying about the gangs, but then you got to worry about the legal gang at the same time. So I mean so the whole thing about how do I work that, how do I be black enough, how do all those pieces? Because I've seen folks who, young people who want to go out and do something different and be ostracized by their community because they want to do something different, because it ain't black enough.
Speaker 5:And all that internal stuff is real important and then, like I said, that whole codependency not being willing to disconnect, ok, and then, on top of that, not being able to actually learn how to forgive. What's surprising to me is, being a black community, we are some of the most unforgiving people in the world. I know I shouldn't say the world, because that's too much To be as religious as we are. Some of the most unforgiving people in the world. I know I shouldn't say the world, because that's too much To be as religious as we are.
Speaker 5:And so that also affects in terms of chemical use and recovery and being able to stay sober.
Speaker 3:I'd like to speak to shame and judgment in the treatment, shelter and sober housing spaces in Minnesota. You know we're the land of 10,000 treatment centers, but it's also Minnesota, so it's the land of 10,000, like white treatment centers or at least like white value treatment centers especially. You know there's this belief that to be sober, you know you have to attain to this like standard of respectability, um, and of atonement and all this stuff in society, um, that's very alive and well in our treatment programs and even in our shelters and they, these programs, can't account for cultural differences, um, they can't account for um mental health challenges and you know trauma itself will, can, can manifest in just some some really tough um mental health issues, um, let alone like living outside Um, and they'll kick people out for conforming to this standard of being and then they're back out on the street again and people really just need a warm meal and a warm place to stay and they're trying their best. But there's no flexibility in these programs and, like you're saying, if someone out in the community.
Speaker 3:You know they may be a drug dealer, they may have like a role that gives them power and gives them meaning, or say they're living in an encampment. They have a role, they play in the encampment. They come, they pick up supplies for everyone in the encampment. Everyone's grateful for them. They're not just some homeless person, but when they go into treatment they lose all that. They're just some person who is told to be experiencing a lot of shame. They don't have any of the meaning that they did out in the community and that's, I think, a real problem.
Speaker 2:And the cycle just keeps continuing when people are kicked out from that. There isn't that same barrier to entry of you know you have to be a certain way, you can. You know harm reduction is really about trying to be an oasis from that of acceptance, of love and and uh, connection. That you know, yeah, we, you know, if you have, if you have to be sober to have a bed tonight, that's not uh, that's not unconditional, that is extremely conditional, that's not unconditional, that is extremely conditional.
Speaker 2:Yeah, how can harm reduction address trauma that people are showing up with? You know one one. I think about that a lot and I think about the power of, uh, relationship right, so many of the folks that we serve, that we treat, that we work with, that we try to help, have experienced unimaginable trauma and harm at the hands of another human, another individual, oftentimes at the hand of someone that was supposed to care for them, and so if that is a primary source of your trauma, then to heal that trauma necessarily requires a new human relationship, one that provides a different template for how to see ourselves we. The mind develops in the context of relationships, develops in the context of relationships. I know who I am because I know who my mom saw me as, sees me as right, and so I think that that is a really important aspect of healing trauma through harm reduction. One of many.
Speaker 4:Yeah, I was thinking about when Sam was talking about earlier that often this is a relational kind of stuff is people use together in community and when you remove that person from the community they feel so isolated and alone. They feel like they have to be dragged back into that community again. And as a physician, if I ignore that and I say, hey, I'm going to give you Suboxone here, but ignore all the stuff you're living around, ignore the fact that your community is so important to you, I'm not really addressing their needs. I'm not really approaching this at a harm reduction standpoint. I'm just throwing a Band-Aid at the situation and and so when someone uses and I've given them suboxone, but they want to be with their family so badly because that's the life they've lived, that's the trauma they've just been part of for an entire life, I have to employ harm reduction to understand that piece of their life. How do I have them still be supported by their family and their community and take care of the drug use they no longer want to be part of?
Speaker 5:oh god, um, um. So remember I was talking about the community being kind of codependent or you, you know that kind of thing. One of the biggest things for me in terms of getting clean and dealing with my trauma but getting clean, you know, staying clean was dealing with the isolation. When you're a codependent people, isolation is extremely difficult. So isolation is extremely difficult and you think, you, you know, it's almost like people talk about how you feel, like your body is hurting and you're feeling all this in your body because you're so emotionally attached to this person for various reasons. Right, being attached to this person allows me to feel empowered, or feel powerful Not empowered but powerful or being attached with this person allows me to be a professional victim, and so once.
Speaker 5:I was able to learn how to be without was the reason I was able to stay sober. Okay, again, we're talking about very codependent people with no boundaries. In our community, parts of our community, there is no boundaries and you have to learn boundaries to be able to stay safe. Right, right and badly when you when all your harm. You know, when I talk to my clients about trauma which this is kind of like unpopular sometime is that I do what I call the trauma, the trauma list.
Speaker 5:You have the system list or, for lack of better words, the white list and you have the black list Right?
Speaker 5:Where have you experienced the most trauma? Once they understand what trauma is, the blacklist is usually longer. And how do you sort that out? How do you work through that? Right, you know the other trauma is big and massive and consistent. But you deal with your community and your family more and if you've got this kind of toxic stuff going in the community, you got to go back to that. You know you talk about being with your family. I remember I used to work with schizophrenics, used to run a three-quarter way house and one of the things I realized with this I hope this connects somehow is that they got to go home on
Speaker 5:holidays and so Thanksgiving you know that holiday time starting with Thanksgiving and Christmas and what I realized is they would make themselves go home and be with their families. And the clients I was dealing with had both chemical issues and schizophrenia or bipolar. And so we're talking about the mix, right, because they don't want to stay on their medications, they'd rather get high. They'd be on their medications. Then when they get high, they get unbalanced and they get in trouble and all this other kind of stuff. And I started realizing they go home, be with their family because that was the thing to do, and come back a wreck. So the next year I said, look, we're going to have a community meeting. This is what I want you to do. I want you to have you ever been invited to somebody else's house for the holiday? They said, yeah, why didn't you go? Well, you know my family. Ok, this is what we're going to do Pick one holiday to go with some friends and then you know if you want to go with your family on the other holiday. Just pick one and then report back. And every time they report back. I had the best time, the best holiday I ever had with these other folks and these kind of things, teaching how, that disconnection because again that neediness is all part of the trauma too, right, and also part of, in my book, the Addiction as well learn how to disconnect from that right. And so when we talk about holding people accountable, so I believe in compassion and accountability. So I don't believe in all this. You know, kumbaya, I don't have time for that right. Never have you know, because it hasn't worked't worked as well with the community that I deal with. We'll kumbaya you to death and resilient you to death. Ok, because even when I started talking about trauma in our community, I would get pushback Well, why are you being so negative? We're resilient people. Yeah, america know that they can do whatever they want to you because you'll you'll, you'll recover from it in some kind of way and be given kudos for being resilient. You're like the Machi of America and so kick in the teeth and you'll come back for more.
Speaker 5:But in terms of that compassion, accountability is really in when you're doing the work with clients. Where do you fit on that? You know, accountability without compassion is never fair. Okay, it's never fair Because there's always somebody you like better than others. You know, because when we're dealing with people. We don't like all our clients. Matter of fact, I don't like a lot of my clients, okay, and I can say that, oh God, no, and I let them know. My job is not necessarily to like you. My job is never to hurt you. I know a lot of people who like clients who are doing a lot of hurt. They feed their own trauma and codependency Right, trauma and codependency right.
Speaker 5:And so when you got accountability without compassion, you get complacent, you get full of yourself and you get self-righteous. You know it's like talking about well, you know, we were tough on crime. Oh, okay, whatever you did, did it make people better? Did it make community better? No, that wasn't your piece. Or I just don't care about certain people, or I don't feel certain people deserve compassion, right, and so we end, or I'm too, that kind of thing.
Speaker 5:Then you got the other side compassion without no accountability ain't nothing but chaos and you ain't doing clients no good. You know, yeah, there is rules. Now, I can, you know, be, you know I can balance them. They don't have to be so hardcore, you know. But my, you know the clients I do have people, the referrals, say why don't the clients get mad at you when you kick them out the program. Because I'm real clear the whole time this is not no love fest. I'm here to help you. You're going to have to help me. Talk to me, okay, we can work this out okay.
Speaker 5:But but again that, that, that compassion without accountability we see that sometime in community programs trying to offset what they see out in the larger. But I have to hold you accountable, somehow for the best for you, and if I'm dealing with a treatment center might be for the best for the treatment center, but I'm not going to give up on you. If these things happen, we can get you here. You know that's part of the growth and getting better. But then you've got that whole thing of moodiness of staff bouncing back and forward because I had client staff tell me, well, they didn't say thank you, what the heck. You know we've heard that routine. They didn't say thank you and all this stuff. Man, this is not about you. So how do we balance? That is where our role becomes critical, right, and then a whole parallel trauma where a lot of the folks who do this work. Now I shouldn't say that, because there I go again with a lot of what I ran into are traumatized folks doing the work.
Speaker 5:That's why they do the work, because they traumatize OK, folks doing the work. That's why they do the work, because they're traumatized. They started doing the work because they were traumatized and then sometimes they get full of themselves and forget they still carry trauma. Because I don't believe you ever recover from trauma. I think you recognize it and you find ways for it not to mess with your life so much. You can have trauma and not have mental health issues. They don't automatically go together, because anything's a trauma. You don't get picked for the favorite college. For some people that's a major trauma depending on how they were raised, right. So am I off on a tangent again? Yes, I am.
Speaker 5:I don't think so.
Speaker 4:So I was in clinic on Friday, last Friday, my entire day, and I wish you were there with me. Uh-oh, as you were talking about this compassion and accountability, I wish I was able to employ that with one of my. It's a completely new person I've never met before, grew up in Minnesota but went to the West Coast, experienced a lot of sexual trauma.
Speaker 4:Was part of the sex industry and decided to leave the West Coast, come back home to Minnesota and desperate to find a primary care doctor and desperate to find a person to give them Xanax for their anxiety, right, and I tried my best to understand their story and I don't have much of their records, and so there's this trust thing that I'm having with this person too. But also knowing that if I'm asking someone questions, they're often very triggering for the trauma and they would run away from me and at the end of it we were talking about all the medications I can do for them and the the labs can do them, all the things that they knew about already, right. But ultimately they wanted me to give them xanax, right, unfiltered right. And I felt so uncomfortable with that right and I said, okay, maybe I can give you a few, but I need you to follow these accountability stuff boundaries there. And they, once they heard me say accountability, they, they left.
Speaker 4:I didn't want to do any more labs, I'm not going to do any of these treatments and left and I felt like a gut punch to my stomach. I cared about this person so much that I was willing to break my own boundaries for this person, even though it could be harmful for this person.
Speaker 5:So I needed you there.
Speaker 4:Talk me through that moment. I didn't know what to do.
Speaker 5:Right, right, right. And at the same time, when you talk to them and you talk about accountability and they responded the only other thing I would have done I hear what you're saying in terms of the self-healing is like, look, if you want to continue to discuss this and figure this out, I'm here, you know. And then that gives them the choice, because sometimes they've never been told that. Right, you know, and I'm real clear about none of this is personal for me, see, I think sometimes we've been doing this work and we worry so much, we care about people so much, because a lot of the people we deal with are in spots that we've been in. Yeah, okay, and so that's why, as a clinician, I have to always check myself. Why am I feeling this way with this client and that kind of stuff? What's going on here in that continuous? And I think that's one of those areas sometimes we come up short.
Speaker 4:Yeah, yeah, sometimes I do things because I want that person to like me too, right, it makes me feel, it feeds me, and I'm not really doing a harm reduction at that point.
Speaker 3:Right, I'm just taking care of my own issues and trauma to that interaction wow, I'm thinking about so much in response to what both of you have said, um, but about the accountability piece, um, I just I see that it's so important to model um having good boundaries with clients, um, and having good boundaries means that you know I can be compassionate and welcoming and not judgmental, and you know I will tell you if you fuck up. And you know, working in a clinic, we have clinic rules and you need to treat like you. Yes, you can, you can be however you want to be when you're in here. It's kind of something I say but like, you also like, have to be respectable to the people around you and to me.
Speaker 3:And, um, I think that it's really powerful when, like just actually last Friday, um, someone was sleeping in the lobby and we have to check on everyone who's sleeping in the lobby to make sure they're okay, um, and when we wanted to check on this guy, he he was really, um, you know, verbally, was really verbally abusive to our staff and threatening to our staff, and he came in this morning, actually just before I came here, and it was powerful to tell him like, hey, it's good to see you, I hope you're doing okay. You cannot talk to our staff. That way, you cannot threaten staff or we're going to have to um ask you to leave again and um, not, it's not all or nothing. Like you know he's not well, I'm not saying well, we'll never see you again and you're a bad person. It's like no, like I am happy you're here, I'm happy you're accessing these services, um, and these are rules that you have to follow.
Speaker 3:I think that that um is pretty powerful for for clients, that um that we're still welcoming them back, and then just thinking about how, like I carry my own trauma and I also I do this work because I am traumatized, as you know, someone who struggles with addiction and it's it's helpful to for me to just be real with what I'm experiencing with clients. Sometimes I'll tell clients you know, oh, I'm having a hard time right now because I've gone through similar things that you're going through and just like leveling with people so they can see where I'm at and kind of what I'm dealing with in the moment, I think is helpful and helpful for me then to really unpack what I'm going through and not I don't know, not re-traumatize this person.
Speaker 1:So can we give the audience something to think about in terms of challenging right these institutions of power? When it comes to substance use treatment, what advice would you give practitioners, what advice would you give the audience in being more mindful or more self-aware about the dynamic of treatment?
Speaker 3:I think the first step is recognizing that you are in a position of power to recognize the power dynamic.
Speaker 4:Start by listening, that moment where you are open to them and you're not trying to probe because you need to know certain answers, but you are open to them, to that path of meeting them where they need to be and want to be, finding that shared goal together and removing the ickiness of harm reduction.
Speaker 4:It's even though you haven't lived that experience and, like I've never injected drugs, I don't think I'll experience that in the future but sometimes I have to be able to hear that story of what they're experiencing. But sometimes I have to be able to hear that story of what they're experiencing so I can at least understand that lived experience and then treat them in a way that makes sense to them.
Speaker 1:Sitting through that personal discomfort.
Speaker 2:Yeah, fellow clinicians and peers, that when we're training or teaching, is that this? The ethos of harm reduction flows from the top. If you're in a position as a supervisor, a manager, as a treatment director, program director, your buy-in is absolutely vital. It's really difficult, as kind of a frontline LADC or therapist, to work against the ethos of a program. But when the leadership is on board, the frontline clinicians have a lot more capability and capacity to be truly person-centered.
Speaker 5:Talking about listening one of the things sometimes. So what happened? Because you know, the thing is is folks walk around like there's something wrong with them, but something's actually happened and what we see are the responses to what that was that happened, and sometimes, especially in the real crisis moments, folks who've been staying in crisis over and over again, because you can even get addicted to the crisis, right, Because it's like one of the few times somebody act like they cared about me, right, and the only way they know how to ask for help or cry for help. But what happened you?
Speaker 5:know, because it's really interesting. You know how that disarms people Even you know my specialty in the pain clinic was to deal with angry clients. That was my job. I ended up making a job dealing with any kinds. And they would come in, they would cuss me out and all like that, and then I would look at them and say, are you done? And they would look at me all strange. So tell me what happened. And then you know the staff thought I was amazing because the person walks out with a smile and all like that. But I'm only going to be able to do that if I'm in a good place, because sometimes we take that stuff personal. You know so.
Speaker 2:but yeah, that piece of that's. You know what happened? Yeah, I want to jump on that, sam, because I think that, as as clinicians, as whether we're providers or um, you know, frontline workers, we always want something to do right, like there's this intense pressure we put on ourselves to have the right answer, here's a skill or here's some homework to do, or here's some medicine to do the thing. And but I, you know, one of the things I've been really walking with lately is is taking considering what I'm doing less as something to do, less on doing and more on being right, being with the person that is in front of me, really trying to listen and strive to understand, acknowledge when I don't understand or can't understand, but to provide that space to for a person to be seen and heard and listened to.
Speaker 3:And I think the next question to ask after what happened is what is what is going right with you, like what is what is what is good with you, and listening to to to that, because I think that's a huge part of understanding, not just kind of what they've been going through, but like who they are as a person. Maybe what's what's going right for them is they've they've been coping and staying alive by skillfully using drugs and I will acknowledge that that can be skillful or maybe they really like to draw on what they are good at or what they've been doing well is also really powerful for building relationship and for recovery.
Speaker 1:Nice Final thoughts everyone.
Speaker 4:I wish that you were all in my clinic because I think this is a team effort and often I find myself by myself with the individual not knowing what the right answers are. And if I had like a dial up, like speed dial, to each one of you and mostly because, like, yeah, I have my own personal views, the work I do, but may not always align with the individual I work with and they might not connect with me in ways that make sense to them, and I wish there was just a more diversity of workforce taking care of people that would employ a harm reduction that makes sense to that person, that community, yeah. So, like, honestly, if Sam was right there with me on Friday, that would have been really helpful for that individual myself.
Speaker 2:Yeah, and we talk a lot about our clients needing community, but we need community too right, having um folks that we can consult with, folks that we can join forces with, um folks that we can get our own support from, I think is um something I'm really taking from this conversation.
Speaker 3:Yeah, settle bodies can settle bodies. I think about that a lot and it's so important to center yourself and take care of yourself. Having a network of coworkers or having someone that you can do sort of just any like therapy, but coming into this work feeling like settling yourself and centering yourself is key.
Speaker 5:Yeah, the big piece is, I think you know, being comfortable enough with yourself to be able to hear what clients are saying and what they're going through. That's been a big focus, because clients are clients, right? You know, I don't have a whole lot of special expectations other than them showing up as themselves, and what does that mean? So I can end with that.
Speaker 1:Right on, all right. Everyone, please take a minute to promote your work or what you do, how people can get a hold of you or how to find more information.
Speaker 2:Sure, yeah, well, you can find my clinic at expansemncom clinic at expansemncom um come check us out. If there's uh any you know psychiatry or psychotherapy or have an interest in psychedelic psychotherapy, um would love to connect there yeah, I work for the red door clinic downtown.
Speaker 3:Um, we are a walk-in. What our harm reduction program is? Walk-in Monday through Friday, 9 am to 3 pm. Folks can come and access services or come and just chat with me. I would love to meet people.
Speaker 4:Yeah, come see me at Cooke Clinic C-U-H-C-C in the Phillips Neighborhood Clinic area. Yeah, I see anyone. Everyone, you're all welcome to come see me.
Speaker 5:Oh well, you can get more information about me from samuelsimonsconsultingcom. Also, I have a new book out called Just Sam, which is a book around black men's journey around healing, and you can get it on Amazon as well, but that title is Just Sam.
Speaker 1:Thank you everyone for the great discussion today. Thank you.
