February 26, 2025 • 28 mins
Getting help for a substance use disorder is not a one-stop proposition. There are obstacles, doubts, backslides, and often frustrating delays, waiting lists, and an absence of resources. Nanci Schiman talks about the challenges an individual encounters when finally making the decision to stop using substances and get help. Nanci is a Licensed Clinical Social Worker with over two decades of experience in the mental health field working with adolescents, adults, families, and couples. Getting help can be challenging, but it is well worth the lifesaving effort. Nanci can be reached at info@orendacounselingservices.com.
The views and opinions of the guests on this podcast are theirs and theirs alone and do not necessarily represent those of the host, Westwords Consulting or the Kenosha County Substance Abuse Coalition.
We're always interested in hearing from individuals or organizations who are working in substance use disorder treatment or prevention, mental health care and other spaces that lift up communities. This includes people living those experiences. If you or someone you know has a story to share or an interesting approach to care, contact us today!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Mike (00:12):
Welcome everybody.
This is Avoiding the AddictionAffliction brought to you by the
Kenosha County Substance Use DisorderCoalition and Westwords Consulting.
I'm Mike McGowan.
Just get help.
That's a phrase often used by peoplewho know or care about somebody
with a substance use disorder.
(00:32):
Like just getting help is a snapof the finger easy thing to do.
Our conversation today is about thehurdles needed to be jumped in order
to get Into substance abuse recovery.
My guest today is Nanci Schiman.
Nanci has joined us before.
She is a licensed clinical socialworker with Arenda Counseling
Services in Cedarburg, Wisconsin.
(00:53):
Nanci has over two decades ofexperience in the mental health
field working with adolescents,adults, families, and couples.
She works with clients on a varietyof mental health and addiction issues.
She's a National Association ofSocial Workers member and an EMDR
International Association member.
Welcome back, Nanci.
Nanci (01:11):
Thanks, Mike.
It's always glad to be here.
Mike (01:13):
Yeah, thanks for joining us.
Okay, so I know you've workedextensively with substance use disorders.
I'd like to walk through the process.
It's an issue, I think, and a topicthat we we skip over sometimes,
and it's a pretty big step, right?
Nanci (01:27):
Yes.
Mike (01:29):
And so first, now, this has been my experience, maybe it's not everybody's.
Most people, it seems, areleveraged into getting help.
They don't come begging youfor help unless something big
has happened and a lot of lifeconsequences have finally piled up.
Yeah, or no?
Nanci (01:47):
I think that's true for a lot of people, whether it's that they're
leveraged by others, or they becomeso sick and tired or so scared of
the direction their life's going.
Something big has to happen to sortof be a catalyst for that change.
Mike (02:02):
So somebody finally says, Fine, I'll get help!
Now, that seems like, oh, we're done.
We're done?
We're not even started, right?
What's the next question?
Where?
Who pays?
Insurance?
All of the above?
Nanci (02:17):
I think all of those questions, you know, when somebody agrees to get help
let's take the first scenario where theirfamily or friends are leveraging them.
One of the questions I have in mymind as a therapist is, are they doing
this to get people off their back orare they actually invested in this?
And so I see my role as helping themto find some intrinsic motivation
(02:43):
that they may buy into beyond justgetting people off their back.
Cause I think we all know peoplethat like, fine, I'll go over,
they do the 28 days and then thewhole time they're planning when
their first drink is going to be.
But let's say that they'veactually said, okay, you know,
there's something to this then.
Yes, I guess the good news and thebad news is there's so many options.
Some people go into a inpatient or aresidential treatment program, where
(03:08):
they're completely isolated fromthe triggers and the temptations.
And that comes with a wholelot of issues about finances,
insurance, things like that.
Other people try to use12 step programs like AA.
Some people try like an intensiveoutpatient program where they're
(03:30):
going for a couple hours a day.
Again, all of this depends oninsurance and what's available.
Sometimes places don't have availabilityand they're on a waiting list.
So it's unfortunately it's notquite that simple as you alluded to.
Mike (03:43):
Right.
I used to watch this show.
I haven't watched it for awhile now called Intervention.
Right.
It was on Arts and EntertainmentNetwork or whatever, and it was a
group of loved ones gathered secretlyand planned an intervention, presented
their concerns, and then if the personsaid they'd get help, the facilitator
would whisk them away, usually on anairplane to some place on a coast.
(04:09):
And they were greetedwith open arms, right?
And, and the productioncompany would pay for it.
Now, let's get back to real life.
In real life, you talkedabout there's a wait time,
oftentimes, between getting help.
What do you do to bridge that waittime between getting into a therapist,
even a therapist's office, becauseso many counselors I know have full
(04:33):
loads, or a treatment facility?
What can somebody do who's listening tothis, who's maybe waiting to get help?
Nanci (04:41):
Well, I have my own biases, so I'll be very straightforward with that.
You know, there's one placethat doesn't have waiting lists.
It doesn't cost anything.
And that is.
around here very accessible andthat is, you know, a 12 step
program, specifically AA or NA.
There are other types of recoveryprograms, again, that don't cost anything.
(05:05):
That can be challenging becauseit takes some courage to
walk into this unknown place.
I remember my own experiencewas, I was scared to death.
I thought I had nothingin common with everyone.
And I walked in there and I thought,why are all these people happy?
You know, pathetic people can't drink.
Very, very judgmental, whichwas just part of my disease.
But you know, it's there at almostany time, you know, in the greater
(05:31):
Milwaukee area and the surroundingareas, you can find meetings,
you know, multiple times a day.
And since the pandemic,we've got them online.
You can go to a meetingin Ireland if you want.
Yeah, it's very accessible, but thatdoes require some self discipline.
But I guess that would be my first thoughtis to connect with a community where you
(05:53):
have people that are going to supportyou until you can get more structure.
Mike (05:57):
The nice thing, you're talking about a suburban area, but the nice
thing is that structure, support groupmeetings are, well, as you said, online.
But they're also available, it's theone thing that actually is available
in many of the rural parts of thiscountry, and not much else is sometimes.
Okay, since you volunteered thatinformation, I've got to ask you,
(06:20):
because... okay, I'll just make itup because I'm sure none of these
take places in a church, right?
You pull up to the church andthe meeting's in the basement.
How do you get yourself fromthe parking lot to the basement
without turning back around?
Nanci (06:37):
It's a great question.
I think part of that comes from do youwant it badly enough and the people
that I've talked to who are in recoverywhether brand new or you know decades of
recovery say at some point they're so sickand tired of the way their life's going.
They were sick and tired of hatingthemselves that they're like,
(06:59):
I'll do anything just about.
And so I think that can be a big push.
I just moved.
And so I'm finding newmeetings where I am.
And I went to one and it's listed,but it was a church and it was huge.
And there's all thesedifferent parking lots.
So I walk in and I'm like, I have no idea.
So I just walked up to the receptionistand said, where's the AA meeting?
(07:22):
Now I'm comfortable doing that,but I don't expect that somebody
brand new is going to be in anyplace where they're able to do that.
It certainly can help if somebody cango with them, you know, even if it's
to find an open meeting, you know,because most 12 step meetings are closed
meetings because of the anonymity andthe confidentiality, but they're also
(07:45):
usually every weekend, there's an openmeeting somewhere where anybody can go.
Somebody gets up andthey tell their story.
And it can really resonate and thenyou have access to people to kind of
say, okay, we're here to help you.
Mike (07:58):
And an open meeting is more like you can just sit there
and listen to a speaker, right?
Nanci (08:02):
Nobody's going to call on you.
Nobody's going to look at you.
You can kind of fade into the woodwork.
Mike (08:08):
And if somebody goes to even a closed meeting thinking I have a
problem, they're not forced to speak.
They can say pass, right?
Nanci (08:16):
Absolutely.
Yeah.
So, you know, a lot of times, you know,I couldn't figure out why everybody
knew that I was new until I realizedthat everybody else knew themselves.
And I walked in looking like anabsolute terrified, you know, on the
verge of tears, middle aged woman.
And so they do what'scalled a first step meeting.
And so I get whisked into thisother room and but it was just
(08:38):
the surrounding of support.
But even in those situations, ifsomebody says, I'm not ready to talk,
nobody's going to force them to.
Mike (08:44):
Right.
Right.
Well, I, you know, what we'retrying to do with this is just take
away some of that uncomfortabilitybecause that would be part of it.
When I was reading your bio, itsaid that for you that therapy is
a collaborative endeavor where theclient is the expert on their own life.
Okay.
So given that now let's, we justtalked about somebody who recognizes
(09:04):
as a problem, but therapists, a lot ofwhom listen to this program, yourself.
You get people that come to you withoutrealizing or without acknowledging
that substance use disorders are aproblem for them or the main problem.
So at some point, you'regoing to bring it up to them.
(09:24):
At some point, you're goingto say, how do you say it?
What do you say?
Nanci (09:29):
Well, if the conversation... I'm thinking about, you know, some of the
conversations I've had, and if they'retelling me about a situation where
some bad things happened, and I'm nottalking like, you know, going to jail
or anything, but they were embarrassed.
They don't remember what happened.
You know, we start talking about,well, how are you feeling about that?
(09:50):
Has that ever happened to you before?
What would you have liked to be different?
Anything to sort of engage themin going a little deeper and then
considering, is this something thatyou are concerned about because it's
happened before or it might happen again?
Or we'll talk about, so whatwould it be like if this happens
(10:13):
the next time you go to a party?
Or what were you afraidmight have happened or what
was it like to not remember?
And once they are acknowledging thatthere's a problem at some level.
You know, getting beyond the,Oh, that will never happen again.
Because quite frankly, if that'stheir attitude, I don't think
they're going to tell me about it.
Mike (10:34):
Right.
Nanci (10:35):
So the fact that they're bringing it up at all says I'm not
feeling comfortable about this.
So validating them really acknowledgingtheir feelings, letting them
know that they're not alone andoffering them some alternatives.
And that's where them being theexpert on themselves is important
because I can bring suggestions.
(10:55):
But I'm always very clear that look,I'm going to throw out suggestions.
Your job is to tell me what you thinkwill work and what won't, because
I'm not going to push something onyou that you're absolutely against.
So if I bring up, for example,AA and somebody's like, Nope,
that's that whole God thing.
I don't want to go there.
Okay.
Maybe we'll have a conversationabout that and I'll check in on
what they believe and what they'veheard versus maybe what is reality.
(11:19):
But I'm also going to be respectful ifthat's just not where they want to be.
And then we look at other things,so that's not the only option.
Mike (11:25):
I would imagine every counselor has their own style
and the way they approach things.
I remember the woman who my mom saw, asmy mom was with her head in her hands in
the hallway at a hospital, walked down thehallway, clickety click, took a seat next
to my mom, and the first words out of hermouth were, Audren, you're an alcoholic.
(laugh)
(11:45):
So there's everything in between, right?
Whatever you're comfortable with.
Nanci (11:49):
Yeah, and it's not to say that I won't be very blunt.
It really depends on the situation.
It's like, read the room.
You know, you gotta know yourclient and see what's gonna work.
And even in my own experience, myfirst sponsor was someone who was
pretty blunt, and I needed that.
Mike (12:06):
Well, I had a kid once say to me, and I assume this is also
part of your therapy and everybodyelse's, is, okay, now that you're
taking away my main coping mechanism,I know they don't put it that way.
What are you gonna gimme instead?
You're, you know, the guy said to me,you're, "Mr. Don't take something away
unless you replace it with something." Itcaught me a little bit upside the head.
(12:27):
Right?
You need something else totake the, whatever that is.
What styles do you find is effective?
You do EMDR, right?
Nanci (12:35):
Yes.
Mike (12:36):
Does that work with substance abuse?
Nanci (12:39):
It's a great, great question.
So EMDR is eye movementdesensitization and reprocessing.
And it's used fortreating trauma primarily.
And what I have found the longer I'm inthis field is that a lot of what people
come in with is related to trauma.
And trauma looksdifferent on every person.
(13:00):
It isn't the car accident, the, youknow, being assaulted in a back alley.
It trauma can be growing up in ahousehold where you were expected to
suck up your feelings and be the nicecooperative child and you didn't have
anybody who you could talk to youabout things that were were going on.
(13:21):
Trauma can be not, you know, being exposedto violence and other people in the home.
It's a whole range of things.
So my experience for the most part isand you obviously, I'm sure you with all
of the years you've experienced you havemight have some other thoughts on this.
We don't just drink and numbourselves out just for the fun of it.
(13:46):
We're usually trying toescape from something.
Mike (13:48):
Right.
Nanci (13:49):
And so acknowledging that and acknowledging that there
is pain and discussing how dowe go about healing that pain?
Because a lot of people are like,we're not going to go there.
I don't want to touch that.
You know, you're not goingto get into that yucky stuff.
It's sort of a combination process oflike, okay, so here's some of the stuff
that's going on underneath that you'reresolving by drinking or drugging.
(14:13):
Or shopping or overexercising orwhatever and we want to address that.
It's going to be hard to address it ifyou're still anesthetizing yourself.
So we got to help you come up withsome other ways to roll through those
emotional tidal waves that come in.
And so teaching some skills forgrounding, centering themselves
(14:36):
getting through that wave.
So I realize that didn't reallyanswer your question about EMDR, but
I guess that's a back up to that.
Mike (14:43):
That's one of the techniques to do that, right?
Nanci (14:45):
Yeah.
I wouldn't typically startsomebody out if they're brand new
and starting to tackle recovery.
I'm not sure that I would throwEMDR in there right away because
that's an awful lot of stuff.
They're just trying to figureout how to get through every
24 hours without drinking.
And EMDR is going to stir up some stuff.
And so I think giving somebody achance to get a little bit of kind
(15:09):
of get their sea legs before wego into some of that deeper stuff.
But it is important.
It's not going to go away.
Mike (15:17):
Well, since you do family and couples as well, let's do the flip
side of that whole therapy equation.
And you touched on it before.
Some clients tell their familymembers, and it sounds just like,
Fine!, I'll go to counseling, right?
That sounds enthusiastic.
And then go a couple of times anddismiss it as BS, ineffective, or the
(15:39):
old gaslighting, I did what you asked!
And then quit.
Now I'm sure it never happens to you, butloved ones also here about the counselor.
She doesn't know what theheck she's talking about.
It's a waste of money, right?
Nanci (15:55):
Oh, I've had that happen.
Mike (15:56):
Yeah.
Well, I know.
And it's like, yeah, we don'tknow what we're talking about.
And then that's reinforced with,I was talking to my buddy down at
the... And then the person quits.
How does a concerned personrespond to those diversion tactics?
If you're working with like the partnerof somebody who wants to go through
(16:17):
that, or an adolescent who says totheir folks, there ain't no way I'm
going back to that wonderful woman.
Right?
Nanci (16:25):
Yeah.
I have an approach that others may ormay not agree with, but I try to manage
the expectations of the family members.
I've had plenty of people comein saying, I really need my
partner to go into therapy.
Mike (16:41):
Yeah.
Nanci (16:42):
And I'm like, okay, so they go to therapy, then what?
You have no idea what they'retalking about in therapy.
You have no idea what their goals are.
I recently had somebody who came in andspecifically because their partner wanted
them to go and I said, okay, that's fine.
Why do you want to be here?
Or do you want to be here?
Because there's no pointin going any further.
(17:04):
So getting them invested inwhatever is motivating for them.
But I think letting family members knowthat you can't push them into it and
expect that that's going to cure them.
Mike (17:19):
You know, there's an old saying, you can't con a con.
Can you tell when somebodyis serious about recovery?
Nanci (17:24):
I've been in family therapy and I've sometimes been the person
to basically say, cut the BS.
I've been in meetings wheresomebody has just, you know, let
somebody ramble on and dig a holefor themselves and then go, okay.
That's garbage.
Let's start over again.
Now tell me, you know,what's really going on.
So yeah, I mean, you can't always,but certainly you can tell, I think
(17:46):
it's easier to tell when somebody'sserious about it than when they're
just trying to go through the motions.
Mike (17:53):
This may be a dumb question, but I think about it sometimes.
Does quitting therapy or treatment makeit easier or harder to get back into it?
Nanci (18:04):
Get back into therapy?
Mike (18:06):
Yes, yes.
Like if you quit something, doesthe shame, the guilt, when you
realize you shouldn't have quit it,does it make it easier to go back
into it because you now know whatit's about, you know where it is?
Or does it make it moredifficult because of your pride?
Nanci (18:21):
I'd say both.
It really depends on the person.
I've heard people say, I don'tthink I have another recovery in me.
Mike (18:30):
I hear that.
Nanci (18:31):
I have heard people say, you know, I went to therapy and I wasn't ready
to do the work, or I was in treatmentand I wasn't ready to do the work.
And then they come back around.
So I would say if you spent any timein either, unless you've just had a
horrible experience and there are,you know, therapists range in quality,
(18:54):
just like any other profession.
But if you've had anypositive experience in there.
Just because you leave you didn'tunlearn the things you learned.
Mike (19:06):
Right.
I used to have my counselor say andthey used to list this is a problem.
She's treatment savvy.
Nanci (19:13):
Resistant?
Mike (19:14):
No savvy like and I'm like why is that a bad thing?
If they know what treatment islike, don't you expect more of them?
If I know the offense, thengo shoot the ball, right?
Nanci (19:26):
Right.
I wonder if their term of that wasthey know how to play the game.
Mike (19:32):
Well, right.
That's what they were saying.
Nanci (19:34):
Yeah, that doesn't sound like that's a compliment.
It's this is somebody who knows how to dowhat they need to do to get out of there.
And we've all heard people whosaid, yeah, I went in there and
I just did what I had to do.
I've seen that a lot with adolescentsand they're smart, you know, and
that's where I try to play on thatskill and say, look, you clearly
have a lot of really great talents.
To be able to, you know, figureout how to beat the system.
(19:58):
How else do you want to use those talents?
Mike (19:59):
Right.
Yeah, I mean, because at somepoint, you never really know.
I've had arguments with people wherethey say, Oh, I always assume that
the client is telling me the truth.
And I'm like, really?
I don't.
Because you don't know, right?
You never know if whatyou're getting is the truth.
Or even if the truth as they see itmight be different than the truth their
(20:21):
boss, their partner, their children.
Nanci (20:25):
Yeah.
And I think, you know, the, I alwaysam under the assumption that I'm
going to get a filtered version.
And it's one of the things I love aboutmy job is, you know, especially as I
get to know my clients and some of themI've worked with for years, I can just
tell by the way they walk into my officeor the look on their face, that there's
(20:45):
something that they're struggling with.
Am I going to tell mytherapist this or not?
And, usually they end up, butyou know, there's that struggle.
And then I've also had clientswhere I had no idea the degree
to which they were fabricating.
But yeah, the most part, I thinkyou kind of know, but yeah, I don't
expect people are going to tellme everything because they want to
(21:08):
present themselves in a positive light.
Mike (21:10):
I spent a long time working with adolescents and I would bump into them
into adulthood and we'd start to talkin a Target or a store and they would
just grab my arm and say, Oh, hey.
When you were working with me,this, this, this was going on.
Would that have helpedif you would have known?
(laugh) And, and I, well, maybe a little.
(21:31):
We certainly wouldn't havewasted all that time on other
things that weren't the problem.
Nanci (21:36):
Yes, I had somebody, it was a newer client, but the other
day, you know, I thought we'dgotten through the whole history.
We're getting ready to start.
She's, Oh, there's this thing thatmaybe would be helpful for you to know.
And I was like, when she gotdone, I'm like, yeah, that
just became like the core.
Mike (21:52):
Yeah.
Right.
But yeah, I'm, I'm cheating on my partner.
I've embezzled fromwork and I'm on the run.
Right.
Okay.
If this is a disease itis and relapse is common.
How do you talk about it without makingit to the client sound inevitable?
Nanci (22:11):
I usually don't bring it up unless it seems like that's a
direction that needs to be addressed.
Interestingly, I had somebodythe other day was talking about
a loved one and they said, well,I know they're going to relapse.
And I said, well, we'llhold it right there.
Don't assume that's an absolute.
Yes, sometimes people relapse,but there are people that get
(22:34):
into recovery and they don't.
Mike (22:36):
Yeah.
My mom didn't.
Nanci (22:37):
And yeah, or they don't for 20 years.
So I wouldn't build that in asbeing an expected part of the
recovery path, because now you'veset somebody up with an out.
So the only thing Ireally bring up is that if
you feel like you're goingto pick up any or use.
(23:01):
Let's talk about the safety plan.
What are you going to do?
And then and if for some reasonyou still end up picking up
you got to come right back in.
And that's why I always say it'sso important to go to a lot of
meetings because you see peoplecome back after a relapse And
you see that they are not shamed.
(23:23):
They are not rejected.
They are not criticized.
They're supported andthey're welcomed back in.
It doesn't mean that they'recoddled, you know, if there's stuff
going on there, people will sayit, but it's important that they
know that that's always an option.
Because some people are too scaredto go back in because of the shame.
Mike (23:45):
Yeah, I think that's really an important point, which is once you
know that, you know, if something doeshappen, it does take away a lot of
the shame of going back in, knowingthat you're going to be accepted
because we're just all human, right?
Nanci (23:59):
Right.
Mike (24:01):
So long term, you know, if somebody's been relying
upon substances for everything.
Celebration, coping,grief, whatever, anger.
Learning new techniques takes time.
Patience is gotta be anessential part of therapy too.
Nanci (24:22):
Yeah, I think managing my client's expectations is important.
Sometimes they're very hard on themselves.
And I have had so many clients sit thereand say, why is this taking me so long?
There's something wrongwith me, I'm failing.
And so we break it down and look,the first thing is to introduce
the idea that you're open tochange and let that sink in.
(24:47):
And then we look at thenext step and the next step.
But if you think you're goingto go from here all the way
over to here in a day or a week.
You're going to be disappointed.
You didn't get here overnight.
You're not going to getout of it overnight.
Mike (25:01):
How long do you think, I know it's a ballpark, but how long does
it take before you feel comfortable?
The analogy I use all the time is ifI lost the use of my right hand and I
had to start doing everything with myleft hand, I might be able to do it.
But before I could feed myself lefthanded, it would be a quite a while for
it felt comfortable that that's who I was.
Nanci (25:27):
It's building new pathways in your brain.
And it doesn't matter how old we are, youknow, our brains have a lot of plasticity.
So it's kind of like, if you keep cuttingacross your lawn in a certain path, you
know, over time that grass is going towear down and the ground is going to get
flat and it's going to look differently.
And if you stop that, and youstart walking a different way.
(25:50):
It's going to take time forthat first path to grow back,
and for that other one to form.
I used to use the analogies of, you know,all the construction that was happening
like on I-43 or whatever, you know.
It becomes, you know, eventuallyyou get a nice smooth road again.
So, to know that it'll take time, andyes, it will be hard at first, but it's
(26:11):
going to get easier and easier and easier.
And when we're talking about small tomoderate behavioral change, like if
you do this consistently for a week,you're going to find that you're not
having to do it in such a focusedmanner, it's going to become automatic.
It's like, how many people thinkabout brushing their teeth or what
they do when they get in the shower?
(26:31):
They just do it.
Mike (26:32):
Right.
Nanci (26:33):
And you will get to that point.
Mike (26:36):
Right.
And you don't even know you're there.
Nanci (26:38):
Right.
Mike (26:40):
And you know, the well, I'll let you go away on this.
There's happiness at theend of the tunnel, right?
Nanci (26:48):
Yes.
Yes.
From my own experience and that of peopleI know both personally and professionally
and granted, I only see the peoplethat, you know, keep coming back.
Mike (27:01):
Right.
Nanci (27:01):
I don't see the people that fade away, but I hear things like, I
never knew my life could be this good.
I never knew that I could navigatethrough problems without, you
know, completely imploding.
My relationships are better,the way I feel about myself is
better, and that's a big one.
You know, we start tolike ourselves again.
(27:21):
So, yeah, people will say, Ihad no idea that I could have
so much fun without alcohol.
Or without drugs or whatever.
And yeah, because you get toexperience it all and remember it all.
You know, I think you had saidonce, why would people go and
spend a ton of money on concerttickets and then be obliterated?
Mike (27:40):
I don't get that.
Nanci (27:41):
And not remember the experience, yeah.
So yes, I think, and for the familiestoo, you know, you know so well that
it takes time to rebuild that trust.
But once it's rebuilt, it's prettydarn solid and it feels really good.
Mike (27:56):
Great.
Well, this has been terrific.
I thought about four different littleareas we could dive even deeper in.
So maybe we'll do this again shortly.
Nanci (28:05):
Absolutely.
Mike (28:06):
As you all know, there's links to Nanci's contact information attached to
the podcast if you want to ask her more.
Thanks for being with us andsharing your expertise, Nance.
And for everybody listening,listen anytime you're able.
And until we talk to you nexttime, stay safe, keep going.
The destination is worth getting to.
Nanci (28:26):
Thanks.
Welcome everybody.
This is Avoiding the AddictionAffliction brought to you by the
Kenosha County Substance Use DisorderCoalition and Westwords Consulting.
I'm Mike McGowan.
Just get help.
That's a phrase often used by peoplewho know or care about somebody
with a substance use disorder.
(00:32):
Like just getting help is a snapof the finger easy thing to do.
Our conversation today is about thehurdles needed to be jumped in order
to get Into substance abuse recovery.
My guest today is Nanci Schiman.
Nanci has joined us before.
She is a licensed clinical socialworker with Arenda Counseling
Services in Cedarburg, Wisconsin.
(00:53):
Nanci has over two decades ofexperience in the mental health
field working with adolescents,adults, families, and couples.
She works with clients on a varietyof mental health and addiction issues.
She's a National Association ofSocial Workers member and an EMDR
International Association member.
Welcome back, Nanci.
Nanci (01:11):
Thanks, Mike.
It's always glad to be here.
Mike (01:13):
Yeah, thanks for joining us.
Okay, so I know you've workedextensively with substance use disorders.
I'd like to walk through the process.
It's an issue, I think, and a topicthat we we skip over sometimes,
and it's a pretty big step, right?
Nanci (01:27):
Yes.
Mike (01:29):
And so first, now, this has been my experience, maybe it's not everybody's.
Most people, it seems, areleveraged into getting help.
They don't come begging youfor help unless something big
has happened and a lot of lifeconsequences have finally piled up.
Yeah, or no?
Nanci (01:47):
I think that's true for a lot of people, whether it's that they're
leveraged by others, or they becomeso sick and tired or so scared of
the direction their life's going.
Something big has to happen to sortof be a catalyst for that change.
Mike (02:02):
So somebody finally says, Fine, I'll get help!
Now, that seems like, oh, we're done.
We're done?
We're not even started, right?
What's the next question?
Where?
Who pays?
Insurance?
All of the above?
Nanci (02:17):
I think all of those questions, you know, when somebody agrees to get help
let's take the first scenario where theirfamily or friends are leveraging them.
One of the questions I have in mymind as a therapist is, are they doing
this to get people off their back orare they actually invested in this?
And so I see my role as helping themto find some intrinsic motivation
(02:43):
that they may buy into beyond justgetting people off their back.
Cause I think we all know peoplethat like, fine, I'll go over,
they do the 28 days and then thewhole time they're planning when
their first drink is going to be.
But let's say that they'veactually said, okay, you know,
there's something to this then.
Yes, I guess the good news and thebad news is there's so many options.
Some people go into a inpatient or aresidential treatment program, where
(03:08):
they're completely isolated fromthe triggers and the temptations.
And that comes with a wholelot of issues about finances,
insurance, things like that.
Other people try to use12 step programs like AA.
Some people try like an intensiveoutpatient program where they're
(03:30):
going for a couple hours a day.
Again, all of this depends oninsurance and what's available.
Sometimes places don't have availabilityand they're on a waiting list.
So it's unfortunately it's notquite that simple as you alluded to.
Mike (03:43):
Right.
I used to watch this show.
I haven't watched it for awhile now called Intervention.
Right.
It was on Arts and EntertainmentNetwork or whatever, and it was a
group of loved ones gathered secretlyand planned an intervention, presented
their concerns, and then if the personsaid they'd get help, the facilitator
would whisk them away, usually on anairplane to some place on a coast.
(04:09):
And they were greetedwith open arms, right?
And, and the productioncompany would pay for it.
Now, let's get back to real life.
In real life, you talkedabout there's a wait time,
oftentimes, between getting help.
What do you do to bridge that waittime between getting into a therapist,
even a therapist's office, becauseso many counselors I know have full
(04:33):
loads, or a treatment facility?
What can somebody do who's listening tothis, who's maybe waiting to get help?
Nanci (04:41):
Well, I have my own biases, so I'll be very straightforward with that.
You know, there's one placethat doesn't have waiting lists.
It doesn't cost anything.
And that is.
around here very accessible andthat is, you know, a 12 step
program, specifically AA or NA.
There are other types of recoveryprograms, again, that don't cost anything.
(05:05):
That can be challenging becauseit takes some courage to
walk into this unknown place.
I remember my own experiencewas, I was scared to death.
I thought I had nothingin common with everyone.
And I walked in there and I thought,why are all these people happy?
You know, pathetic people can't drink.
Very, very judgmental, whichwas just part of my disease.
But you know, it's there at almostany time, you know, in the greater
(05:31):
Milwaukee area and the surroundingareas, you can find meetings,
you know, multiple times a day.
And since the pandemic,we've got them online.
You can go to a meetingin Ireland if you want.
Yeah, it's very accessible, but thatdoes require some self discipline.
But I guess that would be my first thoughtis to connect with a community where you
(05:53):
have people that are going to supportyou until you can get more structure.
Mike (05:57):
The nice thing, you're talking about a suburban area, but the nice
thing is that structure, support groupmeetings are, well, as you said, online.
But they're also available, it's theone thing that actually is available
in many of the rural parts of thiscountry, and not much else is sometimes.
Okay, since you volunteered thatinformation, I've got to ask you,
(06:20):
because... okay, I'll just make itup because I'm sure none of these
take places in a church, right?
You pull up to the church andthe meeting's in the basement.
How do you get yourself fromthe parking lot to the basement
without turning back around?
Nanci (06:37):
It's a great question.
I think part of that comes from do youwant it badly enough and the people
that I've talked to who are in recoverywhether brand new or you know decades of
recovery say at some point they're so sickand tired of the way their life's going.
They were sick and tired of hatingthemselves that they're like,
(06:59):
I'll do anything just about.
And so I think that can be a big push.
I just moved.
And so I'm finding newmeetings where I am.
And I went to one and it's listed,but it was a church and it was huge.
And there's all thesedifferent parking lots.
So I walk in and I'm like, I have no idea.
So I just walked up to the receptionistand said, where's the AA meeting?
(07:22):
Now I'm comfortable doing that,but I don't expect that somebody
brand new is going to be in anyplace where they're able to do that.
It certainly can help if somebody cango with them, you know, even if it's
to find an open meeting, you know,because most 12 step meetings are closed
meetings because of the anonymity andthe confidentiality, but they're also
(07:45):
usually every weekend, there's an openmeeting somewhere where anybody can go.
Somebody gets up andthey tell their story.
And it can really resonate and thenyou have access to people to kind of
say, okay, we're here to help you.
Mike (07:58):
And an open meeting is more like you can just sit there
and listen to a speaker, right?
Nanci (08:02):
Nobody's going to call on you.
Nobody's going to look at you.
You can kind of fade into the woodwork.
Mike (08:08):
And if somebody goes to even a closed meeting thinking I have a
problem, they're not forced to speak.
They can say pass, right?
Nanci (08:16):
Absolutely.
Yeah.
So, you know, a lot of times, you know,I couldn't figure out why everybody
knew that I was new until I realizedthat everybody else knew themselves.
And I walked in looking like anabsolute terrified, you know, on the
verge of tears, middle aged woman.
And so they do what'scalled a first step meeting.
And so I get whisked into thisother room and but it was just
(08:38):
the surrounding of support.
But even in those situations, ifsomebody says, I'm not ready to talk,
nobody's going to force them to.
Mike (08:44):
Right.
Right.
Well, I, you know, what we'retrying to do with this is just take
away some of that uncomfortabilitybecause that would be part of it.
When I was reading your bio, itsaid that for you that therapy is
a collaborative endeavor where theclient is the expert on their own life.
Okay.
So given that now let's, we justtalked about somebody who recognizes
(09:04):
as a problem, but therapists, a lot ofwhom listen to this program, yourself.
You get people that come to you withoutrealizing or without acknowledging
that substance use disorders are aproblem for them or the main problem.
So at some point, you'regoing to bring it up to them.
(09:24):
At some point, you're goingto say, how do you say it?
What do you say?
Nanci (09:29):
Well, if the conversation... I'm thinking about, you know, some of the
conversations I've had, and if they'retelling me about a situation where
some bad things happened, and I'm nottalking like, you know, going to jail
or anything, but they were embarrassed.
They don't remember what happened.
You know, we start talking about,well, how are you feeling about that?
(09:50):
Has that ever happened to you before?
What would you have liked to be different?
Anything to sort of engage themin going a little deeper and then
considering, is this something thatyou are concerned about because it's
happened before or it might happen again?
Or we'll talk about, so whatwould it be like if this happens
(10:13):
the next time you go to a party?
Or what were you afraidmight have happened or what
was it like to not remember?
And once they are acknowledging thatthere's a problem at some level.
You know, getting beyond the,Oh, that will never happen again.
Because quite frankly, if that'stheir attitude, I don't think
they're going to tell me about it.
Mike (10:34):
Right.
Nanci (10:35):
So the fact that they're bringing it up at all says I'm not
feeling comfortable about this.
So validating them really acknowledgingtheir feelings, letting them
know that they're not alone andoffering them some alternatives.
And that's where them being theexpert on themselves is important
because I can bring suggestions.
(10:55):
But I'm always very clear that look,I'm going to throw out suggestions.
Your job is to tell me what you thinkwill work and what won't, because
I'm not going to push something onyou that you're absolutely against.
So if I bring up, for example,AA and somebody's like, Nope,
that's that whole God thing.
I don't want to go there.
Okay.
Maybe we'll have a conversationabout that and I'll check in on
what they believe and what they'veheard versus maybe what is reality.
(11:19):
But I'm also going to be respectful ifthat's just not where they want to be.
And then we look at other things,so that's not the only option.
Mike (11:25):
I would imagine every counselor has their own style
and the way they approach things.
I remember the woman who my mom saw, asmy mom was with her head in her hands in
the hallway at a hospital, walked down thehallway, clickety click, took a seat next
to my mom, and the first words out of hermouth were, Audren, you're an alcoholic.
(laugh)
(11:45):
So there's everything in between, right?
Whatever you're comfortable with.
Nanci (11:49):
Yeah, and it's not to say that I won't be very blunt.
It really depends on the situation.
It's like, read the room.
You know, you gotta know yourclient and see what's gonna work.
And even in my own experience, myfirst sponsor was someone who was
pretty blunt, and I needed that.
Mike (12:06):
Well, I had a kid once say to me, and I assume this is also
part of your therapy and everybodyelse's, is, okay, now that you're
taking away my main coping mechanism,I know they don't put it that way.
What are you gonna gimme instead?
You're, you know, the guy said to me,you're, "Mr. Don't take something away
unless you replace it with something." Itcaught me a little bit upside the head.
(12:27):
Right?
You need something else totake the, whatever that is.
What styles do you find is effective?
You do EMDR, right?
Nanci (12:35):
Yes.
Mike (12:36):
Does that work with substance abuse?
Nanci (12:39):
It's a great, great question.
So EMDR is eye movementdesensitization and reprocessing.
And it's used fortreating trauma primarily.
And what I have found the longer I'm inthis field is that a lot of what people
come in with is related to trauma.
And trauma looksdifferent on every person.
(13:00):
It isn't the car accident, the, youknow, being assaulted in a back alley.
It trauma can be growing up in ahousehold where you were expected to
suck up your feelings and be the nicecooperative child and you didn't have
anybody who you could talk to youabout things that were were going on.
(13:21):
Trauma can be not, you know, being exposedto violence and other people in the home.
It's a whole range of things.
So my experience for the most part isand you obviously, I'm sure you with all
of the years you've experienced you havemight have some other thoughts on this.
We don't just drink and numbourselves out just for the fun of it.
(13:46):
We're usually trying toescape from something.
Mike (13:48):
Right.
Nanci (13:49):
And so acknowledging that and acknowledging that there
is pain and discussing how dowe go about healing that pain?
Because a lot of people are like,we're not going to go there.
I don't want to touch that.
You know, you're not goingto get into that yucky stuff.
It's sort of a combination process oflike, okay, so here's some of the stuff
that's going on underneath that you'reresolving by drinking or drugging.
(14:13):
Or shopping or overexercising orwhatever and we want to address that.
It's going to be hard to address it ifyou're still anesthetizing yourself.
So we got to help you come up withsome other ways to roll through those
emotional tidal waves that come in.
And so teaching some skills forgrounding, centering themselves
(14:36):
getting through that wave.
So I realize that didn't reallyanswer your question about EMDR, but
I guess that's a back up to that.
Mike (14:43):
That's one of the techniques to do that, right?
Nanci (14:45):
Yeah.
I wouldn't typically startsomebody out if they're brand new
and starting to tackle recovery.
I'm not sure that I would throwEMDR in there right away because
that's an awful lot of stuff.
They're just trying to figureout how to get through every
24 hours without drinking.
And EMDR is going to stir up some stuff.
And so I think giving somebody achance to get a little bit of kind
(15:09):
of get their sea legs before wego into some of that deeper stuff.
But it is important.
It's not going to go away.
Mike (15:17):
Well, since you do family and couples as well, let's do the flip
side of that whole therapy equation.
And you touched on it before.
Some clients tell their familymembers, and it sounds just like,
Fine!, I'll go to counseling, right?
That sounds enthusiastic.
And then go a couple of times anddismiss it as BS, ineffective, or the
(15:39):
old gaslighting, I did what you asked!
And then quit.
Now I'm sure it never happens to you, butloved ones also here about the counselor.
She doesn't know what theheck she's talking about.
It's a waste of money, right?
Nanci (15:55):
Oh, I've had that happen.
Mike (15:56):
Yeah.
Well, I know.
And it's like, yeah, we don'tknow what we're talking about.
And then that's reinforced with,I was talking to my buddy down at
the... And then the person quits.
How does a concerned personrespond to those diversion tactics?
If you're working with like the partnerof somebody who wants to go through
(16:17):
that, or an adolescent who says totheir folks, there ain't no way I'm
going back to that wonderful woman.
Right?
Nanci (16:25):
Yeah.
I have an approach that others may ormay not agree with, but I try to manage
the expectations of the family members.
I've had plenty of people comein saying, I really need my
partner to go into therapy.
Mike (16:41):
Yeah.
Nanci (16:42):
And I'm like, okay, so they go to therapy, then what?
You have no idea what they'retalking about in therapy.
You have no idea what their goals are.
I recently had somebody who came in andspecifically because their partner wanted
them to go and I said, okay, that's fine.
Why do you want to be here?
Or do you want to be here?
Because there's no pointin going any further.
(17:04):
So getting them invested inwhatever is motivating for them.
But I think letting family members knowthat you can't push them into it and
expect that that's going to cure them.
Mike (17:19):
You know, there's an old saying, you can't con a con.
Can you tell when somebodyis serious about recovery?
Nanci (17:24):
I've been in family therapy and I've sometimes been the person
to basically say, cut the BS.
I've been in meetings wheresomebody has just, you know, let
somebody ramble on and dig a holefor themselves and then go, okay.
That's garbage.
Let's start over again.
Now tell me, you know,what's really going on.
So yeah, I mean, you can't always,but certainly you can tell, I think
(17:46):
it's easier to tell when somebody'sserious about it than when they're
just trying to go through the motions.
Mike (17:53):
This may be a dumb question, but I think about it sometimes.
Does quitting therapy or treatment makeit easier or harder to get back into it?
Nanci (18:04):
Get back into therapy?
Mike (18:06):
Yes, yes.
Like if you quit something, doesthe shame, the guilt, when you
realize you shouldn't have quit it,does it make it easier to go back
into it because you now know whatit's about, you know where it is?
Or does it make it moredifficult because of your pride?
Nanci (18:21):
I'd say both.
It really depends on the person.
I've heard people say, I don'tthink I have another recovery in me.
Mike (18:30):
I hear that.
Nanci (18:31):
I have heard people say, you know, I went to therapy and I wasn't ready
to do the work, or I was in treatmentand I wasn't ready to do the work.
And then they come back around.
So I would say if you spent any timein either, unless you've just had a
horrible experience and there are,you know, therapists range in quality,
(18:54):
just like any other profession.
But if you've had anypositive experience in there.
Just because you leave you didn'tunlearn the things you learned.
Mike (19:06):
Right.
I used to have my counselor say andthey used to list this is a problem.
She's treatment savvy.
Nanci (19:13):
Resistant?
Mike (19:14):
No savvy like and I'm like why is that a bad thing?
If they know what treatment islike, don't you expect more of them?
If I know the offense, thengo shoot the ball, right?
Nanci (19:26):
Right.
I wonder if their term of that wasthey know how to play the game.
Mike (19:32):
Well, right.
That's what they were saying.
Nanci (19:34):
Yeah, that doesn't sound like that's a compliment.
It's this is somebody who knows how to dowhat they need to do to get out of there.
And we've all heard people whosaid, yeah, I went in there and
I just did what I had to do.
I've seen that a lot with adolescentsand they're smart, you know, and
that's where I try to play on thatskill and say, look, you clearly
have a lot of really great talents.
To be able to, you know, figureout how to beat the system.
(19:58):
How else do you want to use those talents?
Mike (19:59):
Right.
Yeah, I mean, because at somepoint, you never really know.
I've had arguments with people wherethey say, Oh, I always assume that
the client is telling me the truth.
And I'm like, really?
I don't.
Because you don't know, right?
You never know if whatyou're getting is the truth.
Or even if the truth as they see itmight be different than the truth their
(20:21):
boss, their partner, their children.
Nanci (20:25):
Yeah.
And I think, you know, the, I alwaysam under the assumption that I'm
going to get a filtered version.
And it's one of the things I love aboutmy job is, you know, especially as I
get to know my clients and some of themI've worked with for years, I can just
tell by the way they walk into my officeor the look on their face, that there's
(20:45):
something that they're struggling with.
Am I going to tell mytherapist this or not?
And, usually they end up, butyou know, there's that struggle.
And then I've also had clientswhere I had no idea the degree
to which they were fabricating.
But yeah, the most part, I thinkyou kind of know, but yeah, I don't
expect people are going to tellme everything because they want to
(21:08):
present themselves in a positive light.
Mike (21:10):
I spent a long time working with adolescents and I would bump into them
into adulthood and we'd start to talkin a Target or a store and they would
just grab my arm and say, Oh, hey.
When you were working with me,this, this, this was going on.
Would that have helpedif you would have known?
(laugh) And, and I, well, maybe a little.
(21:31):
We certainly wouldn't havewasted all that time on other
things that weren't the problem.
Nanci (21:36):
Yes, I had somebody, it was a newer client, but the other
day, you know, I thought we'dgotten through the whole history.
We're getting ready to start.
She's, Oh, there's this thing thatmaybe would be helpful for you to know.
And I was like, when she gotdone, I'm like, yeah, that
just became like the core.
Mike (21:52):
Yeah.
Right.
But yeah, I'm, I'm cheating on my partner.
I've embezzled fromwork and I'm on the run.
Right.
Okay.
If this is a disease itis and relapse is common.
How do you talk about it without makingit to the client sound inevitable?
Nanci (22:11):
I usually don't bring it up unless it seems like that's a
direction that needs to be addressed.
Interestingly, I had somebodythe other day was talking about
a loved one and they said, well,I know they're going to relapse.
And I said, well, we'llhold it right there.
Don't assume that's an absolute.
Yes, sometimes people relapse,but there are people that get
(22:34):
into recovery and they don't.
Mike (22:36):
Yeah.
My mom didn't.
Nanci (22:37):
And yeah, or they don't for 20 years.
So I wouldn't build that in asbeing an expected part of the
recovery path, because now you'veset somebody up with an out.
So the only thing Ireally bring up is that if
you feel like you're goingto pick up any or use.
(23:01):
Let's talk about the safety plan.
What are you going to do?
And then and if for some reasonyou still end up picking up
you got to come right back in.
And that's why I always say it'sso important to go to a lot of
meetings because you see peoplecome back after a relapse And
you see that they are not shamed.
(23:23):
They are not rejected.
They are not criticized.
They're supported andthey're welcomed back in.
It doesn't mean that they'recoddled, you know, if there's stuff
going on there, people will sayit, but it's important that they
know that that's always an option.
Because some people are too scaredto go back in because of the shame.
Mike (23:45):
Yeah, I think that's really an important point, which is once you
know that, you know, if something doeshappen, it does take away a lot of
the shame of going back in, knowingthat you're going to be accepted
because we're just all human, right?
Nanci (23:59):
Right.
Mike (24:01):
So long term, you know, if somebody's been relying
upon substances for everything.
Celebration, coping,grief, whatever, anger.
Learning new techniques takes time.
Patience is gotta be anessential part of therapy too.
Nanci (24:22):
Yeah, I think managing my client's expectations is important.
Sometimes they're very hard on themselves.
And I have had so many clients sit thereand say, why is this taking me so long?
There's something wrongwith me, I'm failing.
And so we break it down and look,the first thing is to introduce
the idea that you're open tochange and let that sink in.
(24:47):
And then we look at thenext step and the next step.
But if you think you're goingto go from here all the way
over to here in a day or a week.
You're going to be disappointed.
You didn't get here overnight.
You're not going to getout of it overnight.
Mike (25:01):
How long do you think, I know it's a ballpark, but how long does
it take before you feel comfortable?
The analogy I use all the time is ifI lost the use of my right hand and I
had to start doing everything with myleft hand, I might be able to do it.
But before I could feed myself lefthanded, it would be a quite a while for
it felt comfortable that that's who I was.
Nanci (25:27):
It's building new pathways in your brain.
And it doesn't matter how old we are, youknow, our brains have a lot of plasticity.
So it's kind of like, if you keep cuttingacross your lawn in a certain path, you
know, over time that grass is going towear down and the ground is going to get
flat and it's going to look differently.
And if you stop that, and youstart walking a different way.
(25:50):
It's going to take time forthat first path to grow back,
and for that other one to form.
I used to use the analogies of, you know,all the construction that was happening
like on I-43 or whatever, you know.
It becomes, you know, eventuallyyou get a nice smooth road again.
So, to know that it'll take time, andyes, it will be hard at first, but it's
(26:11):
going to get easier and easier and easier.
And when we're talking about small tomoderate behavioral change, like if
you do this consistently for a week,you're going to find that you're not
having to do it in such a focusedmanner, it's going to become automatic.
It's like, how many people thinkabout brushing their teeth or what
they do when they get in the shower?
(26:31):
They just do it.
Mike (26:32):
Right.
Nanci (26:33):
And you will get to that point.
Mike (26:36):
Right.
And you don't even know you're there.
Nanci (26:38):
Right.
Mike (26:40):
And you know, the well, I'll let you go away on this.
There's happiness at theend of the tunnel, right?
Nanci (26:48):
Yes.
Yes.
From my own experience and that of peopleI know both personally and professionally
and granted, I only see the peoplethat, you know, keep coming back.
Mike (27:01):
Right.
Nanci (27:01):
I don't see the people that fade away, but I hear things like, I
never knew my life could be this good.
I never knew that I could navigatethrough problems without, you
know, completely imploding.
My relationships are better,the way I feel about myself is
better, and that's a big one.
You know, we start tolike ourselves again.
(27:21):
So, yeah, people will say, Ihad no idea that I could have
so much fun without alcohol.
Or without drugs or whatever.
And yeah, because you get toexperience it all and remember it all.
You know, I think you had saidonce, why would people go and
spend a ton of money on concerttickets and then be obliterated?
Mike (27:40):
I don't get that.
Nanci (27:41):
And not remember the experience, yeah.
So yes, I think, and for the familiestoo, you know, you know so well that
it takes time to rebuild that trust.
But once it's rebuilt, it's prettydarn solid and it feels really good.
Mike (27:56):
Great.
Well, this has been terrific.
I thought about four different littleareas we could dive even deeper in.
So maybe we'll do this again shortly.
Nanci (28:05):
Absolutely.
Mike (28:06):
As you all know, there's links to Nanci's contact information attached to
the podcast if you want to ask her more.
Thanks for being with us andsharing your expertise, Nance.
And for everybody listening,listen anytime you're able.
And until we talk to you nexttime, stay safe, keep going.
The destination is worth getting to.
Nanci (28:26):
Thanks.
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