December 8, 2025 • 50 mins
What if the fastest way to help a loved one stop using isn’t pushing harder but stepping out of the “villain” role? We sit down with master addiction counselor and YouTuber Amber Hollingsworth to unpack a practical, compassionate framework that actually moves people from resistance to readiness. Amber explains why policing, nagging, and ultimatums create the perfect distraction from change—and how strategic empathy, active listening, and credibility open the door to real motivation.
We break the recovery process into simple, workable steps: stop being the bad guy, build trust by reflecting the person’s perspective, and allow the bargaining phase—“only on weekends,” “just beer,” “no more pills”—to serve as useful data rather than defeat. You’ll hear how to accelerate learning without triggering defensiveness, why a 30-day trial of sobriety is a powerful reality check, and how to prepare resources so you can act quickly when the “I’m ready” moment arrives. We also dive into separate-counselor models that lower conflict, how to align change with a person’s values and strengths, and the role of humor and respect in keeping people engaged.
We don’t ignore medical realities. From treating insomnia, anxiety, and depression in early recovery to using long-acting buprenorphine injections for opioid use disorder, we explore low-barrier tools that improve safety and adherence—especially vital in the fentanyl era. The goal isn’t to force a path; it’s to create conditions where the next right step feels easier than the last wrong one.
If you’re a parent, partner, or clinician looking for strategies that work in the real world, this conversation offers concrete scripts, mindset shifts, and timing cues you can use today. Subscribe, share with someone who needs it, and leave a review with your biggest insight—what’s one change you’ll make in your next hard conversation?
To contact Dr. Grover: ammadeeasy@fastmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
Welcome to the Addiction Medicine Made Easy
podcast.
Hey there, I'm Dr.
Casey Grover, an addictionmedicine doctor based on
(00:20):
California's Central Coast.
For 14 years, I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side of thefight, helping people rebuild
their lives when drugs andalcohol take control.
Thanks for tuning in.
Let's get started.
This episode is on how tomotivate someone to stop using
(00:44):
drugs and alcohol.
Let me give you the context onthis episode.
So I get random emails all thetime from publicists saying,
hey, don't you think my clientshould be on your podcast?
And sometimes they connect mewith an awesome guest, and
sometimes I have to say thatthey are not a good fit for my
podcast.
So I got an email sayingsomething like, hey, my client
(01:06):
is a drug and alcohol counselorwho specializes in helping
people who aren't motivated toget sober change their mind and
actually start wanting to getsober.
And you can bet I wanted to havethat person on my podcast.
So this episode is with thatperson.
Her name is Amber, and she is adrug and alcohol counselor.
And this interview was amazing.
(01:27):
I will be sharing this episodewith so many of the families
that I work with.
Amber has worked out a uniqueapproach on how to motivate
someone, even if they areresistant, to want to quit drugs
and alcohol.
Here's the summary.
First, don't be the bad guy.
The family member needs tochange their role from nagging
their loved one about drug andalcohol use to being more
(01:50):
supportive.
Second, start building credit.
The family member needs to feelthat their loved one is on their
side and trying to genuinelyunderstand their problem with
drugs and alcohol and supportthem.
Third, let them bargain.
People often, when they have anaddiction, aren't ready to
completely quit and often offervarious approaches to make
(02:12):
progress, like, hey, I'm onlygoing to drink beer, not liquor,
or, hey, I'm only going to smokeweed and nothing harder.
The family member needs to allowthis to happen so that the
person with addiction triesdifferent approaches, many of
which will not work, and so theycan start seeing that sobriety
is the best option.
And finally, the family memberneeds to be ready with treatment
(02:32):
resources when their loved oneis.
So when that, hey, I'm ready tobe sober moment comes, the
family member is all ready withthe right resources.
This approach is amazing.
I think Amber should publish hermethod so more clinicians can
start using it.
One final clarification beforewe start.
Amber usually has the patientwho has addiction and their
(02:53):
family see different cliniciansin her practice because putting
them in the same room usuallyinvolves a lot of conflict.
So her practice works with boththe patient and their family,
but the majority of the work isdone seeing separate counselors
to avoid that conflict.
Fantastic interview.
Let's get into it.
(03:15):
Okay, I'm so glad to have you onmy podcast today.
Why don't we start by just youtelling us who you are and what
you do?
SPEAKER_02 (03:21):
Sure.
My name is Ambert Hollingsworth.
I'm a master addiction counselorand a licensed mental health
counselor, and I've been helpingpeople overcome addiction for
more than 20 years now.
These days, most people know mefrom YouTube.
I'm a YouTuber and the channelis called Put the Shovel Down,
which may sound strange, butit's a recovery saying.
(03:42):
It means you hit your bottomwhen you put your shovel down.
You don't have to keep digging,you don't have to burn every
bridge and lose everything.
You can decide when you're done.
SPEAKER_01 (03:50):
You said you were a master addiction counselor?
Yes.
What does that mean?
SPEAKER_02 (03:54):
It's a national certification through NADAC.
unknown (03:57):
Oh.
SPEAKER_02 (03:58):
So you can be like a licensed counselor in your
state.
It's just like a level up fromthat.
SPEAKER_01 (04:03):
So let's start with your comment about put the
shovel down.
SPEAKER_02 (04:06):
Yeah.
SPEAKER_01 (04:07):
I've not heard that.
Tell me if you do you know anyhistory behind that phrase?
SPEAKER_02 (04:11):
My history with the phrase is one of my first jobs
in the field is I had anintensive outpatient program for
teens.
And one of the teens used to saythat.
I think you heard it in ameeting.
So you hit your bottom, you putyour shovel down.
And I feel like people hear thatall the time.
You have to hit bottom, you haveto lose everything, but I
disagree.
SPEAKER_01 (04:28):
Interesting.
Let's unpack that.
Have clients that come to me forall different reasons.
And I've heard people havinghigh bottoms and low bottoms.
So a person who has a highbottom maybe just gets a single
DUI, makes a big change, andmoves on.
A low bottom would be somebodywho maybe had an overdose or was
homeless.
(04:48):
Talk to me about how you use theidea of rock bottom in in your
work as a drug and alcoholcounselor.
SPEAKER_02 (04:55):
In my work, the idea of rock bottom is I try to get
people off of that track beforewe get there.
I deal a lot with people who Iwould call like a functional
alcoholic or addict.
Some of them actually very highfunctional addicts and
alcoholics.
And so I work a lot with theirfamilies on how do you get
through someone's denial who'sin that situation?
How do you get them movingtowards change, which can be
(05:17):
quite a task if someone'ssuccessful in other areas of
their life, it's really hard toget them to see, hey, this
really is a problem.
SPEAKER_01 (05:26):
So I'm gonna cut to the chase.
What's the answer?
How do you get to them?
SPEAKER_02 (05:30):
There's a there's a system.
The first thing you have to doas the family member is you have
to get out of the bag I rollbecause almost always what
happens when you have anaddicted loved one, of course,
you're you're watching them makemistakes, they're changing,
they're not themselves, they'reruining their life and yours
too, probably.
And so your natural inclinationis to want to grab them by the
(05:51):
shoulders and say, Wake up, whatare you doing?
And you start trying to get themto see the problem, and you're
doing that very directly, andyou start trying to catch them
because they tell you thatthey're not doing it or they're
not doing as much as you thinkthey're doing it.
And so you become like thesecret spy, you get, I don't
know, equipment, black lights orsomething in your purse, and you
get this whole cat mouse dynamicgoing on.
(06:12):
And that's a huge problem.
And the biggest reason that's aproblem is because as long as
you're the villain in theirstory, they don't have to look
at what's going on with them.
It's like you're a giantdistraction.
And the reason I know this isbecause all my years of
counseling people with drug andalcohol problems, if the family
is playing the villain, that'sthe only thing that they will
(06:34):
talk to me about.
Like we cannot talk aboutanything else other than my wife
or my husband or my mom or mysister or whoever it is.
It's like it's the first, that'sthe first piece that has go.
The most important piece is tonot play the villain in someone
else's story.
SPEAKER_01 (06:50):
That's so funny because I heard you say the
first thing you've got to do,and then I didn't understand the
phrase.
That's so fascinating.
You have to stop being thevillain.
One of my patients this week,his wife brought him in and she
said, I'm tired of being thealcohol police.
Interesting.
Okay, so that's step one.
What's next?
SPEAKER_02 (07:09):
So once you get out of the villain role or bad guy
role, as I call it, you start tobuild credibility with your
loved one.
And I it's kind of like buildingcredit if you wanted to buy a
house and you need a certaincredit score or something.
You start building credit withyour loved one.
And if you're in the bad guyrole, you got negative credit.
So first we gotta get toneutral, right?
(07:30):
And then the way you can buildcredit with your loved one is
they wanna know that youunderstand them, which is
different than you love them.
They know that you love them.
And sometimes that's annoying tobe honest, right?
It's they want to know that youunderstand their point of view
because someone doesn't carewhat you think if they don't
think that you get them.
(07:50):
Like, for example, you may knowyour grandmama loves you, but
you're probably not gonna listento her opinion or follow her
advice if you don't think shegets your situation.
So you spend whatever amount oftime it takes to help this
person understand that youunderstand them.
The way you do that is you use alot of active listening skills,
you look at things from theirperspective, you use a lot of
(08:11):
strategic empathy.
That's what I do as a counselor.
I just spend however many weeksit takes to just do that.
And I just wait until I got mycredit score where it needs to
be.
And then I wait for the rightmoment and then I cash my credit
in.
And then they're like, thankyou, Abby, you helped me so
much, instead of this whole, I'mtrying to make you do something.
When you have good credit withyour loved one, they care what
you think and they care aboutthe relationship.
(08:33):
And so this idea of if I don'tget it together, I'm gonna lose
this relationship is actuallymeaningful.
When you're in the villain role,this whole if you don't get it
together, I'm gonna leave,they're thinking, I wish you
would.
So it doesn't work, the wholelike ultimatum thing.
SPEAKER_01 (08:48):
Addiction medicine is a listening specialty.
I do a lot of listening.
So let me make sure I understandthis.
So you're saying step one is togo from not being the villain,
and step two is to get creditwith them.
Essentially, it sounds likeyou're trying to remind them
that you care and you're ontheir side.
SPEAKER_02 (09:07):
It's of course it's that you care, but it's that you
get it.
Like what a counselor would do.
Like I listen to you and I'mlike, oh, it's like this.
Oh, you're oh, this is what'sgoing on.
So you're just spending timecompletely understanding their
perspective and mirroring thatback to them so that they get
that you get it.
And then what you have to say isvalid.
SPEAKER_01 (09:30):
So it's listening, but being actually willing to
accept their perspective.
SPEAKER_02 (09:35):
Because we may not agree with everything that they
think or everything that theydo, but there's a piece of it we
can understand.
Like we could understand whysomeone might want to come home
and have some drinks after workbecause they're stressed.
We can understand why someonemight want to do drugs at a
party to fit in.
Like we may not agree that's theright answer, but there's a
piece of it we can empathizewith.
(09:56):
And if we can understand theirpoint of view, it just helps
them lower their guard down andbe so much more influenzable.
SPEAKER_01 (10:06):
So interesting.
So I'm thinking in my own mindabout my own practice.
When I'm seeing a new patient, Iusually ask two questions that
are the most helpful.
The first is, why do you want toget help?
And to your point, if I hear mywife is annoying me, I know it's
not gonna go well.
So that's like you were saying,that spouse has to stop being
the bad guy.
(10:27):
And then the second question is,what does the substance do for
you?
How does it help you?
And that goes back to yoursecond piece.
How interesting.
I've never thought of yourframework, but it makes perfect
sense.
Yeah.
SPEAKER_02 (10:37):
Well, I think the reason why I'm good at dealing
with people in denial, becausemy whole career, people that
come sit in an addictioncounselor's office don't usually
want to be there.
They're usually leveraged in bysomeone or they don't think they
have a problem, or they're justdoing it to get out of some
trouble or something.
And so I've had to learn to workwith that.
So when someone, it's the samequestion I ask.
When someone tells me that, I'mlike, good, you're in the right
place.
I'm gonna get you out of thismess.
(10:59):
When I'm on your side, I'mliterally like, what do you
need?
You need to do something?
Let me write you a letter, we'regonna get you out of trouble.
And then they see me as alignedwith them.
And now we can be a team and wecan figure out this problem as a
team.
SPEAKER_01 (11:11):
Yeah, it's interesting.
I do a lot of educating parentson how to talk to their kids
about drugs and alcohol.
And there's three situations welook at.
The my kid's doing fine, I justneed to teach them.
I'm worried about my kid andoops, I found my kid using.
And the advice I give theparents around the I found my
kids using is to sit down andask legitimate questions with
(11:33):
genuine curiosity to try tounderstand them.
Same thing, your same idea,different framework.
This makes perfect sense.
SPEAKER_02 (11:40):
Yeah.
If you're working in this field,this is what you've been doing
all these years.
So I'm just basically teachingfamily members how to do this
because sometimes you can't getyour person to sit in front of a
professional.
It'd be great, yeah, send themover to Amber and you can do it
for me.
But what if you can't get themto see Dr.
Grover or Amber, whatever?
You're the only one.
You're the front line.
And honestly, it's not reallythat complicated, really.
(12:00):
It's it's just against yourinstincts.
But once you understand theprinciples of it and what you're
doing, then you can help movethat person along in their
stages of change.
SPEAKER_01 (12:09):
How do you navigate difficult history between a
loved one to help them be ableto start being genuinely
curious?
SPEAKER_02 (12:18):
If you got a lot, and you usually do, of like bad
blood or distrust on both sides,one of the quickest ways you can
get yourself out of the villainroll is just admit it.
So if you can say, I've beendoing a lot of thinking about
it, or I went and saw somebodyand I realized I've been
handling this all wrong, and Ihave not been helpful to you at
all.
And I'm gonna rein that in.
(12:38):
I've been trying to control it,I've been critical of you.
Like whatever it is that theythink you've been doing, you own
it.
Call it an accusation audit.
Think of what they would accuseyou of and give it, give them
all the leeway, all you know,and use their words and say,
you're right, I've been doingthis and this, and that's not
even helpful.
And then they're all of a suddenpaying attention to you, and now
you got their attention.
(12:58):
Now you have to consistently bedifferent, but that's a good way
to get them to shift faster.
SPEAKER_01 (13:04):
I think I'm gonna have trouble articulating my
question, but what's the mostnumber of years you've seen a
couple, brother, sister, parent,child, have the person with
addiction, bad guy role make thepositive change to no longer
being the bad guy and startingto be on the person with
addiction side?
What's the quickest or what'sthe what's the longest period of
(13:27):
bad blood before they startedusing your framework that you
saw at work?
SPEAKER_02 (13:31):
Oh my gosh, I don't know.
Any number of years.
Depends on how old they are whenthey come to see me.
Like they could have beenmarried 40 years.
They could have been parentingthis kid 30 years.
It depends.
SPEAKER_01 (13:42):
Do you find that there's like a certain amount of
time of the bad blood years, ifyou will, that makes it harder
for them to work with you anduse your framework?
SPEAKER_02 (13:51):
Yes, but it's not really the amount of years, it's
the amount of hurt feelings andemotional damage more from the
family member's role than fromthe addict's role.
Like the family member has ahard time getting past their own
hurt feelings to do what I'mtelling them to do.
And I don't blame them.
It is completely unfair.
And that's what I say.
Everything I tell you is gonnabe totally unfair.
Let's just say it, but it'sgonna work.
(14:13):
I'm not about what's fair, I'mabout what's gonna work.
And this is what you want tohappen.
And I'm very directive becausewhen people are in crisis,
they're like, what do I do?
What do I say exactly?
Say this at this moment you'regonna do this, and it's gonna
work.
But it's hard to hold back allthose things you want to say.
SPEAKER_01 (14:28):
And is your practice more with families or with
people with addiction or both?
SPEAKER_02 (14:33):
Both.
The way that I've done practicesince I've been in private
practice is I usually see theperson who has an addiction, and
I have other counselors orcoaches who work with the family
members.
And instead of doing it all inthe same room, we do it
separately.
So on the back end, I would havethe family counselors working
with the family members while Iwork with the person, and that
(14:54):
sort of expedites the wholeprocess.
SPEAKER_01 (14:57):
Do you find that transition to being on someone's
side is more complicated when,say, the person with addiction
is a teenager and you're workingwith their parents?
SPEAKER_02 (15:05):
I I think it it's not really any more complicated
in that the strategies work justas well, but it is more
complicated in that when you'reminor, your person under 18 is
doing things that are illegal,and then you feel like you have
certain responsibilities as aparent that you really just
can't quite take your hands offof.
There's some complications withthat.
Just as far as like what's yourliability, what are your
(15:28):
responsibilities, and that sortof thing.
SPEAKER_01 (15:31):
Because I find with my teenage patients, they come
in with their parents and I playref.
Mom and dad are upset, and thenthe patient's upset, and then
mom and dad are upset, and it'struly I am the referee.
SPEAKER_02 (15:42):
That's why I don't put them in the same room.
I can't do it.
I hate it.
SPEAKER_01 (15:46):
Interesting.
I've not done that.
SPEAKER_02 (15:48):
No, that's why everybody gets their own person.
We call it lawyering.
And I'm always the defenseattorney.
And so when I see one person,it's my job to get you out of
trouble.
What we need to do.
And uh sometimes we'll meet allin the same room, but not until
we're ready.
And when we do, the family comeswith their person.
I go with my person, likeliterally, like you're going
with your advocate.
Because then you feel like youhave someone on your side.
(16:09):
Because if it's just one person,both sides are just trying to
convince you to tell the otherside that they're wrong.
And I hate that.
SPEAKER_01 (16:16):
100%.
Yes, happens all the time.
SPEAKER_02 (16:18):
Hate it, hate it.
I'm just not good enough to dothat kind of family counseling,
I think.
SPEAKER_01 (16:23):
So let me just make sure I get this straight.
So you're saying that yourmodel, first don't be a villain,
next, get credit with them,works best when the person with
addiction has their counselor,the family has their counselor,
and then you all, when you allmeet together, the counselors do
basically the negotiation.
SPEAKER_02 (16:40):
Yeah, and a lot of the negotiation happens behind
the scenes, just like court,right?
A lot of times the lawyers workit out.
It might be like, I want my momto quit reading my journal
behind the scenes.
We hash it out and we say,Listen, I need your person quit
doing this.
Listen, I need your person tounderstand this, and we kind of
like help that happen.
And these days, because I'm onYouTube and I teach families
(17:01):
this on YouTube, like they'realready doing it long before
they ever even see us or anybodyfor that sake.
So it's already like when theperson gets to me now that the
family's been doing that allalong, they come in ready.
They're like, Amber, got a bigproblem.
You gotta help me.
And I've been treating my familyterrible, and I gotta stop doing
that, which is completelydifferent than like most of my
(17:22):
career, which is I'm herebecause my wife made me, I'm
here because, you know, thenorm.
SPEAKER_01 (17:28):
Yeah.
Okay.
So we've got step one and steptwo.
What's the next?
SPEAKER_02 (17:32):
Okay, so as you're building credit and you're not
being the villain, your personis probably gonna move into the
fancy word, be contemplationstage, but I call it bargaining.
So before a person decides theyneed to stop completely, they're
gonna try to cut it back orcontrol it, and they're gonna
try a lot of bargains.
(17:52):
And as the family member, if youjust understand that this
actually is good news because itmeans they're trying to figure
out what they need to do tochange, but they're gonna try a
lot of wrong things first.
So I teach families, it's yourjob to help that go faster.
You can't make someone skipthat.
And maybe they say they're gonnaonly drink this much or they're
only gonna smoke that much orwhatever.
(18:13):
That's not true.
It's your job to say, okay,let's try that.
That'd be good.
And then let that person fail.
And then we move to the nextbargain, next bargain.
And that's how we get to thepoint of what old school
recovery would callpowerlessness.
You're not gonna get to that, Igotta let go of this completely
until you've tried all thethings.
And so we teach family membersto say, let's try that.
(18:34):
Okay, let's try that.
Well, that doesn't work, let'stry that, but if that didn't
work, let's try this to help aperson move through that faster.
You can expedite it.
SPEAKER_01 (18:43):
How long does that bargaining phase usually last?
SPEAKER_02 (18:47):
I don't, that's hard for me to say.
I feel like when people startusing our strategies, I'd say
within, I want to say for themost part, within six months to
a year, sometimes faster.
SPEAKER_01 (18:57):
Yeah, that makes perfect sense.
So I'm just thinking about thiswith my patients.
Interesting.
Okay.
Do you have your patients keep awritten ledger?
Like you literally write downthe idea and it didn't work,
cross it out just so they don'tgo back to the same idea before.
SPEAKER_02 (19:10):
No, because they will go back to the same idea
before.
They'll try it a few timesbecause what will happen is
they'll say, let's say I'm justgonna drink beer, not liquor, or
something like that.
Or I'm just gonna smoke weed,I'm not gonna do cocaine
anymore.
It doesn't matter, whatever thething is.
They'll probably be successfulat that for a little bit, and
then they'll fall off the cliff.
And then they'll think, I justgotta go back.
I was doing really good.
So they'll try it more thanonce.
(19:33):
So it's not a matter of, okay,try it, check it off.
It's let me try that again.
And you gotta give people roomto do that.
But while they're doing that, Iplant some seeds.
I say, yeah, let's try that,then that'd be good.
Say a lot of times people end upfiguring out that actually
easier to do none than a little,but it's really different for
everybody.
So let's try that.
If it doesn't work, don't worry.
We got plan B, C, D, E.
(19:55):
We're gonna figure this out.
So that way when it doesn'twork, they come, they don't have
an issue coming to me saying, Itried it, it didn't work, or it
worked for this long and then itdidn't, because we're just
problem solving it together.
And then they come to theconclusion that it really is
easier to do nothing than alittle.
Because I plant these seeds, Isay, no, like even if you can
pull it off, is it really evenworth it to drink two beers?
(20:19):
What's that gonna do but makeyou thirsty?
And so we have these funconversations along the way.
I'm sending these, this couldhappen to you, but I'm not
saying this will happen to you,I'm saying this could.
It plants a seed and then theyfigure that out fast.
SPEAKER_01 (20:32):
And how do you support the family member who
wants immediate change to beokay being patient?
SPEAKER_02 (20:40):
I just tell them that they couldn't want that all
day long, but as if they'retrying to force it, they're
slowing down the process.
And I'm just if they just lookback at their own experience,
they're gonna know I'm they'regonna know it's true because
they've been trying that beforethey got to me for a long time.
So I'm like, you're just slowingit down.
We could get to this faster.
SPEAKER_01 (20:59):
So it almost seems like by trying to rush it, they
go back to being the villain.
SPEAKER_02 (21:03):
That's right.
But it's in patience, is what itis.
It's I want them to figure itout faster, but there's a
process of figuring it out.
And I also teach them how tolook for the winds that things
are actually moving alongdifferently, and then it helps
the family tolerate it.
So, like I'll say, when yourperson comes to tell you, I'm
(21:26):
just gonna smoke on theweekends, and then we're two or
three weeks in and they'resmoking on Monday and Tuesday.
I don't want you to be upset.
I want you to be like, thankgosh, because we gotta prove
this theory wrong quickly.
And then I'll say, whatever youdon't remind them and tell them
they said they were only gonnado it this much and they need to
do it this much.
Because the whole pulling itback thing is never gonna work
anyway.
(21:46):
So you want not to be upset whenthat happens, but rather be
like, okay, good.
Okay, good.
Now, like they're learningfaster.
And then you tolerate it betterbecause you see it more as
movement rather than as they'renot trying or they lied or
they're never gonna figure itout.
You see it as, oh, that that'swhat we need to happen.
SPEAKER_01 (22:04):
Do you teach the family member specific scripting
of, hey, I see you're smoking ona Monday.
It sounds like our plan didn'twork.
What's next?
Do you teach them how to not getupset and be able to, again,
build credit, maintain creditwhile they say, hey, this didn't
work?
SPEAKER_02 (22:20):
Sometimes it if I'm working directly with them, it
depends on their loved one andwhat I know about their
situation.
If that relationship couldtolerate that, or if I know that
relationship, if the person isjust extremely defensive and
would just get super mad.
So I would case by case basisabout whether you brought it up
and how to bring it up.
SPEAKER_01 (22:41):
How does it go when someone's life is on the line
because of their addiction?
Let's say somebody has advancedcirrhosis from alcohol, and
maybe we don't have a yearbefore their liver's gonna give
out.
SPEAKER_02 (22:51):
In that case, you're not dealing with someone in
denial.
That's a harder case.
I always say dealing with peoplein denial, it's not that hard.
That's dealing with somebodywho's just given up.
If you've got advancedcirrhosis, you might be
minimizing it to someone elseout loud, but in your head, you
know.
And so that's actually harder, Ithink.
When I'm talking about denial,I'm talking about like literally
(23:12):
this person does not know.
Not they're denying it to you,of course they're doing that,
but like they're denying it tothemselves.
When you're dealing with someonewho's super far in like that,
like into stage four, like tothat level, they probably know
the issue there is probably morethey're telling themselves
something like, just screw it.
If I'm this far, or I'm nevergonna get better, or that's just
who I am.
(23:33):
Like, that's a different line ofthinking, I think.
SPEAKER_01 (23:36):
Usually let me just see if I can process that.
I'm thinking of a case where agentleman just seemed completely
oblivious to the fact that hewas going to die of hysterosis
if he kept drinking and heeventually just stopped seeing
me.
Yeah, interesting.
So it sounds like this worksbest when there isn't an urgent
health matter as a consequenceof the addiction complicating
(23:56):
the situation.
SPEAKER_02 (23:59):
This is the technique to get someone out of
denial, even if that's the case.
I just find that usually if thatsomeone's that far gone, they
may be denying it to otherpeople out loud because they
don't want to hear it.
But there's a level of knowing,I think.
But regardless, this is thething that's gonna work.
Even if this person's gonna diein six months.
(24:19):
Coming at it another way from afamily member perspective might
not work.
If you're in a situation wheresomeone's like overdosing a lot
or something like that, youmight want to do like an old
school type of intervention.
That can work with someone whoknows they have a problem but
can't stop or just has giveninto it or something like that.
(24:40):
Because when you force someonelike that into treatment,
sometimes, you know, when theirbrain clears up enough, they
decide to get sober.
I don't have a problem withthat.
Like sometimes these people justneed to get sober long enough.
But if they truly do not thinkthey have a problem, I don't
care how long you force them inthere, if they're not done with
their bargains, they're not donewith their bargain.
And I know it's scary because itcould be like super obvious.
(25:01):
It's it's just the way thepsychology of it works, in my
experience.
SPEAKER_01 (25:05):
And let me ask a clarifying question.
So is your model specificallyaround getting people to admit
they have a problem, or is it tomotivate people to change, or is
it both?
SPEAKER_02 (25:16):
Both.
They can admit it or not admitit.
The point is for them to decideto do something about it.
And so it depends on howstubborn headed they are, you
know, what the dynamic of therelationship is.
Because what family owners don'tknow is actually they've
probably been trying to solvethis problem for a long time,
but they haven't told you thatbecause they haven't admitted it
to you because they don't wantto be backed into a corner and
(25:38):
they're not sure if they can doit, and they're not sure if they
want to do it, and they don'twant to say, I'm trying to stop.
They'll secretly try to stopbecause they don't want to hear
it from you.
SPEAKER_01 (25:48):
Makes perfect sense.
Okay, so we talked about notbeing the villain.
We talked about building credit,and we're talking about
bargaining.
Tell me about how the bargainingphase of the process wraps up
and segues into the next bit.
SPEAKER_02 (26:01):
Because eventually you figure out either this
doesn't work or it's too mucheffort to make this work.
That's what I do a lot oftalking to people.
How much energy do you have todo thinking about trying to keep
this under control?
And then you're planning andyou're scheming, and so they
just eventually figure out it'snot worth it or it doesn't work.
And then the next thing I do, ifa person is still not all the
(26:24):
way there, then what I'll do isI'll have them do a trial sober
run.
And I try to get them to do atleast 30 days because you feel
worse for the first two or threeweeks.
So that's not a good sober runbecause you don't get a good
take on what being sober is, youget a good take on what being a
withdrawal is.
So I'm like, I could be wrong.
I think you're gonna feelbetter, I think it's gonna be
(26:45):
easier.
Let's just test.
After we've done somebargaining, try to get them to
do 30 days, or if you can getmore than 30 days, it's even
better.
But I feel like we got to get to30 days for them to start
feeling better.
And that's the key because evenif they go back to using or
drinking after 30 days, ifthey've experienced it and we've
set the stage right, now theyknow what it feels like over
(27:07):
here, what life feels like overhere, and they have a much
better comparison.
So they probably almostcertainly will go back to using
after 30 days or 60 days,however.
And then they're gonnaimmediately find that they're
right back in the samesituation.
Now the dots start connecting somuch better.
SPEAKER_01 (27:24):
So, do you find that people sometimes after failed
attempts come to their ownconclusion?
I'm ready for sobriety.
And on the flip side, ifsomebody just keeps failing,
it's your job as the counselorto say, why don't we just try
being sober and see whathappens?
Yeah.
Yeah, it makes perfect sense.
Yeah.
SPEAKER_02 (27:41):
Yeah, it's just a learning process.
And it's really just helpingpeople move through that
learning process.
And the biggest key is tryingnot to make someone defensive
because that just slowseverything down.
And so once you know where theyare, you can figure out how to
not step on them.
You can step around them.
SPEAKER_01 (27:57):
And do you ever get someone who when you suggest a
trial of sobriety, they say no?
Oh, yeah, sure.
What do you do?
SPEAKER_02 (28:06):
I'll say okay, whatever they're wherever
they're at, and I'll put it outthere, even ahead.
I'll say this doesn't work, wecan try that.
And they may skip around, buteventually they come to that and
they'll try that.
And and I'll set the stage, I'llsay, don't feel I always tell
them the truth.
You're gonna feel real bad for aweek.
That don't count because you'rein withdrawal, and then this, so
that they they have a realisticexpectation of what that's gonna
(28:30):
be like.
And then as all this is goingon, I'm planting these little
seeds in their head about whatit feels like to be sober, like
sober sober.
I'm like, oh my gosh, so mucheasier.
You don't have no complications,you have more energy, and so I'm
like subliminally putting thesein there.
(28:50):
So they start to see itdifferently.
You know, they want to start tosee the substance more
accurately.
SPEAKER_01 (28:57):
How much medical support do your patients need
when they start getting sober?
SPEAKER_02 (29:02):
It depends.
Like sometimes they need detoxsupport, depending on what
they're using.
Sometimes they don't need detoxsupport, but sometimes they need
help with depression or anxietyor some other kind of issue.
So I would say prettyfrequently, but less they're
drinking too much for a longtime, I'll say, I want to at
least see your doctor and talkabout something for sleep or
something just to get us throughthis period to make it doable.
SPEAKER_01 (29:25):
Yeah, the majority of medications I prescribe are
mental health medications.
Insomnia, anxiety, depression,PTSD, all of that comes out when
the substance goes away.
SPEAKER_02 (29:34):
And sometimes people say, Well, that's cheaty.
I'm like, that's ridiculous.
I'm gonna do whatever it takes.
I'm gonna be this thing.
What do I need to do?
Like that's you literally likepulling all the tools out of the
toolbox.
SPEAKER_01 (29:44):
Yeah, that that strikes a nerve with me given
I'm a physician.
Here's how I describe it topeople, right?
Addiction is using substances tochange how you feel, and the
goal is to feel good and notneed anything.
Medicines, substances, andmedications are like a bridge.
unknown (29:59):
Yeah.
SPEAKER_01 (30:00):
Help the transition work better and you don't need
them forever.
Because a lot of my patientstell me, like, okay, I stopped
the cannabis, but I don't wantto be on Lexapro for forever.
SPEAKER_02 (30:08):
Yeah, I don't want to be dependent.
SPEAKER_01 (30:10):
Yeah.
Yeah.
So that's usually how I frameit.
Yeah.
Is medicine facilitates theprocess.
Okay.
SPEAKER_02 (30:15):
Honestly, it cracks me up when you get that.
And you get it a lot.
I don't want to take a medicine.
I'm like, and you're puttingwhat in your body?
It's just, it's kind of it'stotal cognitive dissonance.
SPEAKER_01 (30:24):
My favorite.
I have one page.
I just love her.
She's so funny.
And she was so afraid to takeany of my meds.
She has horrible PTSD.
Was using fentanyl and meth.
And, anyways, her dealer lacedsomething horrible in there.
And she looks at me, she goes,Dr.
Grover, my drug dealer is sounreliable.
And we had a laugh about it.
And then finally she startedtaking her meds for PTSD.
(30:46):
And I saw her this week.
She's like, Dr.
Grover, I feel so much better.
unknown (30:48):
I know.
SPEAKER_01 (30:49):
Yeah.
SPEAKER_02 (30:49):
I know you've got people pouring all these like
poisons in themselves, but theydon't want to take an
antipressant.
I'm like, Yeah.
And I use a lot of humor.
And sometimes I just joke withthem like that and just help
them see it funny.
SPEAKER_01 (31:00):
I laugh with my patients all the time and it
really helps.
Yeah.
Yeah.
Okay.
So we've working on bargaining.
What's the path from bargainingto the next step?
SPEAKER_02 (31:10):
You have to go through all those bargains.
Then you sometimes people justgo from bargaining to okay,
you're right, let's just bedone.
Then sometimes people do the30-day period or the 60-day
period.
They will go back after that.
If they're telling you I'm justgoing to do a sober period, dry
January, so work time, whateverit is, they will go back.
And so I try to help the familymember be prepared for that so
(31:30):
that they're not freaked out.
What we're trying to do is justget them to see what life is
like when you don't have to beon that merry-go-round, when
you're not running on thattreadmill, when you feel better
and you think clearer.
Because when you're doing atrial period, sometimes you're
just trying to get them to seethe difference.
And then when they go back,they're going to see it more
(31:52):
clearly.
Because when they go back,they're going to tell
themselves, okay, I'm going todrink again or I'm going to use
again, but I'm not going to dolike I did before.
I'm just going to do a littlebit.
So they'll be back into thebargain.
And then the bargain won't work.
And the good news is it won'twork very quickly, it won't
work.
And so the truth just becomesharder and harder to not see.
And so that moves people out ofdenial.
SPEAKER_01 (32:14):
Okay, and then once they're out of denial, what's
next?
SPEAKER_02 (32:17):
Then I'll say, What do you need to do to get sober?
And I'll let them tell me.
And they may say, What do youthink I should do?
I don't know what I don't findthat it's about telling people
how to get sober.
And most people they may trysome different things as far as
staying sober.
They may do a little bargainingwith that.
Maybe I don't like this or likethat or whatever.
(32:38):
And that's okay too.
But I try not to be super pushyon how people get sober.
SPEAKER_01 (32:45):
I joke with my patients all the time, and
they'll have an idea of whatthey want to do.
And I said, you know what?
If you told me, Dr.
Grover, when I put mayonnaise onmy left ear, I am sober.
What do you think I would tellyou to do?
And the answer is put mayonnaiseon your left ear because it
works.
Yeah, exactly.
Truly to your point, it soundslike your work is let's motivate
(33:06):
people to get ready for changeand be ready to accept what they
need to do to get sober.
And then the process of workingwith someone like myself or
whatever program you work with,it just becomes easier because
they're motivated.
And then, yes, I totally agree.
Everyone's ultimate path tosobriety is different.
SPEAKER_02 (33:21):
Right.
And it once you get someone whodecides that's what they want to
do and they're gonna do, they'llfigure that out for themselves.
In fact, they've probablyalready known the whole time.
They just hadn't decided thatthey wanted to do that.
And I can give people tips onhow to manage a craving or basic
stuff, but I don't push peopledown any certain path.
(33:41):
There is a there is anotherpiece that I probably haven't
elaborated on, but a lot of whatI do is I look for this person's
sort of natural gifts andstrength and I focus on seeing
that.
Like when I say you have to helpsomeone understand them, like I
see them like, oh, you are likethe master.
And I start planting these seedsabout all the things that
(34:03):
they're missing.
And we're talking about that allalong.
And then I do a lot of talking,it's like you need to use your
superpower for the good.
SPEAKER_01 (34:09):
That's almost like contingency management is giving
them some positive affirmationsto work towards.
SPEAKER_02 (34:14):
And it has to be true things, like I have to like
see them and hear who they areand be able to reflect that to
them.
And then they're like, You'reright.
And then they just get excitedabout it.
One of the things I teach familymembers to do is to decide what
is your person's values.
How do they want to be seen byother people?
How do they see themselves?
(34:35):
And instead of trying to tellthem, You're a terrible father,
what you say is I've alwaysappreciated how you've put
priority in the kids.
You're reminding them of theirvalues.
That creates that dissonance,and they start to see the
difference.
SPEAKER_01 (34:51):
Interesting.
One thing that I say a lot to mypatients is they'll start after
about three to four months ofsobriety being like, hey, I
think I want to get a peersupport specialist class, and I
think I want to be a drug andalcohol counselor.
And this is something I use alot, and it I get goosebumps
every time I say it.
But addiction is a disease ofshame and stigma.
(35:12):
And my patients have done somehorrible things.
And what's amazing is when theytransition from living with
addiction to recovery andworking to help others, all
those skeletons in their closetnow become their superpower.
SPEAKER_00 (35:25):
That's right.
Yeah.
SPEAKER_01 (35:26):
And it's the coolest thing to watch when they realize
like the fact that I used to dothis could help people.
And I'm like, yes.
SPEAKER_02 (35:34):
Yeah.
I heard somebody this past yearsay, and I hadn't heard it
before, they turn your mess intoyour message.
SPEAKER_00 (35:41):
Ooh, that's like that.
That is great.
SPEAKER_02 (35:44):
Yeah.
No, totally.
Some form of purpose has to comein, whether it's I want to help
other people or there's biggerthings in store for me.
But it's that purpose piece, soimportant.
SPEAKER_01 (35:56):
Yeah.
What uh what's your success ratewith this approach?
SPEAKER_02 (35:59):
I don't know because I don't measure.
SPEAKER_01 (36:01):
Anecdotally?
SPEAKER_02 (36:03):
People that come see me usually get sober.
Reason is because my focus isn'treally on trying to make them
get sober.
My focus is making them have apleasant experience.
If they like me, they'll keepcoming in.
And if they keep coming to seeme, I'm gonna get you there.
SPEAKER_01 (36:15):
Yeah, it's just I've said that so often.
If someone's not ready to getsober on the first visit, I'm
like, you know what?
Let's just book a follow-up.
I'd love to see you again.
100%.
If they like the experience,they come back.
Yeah.
Our practice, there are fivephysicians and I think eight
peer support specialists.
So these are all folks who livedexperience.
And addiction is a verytraumatizing disease.
A lot of my patients havedifficult homes or abusive
(36:38):
family members.
And sometimes we just tellpeople, like, just come hang out
in the waiting room.
Just come hang out with us.
And yes, you are spot on withthat to try to make them have a
good experience and feelrespected is so important.
SPEAKER_02 (36:48):
Right.
And they feel safe.
They know you're not trying topush them.
And then I build the creditscore as we go along.
And then I just basically waittill they get themselves in a
mess.
And then I'm like, oh, maybe youshould try this.
They're like, yeah, let's dothat.
I'm gonna get out of trouble.
And then I like I said, thenthey're like, oh, thank you so
much.
Versus feeling like someone madethem.
SPEAKER_00 (37:07):
Hmm.
I want to unpack that.
I want to get you out oftrouble.
SPEAKER_01 (37:11):
How does that usually land with your patients?
SPEAKER_02 (37:15):
It depends on what kind of trouble they're in.
If they're in, let's say theyhave a D UR or something, I'll
say, Let me write a letter toyour lawyer saying you're
coming, you're compliant, comingevery week, you're working,
you're doing all these things.
Great.
If they're in trouble with theirspouse, that's easy because I
got the family counselor onthem.
Let me fix that for you.
Like, whatever it is, if there'ssomething that I can help make
better for them, I I do.
SPEAKER_01 (37:36):
Is that usually what you open with in your first
meeting with a person?
I think you said that I'm yousaid, like, hey, I'm Amber, I
want to get you out of trouble.
Go ahead.
SPEAKER_02 (37:46):
Oh, I just say, Hey, I'm here on be on your side.
Whatever happens, I'm youradvocate.
So you I'm not the principal,you I'm not against you, I'm
your person.
They're there to be on yourside.
So I set it up that way.
Sometimes it takes me a minuteto figure out what that
something is that they need helpwith.
Sometimes it's pretty immediateand urgent, and then sometimes
(38:07):
it may just come along the way.
SPEAKER_01 (38:10):
Do you have a particularly memorable case of
where this worked really well ina family that was particularly
frustrated or at wit's end?
SPEAKER_02 (38:18):
I see it a lot, especially when I I used to deal
a lot more with like teens, kidsstill living at home or young
adults, like college kids andstuff.
And getting their parents toback up off of them is super
helpful and they're superappreciative.
But I'm funny about it.
I'm gonna say, listen, I'm gonnamake that happen for you.
In fact, actually, the familycounselor's gonna make that
happen for you.
(38:38):
So, but I'm just gonna tell youa secret right now.
You're gonna think that they'rejust oblivious and they're not
even paying attention andthey're like fine with it.
Let me tell you what's reallyhappening.
That family counselor's overthere giving them a strategy and
they're just waiting and lettingyou mess up.
So I'm just telling you, they'rejust gonna let you figure this
(38:59):
out the hard way.
So fair one it.
And they're like, okay, great.
SPEAKER_01 (39:04):
In the era of fentanyl, when the risk of
overdose and lace drugs is somuch higher, have you had to
change your approach?
SPEAKER_02 (39:12):
I don't know that I would change that approach,
really.
If someone is in that phase, Imight talk to them about um a
buprenorphine medicine, asuboxone, something like that.
Just depends on where they'reat.
But I don't know that approachwould be different.
I know that there's an urgencythat's there more.
And I wish you could make itfaster.
This is the fastest way to getthere.
(39:34):
Like it really is.
It doesn't feel fast enough,maybe to the family members, but
I'm like, this is the fastest.
SPEAKER_01 (39:40):
Yeah, I guess maybe it was a read-my-mind question,
but I think about someone usingcannabis, really can't overdose
on it.
Sure, you can get sick.
It's going to cause mentalhealth symptoms over time.
But we have some time, we havesome breathing room.
SPEAKER_00 (39:52):
Yeah.
SPEAKER_01 (39:53):
But with fentanyl, it's just so urgent.
Here in California, we've gottenplenty of these fentanyl
analogs, acryl, fentanyl,acetyl, fentanyl, paraflora
fentanyl.
I'm sure they're in SouthCarolina too.
But it just feels like thestakes are so much higher in the
era of fentanyl.
And I wasn't sure if you had tochange how you do things just to
help communicate that urgency.
SPEAKER_02 (40:13):
I think that the family already understands that
urgency.
The person knows what they'redoing and they know that it's
risky.
So it's not like I can sayyou're playing with life and
death.
When someone's that far intoaddiction, there's passively
suicidal anyway.
So that whole this is gonna killyou thing is just not that
powerful because there's thispart of them that's like
(40:36):
sometimes wishes they wouldn'twake up.
They may not be activelysuicidal with a plan, but
they're miserable and unhappyand trying to not be sick all
the time.
And in the back of their mind,it wouldn't be the worst thing.
So that whole like trying topress, you're gonna kill
yourself.
I just haven't found that works,even though I want to do that
(40:56):
because it's scary.
I just don't know that it iseffective.
SPEAKER_01 (41:00):
Yeah, it's funny.
When I was in my training and Itrained at a very good
institution, I did my residencyat Stanford in the emergency
department.
We would literally write, youneed to stop drinking in their
discharge instructions.
And oh, I'm such a good doctor.
They didn't teach us anything.
SPEAKER_02 (41:14):
I told them to stop.
SPEAKER_01 (41:16):
Yeah, yeah.
My very lovely and veryintelligent spouse and
colleague, Dr.
Reb Close.
We've been married for 18 years.
We've been practicing addictionmedicine together for three or
four years.
SPEAKER_02 (41:26):
That's really cool.
SPEAKER_01 (41:27):
Yeah.
So she did emergency medicine.
I did emergency medicine.
Between the two of us, 15 yearsof medical education at UC Land
Stanford.
We got an entire hour in 15years of training on addiction.
SPEAKER_02 (41:38):
Wow.
That's crazy.
SPEAKER_01 (41:40):
So, yes, we've learned all this after the fact
and gone through the AmericanBoard of Preventative Medicine's
practice pathway for addictionmedicine, and now we're both
certified.
But yeah, for years I just toldpeople like you need to stop
using.
And that's what I thought waswhat they needed.
And clearly that was not thecase.
I just wonder if there's somesignal around fentanyl
specifically, just doing maybesome psychoeducation on specific
(42:02):
risks just to let them know theurgency, but in a supportive,
empathetic way.
SPEAKER_02 (42:08):
If I'm talking to someone who doesn't know that,
then I probably would.
But I haven't ran across someonethat's using that kind of drug
that doesn't know that already.
SPEAKER_01 (42:16):
I guess that's a good point.
SPEAKER_02 (42:17):
I might do a lot of education with their family and
I might get them to get an Arcanand I might do some things like
that, and I might talk to themabout Suboxone or something and
say, hey, like I know you'restuck on this four-hour
treadmill and that's miserable.
And I might work that angle ofsaying, man, this would
stabilize you.
This would make it where youcould go to work and you
wouldn't have to like constantlybe stealing or hiding or you're
(42:40):
spending all your money.
But I don't know, that's adifferent technique.
SPEAKER_01 (42:44):
Okay.
So in other words, people knowthe harms, and part of what the
family members do in gettingcredit is to acknowledge that
their loved one is intelligentand understands what they're
doing and they need to work onfinding the why.
SPEAKER_02 (42:56):
If they're 14 or 15 years old, maybe they don't.
I don't even know about that.
I if you're that far in, but youmay be like, whatever, it's not
gonna happen to me.
It's not that you don't know it.
So I tell families, do not sendno medical article to your
person about this is your lungs.
Do not send, do not do it.
Because that's it just and Idon't do that either.
(43:18):
They know that.
SPEAKER_01 (43:18):
On the flip side, do you have the loved ones send
maybe information aboutaddiction or brain science or
new treatments as a way to besupportive?
Hey, what do you think?
SPEAKER_02 (43:28):
Not until the person is expressing some sort of
change talk.
And depending on what sort ofchange talk, I tell the family
members I train them to behaving some resources in their
back pocket and like findingones that their loved one will
go for.
And that could just be apodcast, that could be a book,
that could be anything, like afriend that's in recovery, and
(43:50):
to wait for the right moment toplay that card.
Because if you play that cardtoo soon, someone's in denial
and they don't think they have aproblem and you're constantly
talking to them about going totreatment, you've destroyed your
credit rating.
You're just an idiot who doesn'tknow what you're talking about.
And then everything you say,you're just overreactor.
So I encourage them to findresources that the person will
(44:11):
go for.
If the person's not religious,it needs to be a not religious
one.
If their person's an outdoorsone, it needs to be an
outdoorsman and be waiting,sitting on ready till they get
their moment.
And then say, and then I teachthem to say, I don't really know
if this is for you or not.
I don't know.
I thought you might like itbecause it's outdoors.
I call it the leave it on thecoffee table method.
Someone's like more likely tolook at it if they don't feel
(44:34):
pushed.
SPEAKER_00 (44:36):
That is a beautiful pearl right there.
SPEAKER_01 (44:39):
Okay, is there any part of your approach we haven't
gone over yet?
SPEAKER_02 (44:42):
Those are the basics of it.
That's the big outline.
SPEAKER_01 (44:45):
And did you come up with it yourself?
SPEAKER_02 (44:48):
Yeah, trial and error, figuring it out.
Because when you go tocounseling school, I guess you
get more than doctors.
We got a course on it, but thecourse entails go to three
12-step meetings and come backand report to us what it was
like.
That's it.
And they put the disease modelcurve up on the whiteboard.
SPEAKER_01 (45:06):
That's it.
Have you published this like ina book or a scientific article?
SPEAKER_02 (45:10):
No, I'm thinking about writing a book.
I have an online course calledThe Invisible Intervention.
I have a little workbook, but Ihaven't decided if I want to go
the writing route.
I'm I do better talking.
SPEAKER_01 (45:21):
So Yeah.
Thus, thus YouTube and podcasts.
Okay.
As we get to the end of thehour, is there anything else you
wanted to add that we missed?
SPEAKER_02 (45:30):
I don't think so.
I just want to say I appreciatethe work that you're doing.
SPEAKER_01 (45:35):
So, yes, I'm very proud.
I got a minute to brag.
We have a five physicianaddiction medicine practice in
little old Monterey, California.
And it's great.
Yeah, we can get people in thesame day.
We have four pillars to ourmedical approach.
It's kindness and respect, it'slow barrier to entering
treatment.
It's really emphasizing the roleof peer support and those with
(45:57):
lived experience, supporting aperson wanting to get sober and
then using long-actinginjectable medications.
So the way I say it is let's sayyou're on Suboxone, you're on it
three times a day, you've got tomake what over 900 choices a
year to make sure you take yourmeds.
And once we get you on aonce-a-month injection, you just
have to come see me 12 times.
Yeah.
SPEAKER_02 (46:18):
And how easy is it to talk to people into doing
that?
SPEAKER_01 (46:22):
It's an interesting question.
So same thing that you weretalking about is trying to
understand the why.
I mentioned what do I do in myfirst appointment?
What makes you want to change?
And for a lot of people, it's myhealth.
I lost my kids.
I'm going to face jail time.
And I really look at it, again,back to my man is on the ear
(46:43):
joke.
What for them feels easiest?
Some of my patients are superdiligent.
I prescribe it, they don't missa dose.
All of us are humans.
Some people really struggle withremembering medications.
And so some people hear thatthere's a once-a-month shot and
they're like, oh, thankgoodness, it'd be so much
easier.
And they want to go for that.
Others, to your point, we trynot doing it and it doesn't
(47:04):
work.
And I'm finally like, okay,we're if we're here in the next
month, I think we should try theinjection.
SPEAKER_02 (47:09):
And it's a good idea.
The bargaining working up to it.
Same thing, same thing.
Yeah.
SPEAKER_01 (47:13):
Yeah.
SPEAKER_02 (47:13):
So do you find that people, because one of the ways
I sell, I don't do sublica, butI sell people on the idea of
sublicate a lot, is I'll say, ifyou ever decide you want to come
off, it's so much easier to comeoff of subplica than it is
Suboxone.
And then I explain all that tothem.
Maybe you don't need to comeoff.
But if you decided you wantedto, people say that they can
slow down on this and come offwithout feeling anything.
SPEAKER_01 (47:35):
You are correct.
I do it all the time.
We give them four to six shotsof sublicade.
It builds up in their system.
There's a depot of it, and thenthey don't kick.
It is unbelievable.
SPEAKER_02 (47:46):
Isn't it?
I know.
And once people like can startto think about that way, they're
like, yeah.
SPEAKER_01 (47:53):
Totally.
Usually my conversation withthem is look, let's get you on
Suboxone.
I promise I can get you off ofit, and it's no big deal.
And when they hear that, they'relike, okay, I'm ready.
SPEAKER_02 (48:01):
Yeah.
I love it.
My my experiences is that mostpeople that are in our field use
these same techniques, butsometimes we don't have words on
them.
We just know we just do them.
Like because we've just beendoing them forever.
I think teaching YouTube ortalking to families has forced
me to have to figure out what isit that I do?
Can I put some names on thosesteps or whatever?
(48:23):
But you inherently figure thisout.
SPEAKER_01 (48:26):
Yeah.
And part of why I have a podcastis one of my patients will be
like, Dr.
Grover, what do I do?
And I'm like, wait, I have anepisode for you.
And then I just email them thepodcast episode, they'll listen
to it.
And then it's almost like I canget work done with my patients
in between our visits by havingpodcast episodes that they can
listen to.
SPEAKER_02 (48:42):
And I think you can get work done even more because
when you're telling someonesomething face to face, their
walls are up a little bitbecause they're just not sure
and they feel pushed.
And when they're just listeningand they just know you're
talking to the world, theirwalls are down and they actually
absorb it better that way, Ithink.
SPEAKER_01 (48:58):
I would agree.
Yeah.
So, Amber, if someone wants tolearn more about your work,
where can they find you?
SPEAKER_02 (49:03):
Best place to find me is on YouTube.
Put the shovel down.
Whether you are a personthinking about getting sober in
early recovery, you have a lovedone who needs to think about it.
We have every kind ofinformation for every angle.
SPEAKER_01 (49:18):
Fantastic work.
I will be sending this to somany of my patients' family
members as soon as it is live.
So, Amber, I have to say thankyou so much for coming on my
podcast and teaching me.
SPEAKER_02 (49:27):
Thanks for having me.
Appreciate it.
SPEAKER_01 (49:32):
Before we wrap up, a huge thank you to the Montage
Health Foundation for backing mymission to create fun, engaging
education on addiction.
And a shout out to the nonprofitCentral Coast Overdose
Prevention for teaming up withme on this podcast.
Our partnership helps me get theword out about how to treat
addiction and prevent overdoses.
(49:54):
To those healthcare providersout there treating patients with
addiction, you're doinglife-saving work and thank you
for what you do.
For everyone else tuning in,thank you for taking the time to
learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together, we can make it happen.
(50:15):
Thanks for listening.
And remember, treating addictionsaves lives.
Welcome to the Addiction Medicine Made Easy
podcast.
Hey there, I'm Dr.
Casey Grover, an addictionmedicine doctor based on
(00:20):
California's Central Coast.
For 14 years, I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side of thefight, helping people rebuild
their lives when drugs andalcohol take control.
Thanks for tuning in.
Let's get started.
This episode is on how tomotivate someone to stop using
(00:44):
drugs and alcohol.
Let me give you the context onthis episode.
So I get random emails all thetime from publicists saying,
hey, don't you think my clientshould be on your podcast?
And sometimes they connect mewith an awesome guest, and
sometimes I have to say thatthey are not a good fit for my
podcast.
So I got an email sayingsomething like, hey, my client
(01:06):
is a drug and alcohol counselorwho specializes in helping
people who aren't motivated toget sober change their mind and
actually start wanting to getsober.
And you can bet I wanted to havethat person on my podcast.
So this episode is with thatperson.
Her name is Amber, and she is adrug and alcohol counselor.
And this interview was amazing.
(01:27):
I will be sharing this episodewith so many of the families
that I work with.
Amber has worked out a uniqueapproach on how to motivate
someone, even if they areresistant, to want to quit drugs
and alcohol.
Here's the summary.
First, don't be the bad guy.
The family member needs tochange their role from nagging
their loved one about drug andalcohol use to being more
(01:50):
supportive.
Second, start building credit.
The family member needs to feelthat their loved one is on their
side and trying to genuinelyunderstand their problem with
drugs and alcohol and supportthem.
Third, let them bargain.
People often, when they have anaddiction, aren't ready to
completely quit and often offervarious approaches to make
(02:12):
progress, like, hey, I'm onlygoing to drink beer, not liquor,
or, hey, I'm only going to smokeweed and nothing harder.
The family member needs to allowthis to happen so that the
person with addiction triesdifferent approaches, many of
which will not work, and so theycan start seeing that sobriety
is the best option.
And finally, the family memberneeds to be ready with treatment
(02:32):
resources when their loved oneis.
So when that, hey, I'm ready tobe sober moment comes, the
family member is all ready withthe right resources.
This approach is amazing.
I think Amber should publish hermethod so more clinicians can
start using it.
One final clarification beforewe start.
Amber usually has the patientwho has addiction and their
(02:53):
family see different cliniciansin her practice because putting
them in the same room usuallyinvolves a lot of conflict.
So her practice works with boththe patient and their family,
but the majority of the work isdone seeing separate counselors
to avoid that conflict.
Fantastic interview.
Let's get into it.
(03:15):
Okay, I'm so glad to have you onmy podcast today.
Why don't we start by just youtelling us who you are and what
you do?
SPEAKER_02 (03:21):
Sure.
My name is Ambert Hollingsworth.
I'm a master addiction counselorand a licensed mental health
counselor, and I've been helpingpeople overcome addiction for
more than 20 years now.
These days, most people know mefrom YouTube.
I'm a YouTuber and the channelis called Put the Shovel Down,
which may sound strange, butit's a recovery saying.
(03:42):
It means you hit your bottomwhen you put your shovel down.
You don't have to keep digging,you don't have to burn every
bridge and lose everything.
You can decide when you're done.
SPEAKER_01 (03:50):
You said you were a master addiction counselor?
Yes.
What does that mean?
SPEAKER_02 (03:54):
It's a national certification through NADAC.
unknown (03:57):
Oh.
SPEAKER_02 (03:58):
So you can be like a licensed counselor in your
state.
It's just like a level up fromthat.
SPEAKER_01 (04:03):
So let's start with your comment about put the
shovel down.
SPEAKER_02 (04:06):
Yeah.
SPEAKER_01 (04:07):
I've not heard that.
Tell me if you do you know anyhistory behind that phrase?
SPEAKER_02 (04:11):
My history with the phrase is one of my first jobs
in the field is I had anintensive outpatient program for
teens.
And one of the teens used to saythat.
I think you heard it in ameeting.
So you hit your bottom, you putyour shovel down.
And I feel like people hear thatall the time.
You have to hit bottom, you haveto lose everything, but I
disagree.
SPEAKER_01 (04:28):
Interesting.
Let's unpack that.
Have clients that come to me forall different reasons.
And I've heard people havinghigh bottoms and low bottoms.
So a person who has a highbottom maybe just gets a single
DUI, makes a big change, andmoves on.
A low bottom would be somebodywho maybe had an overdose or was
homeless.
(04:48):
Talk to me about how you use theidea of rock bottom in in your
work as a drug and alcoholcounselor.
SPEAKER_02 (04:55):
In my work, the idea of rock bottom is I try to get
people off of that track beforewe get there.
I deal a lot with people who Iwould call like a functional
alcoholic or addict.
Some of them actually very highfunctional addicts and
alcoholics.
And so I work a lot with theirfamilies on how do you get
through someone's denial who'sin that situation?
How do you get them movingtowards change, which can be
(05:17):
quite a task if someone'ssuccessful in other areas of
their life, it's really hard toget them to see, hey, this
really is a problem.
SPEAKER_01 (05:26):
So I'm gonna cut to the chase.
What's the answer?
How do you get to them?
SPEAKER_02 (05:30):
There's a there's a system.
The first thing you have to doas the family member is you have
to get out of the bag I rollbecause almost always what
happens when you have anaddicted loved one, of course,
you're you're watching them makemistakes, they're changing,
they're not themselves, they'reruining their life and yours
too, probably.
And so your natural inclinationis to want to grab them by the
(05:51):
shoulders and say, Wake up, whatare you doing?
And you start trying to get themto see the problem, and you're
doing that very directly, andyou start trying to catch them
because they tell you thatthey're not doing it or they're
not doing as much as you thinkthey're doing it.
And so you become like thesecret spy, you get, I don't
know, equipment, black lights orsomething in your purse, and you
get this whole cat mouse dynamicgoing on.
(06:12):
And that's a huge problem.
And the biggest reason that's aproblem is because as long as
you're the villain in theirstory, they don't have to look
at what's going on with them.
It's like you're a giantdistraction.
And the reason I know this isbecause all my years of
counseling people with drug andalcohol problems, if the family
is playing the villain, that'sthe only thing that they will
(06:34):
talk to me about.
Like we cannot talk aboutanything else other than my wife
or my husband or my mom or mysister or whoever it is.
It's like it's the first, that'sthe first piece that has go.
The most important piece is tonot play the villain in someone
else's story.
SPEAKER_01 (06:50):
That's so funny because I heard you say the
first thing you've got to do,and then I didn't understand the
phrase.
That's so fascinating.
You have to stop being thevillain.
One of my patients this week,his wife brought him in and she
said, I'm tired of being thealcohol police.
Interesting.
Okay, so that's step one.
What's next?
SPEAKER_02 (07:09):
So once you get out of the villain role or bad guy
role, as I call it, you start tobuild credibility with your
loved one.
And I it's kind of like buildingcredit if you wanted to buy a
house and you need a certaincredit score or something.
You start building credit withyour loved one.
And if you're in the bad guyrole, you got negative credit.
So first we gotta get toneutral, right?
(07:30):
And then the way you can buildcredit with your loved one is
they wanna know that youunderstand them, which is
different than you love them.
They know that you love them.
And sometimes that's annoying tobe honest, right?
It's they want to know that youunderstand their point of view
because someone doesn't carewhat you think if they don't
think that you get them.
(07:50):
Like, for example, you may knowyour grandmama loves you, but
you're probably not gonna listento her opinion or follow her
advice if you don't think shegets your situation.
So you spend whatever amount oftime it takes to help this
person understand that youunderstand them.
The way you do that is you use alot of active listening skills,
you look at things from theirperspective, you use a lot of
(08:11):
strategic empathy.
That's what I do as a counselor.
I just spend however many weeksit takes to just do that.
And I just wait until I got mycredit score where it needs to
be.
And then I wait for the rightmoment and then I cash my credit
in.
And then they're like, thankyou, Abby, you helped me so
much, instead of this whole, I'mtrying to make you do something.
When you have good credit withyour loved one, they care what
you think and they care aboutthe relationship.
(08:33):
And so this idea of if I don'tget it together, I'm gonna lose
this relationship is actuallymeaningful.
When you're in the villain role,this whole if you don't get it
together, I'm gonna leave,they're thinking, I wish you
would.
So it doesn't work, the wholelike ultimatum thing.
SPEAKER_01 (08:48):
Addiction medicine is a listening specialty.
I do a lot of listening.
So let me make sure I understandthis.
So you're saying step one is togo from not being the villain,
and step two is to get creditwith them.
Essentially, it sounds likeyou're trying to remind them
that you care and you're ontheir side.
SPEAKER_02 (09:07):
It's of course it's that you care, but it's that you
get it.
Like what a counselor would do.
Like I listen to you and I'mlike, oh, it's like this.
Oh, you're oh, this is what'sgoing on.
So you're just spending timecompletely understanding their
perspective and mirroring thatback to them so that they get
that you get it.
And then what you have to say isvalid.
SPEAKER_01 (09:30):
So it's listening, but being actually willing to
accept their perspective.
SPEAKER_02 (09:35):
Because we may not agree with everything that they
think or everything that theydo, but there's a piece of it we
can understand.
Like we could understand whysomeone might want to come home
and have some drinks after workbecause they're stressed.
We can understand why someonemight want to do drugs at a
party to fit in.
Like we may not agree that's theright answer, but there's a
piece of it we can empathizewith.
(09:56):
And if we can understand theirpoint of view, it just helps
them lower their guard down andbe so much more influenzable.
SPEAKER_01 (10:06):
So interesting.
So I'm thinking in my own mindabout my own practice.
When I'm seeing a new patient, Iusually ask two questions that
are the most helpful.
The first is, why do you want toget help?
And to your point, if I hear mywife is annoying me, I know it's
not gonna go well.
So that's like you were saying,that spouse has to stop being
the bad guy.
(10:27):
And then the second question is,what does the substance do for
you?
How does it help you?
And that goes back to yoursecond piece.
How interesting.
I've never thought of yourframework, but it makes perfect
sense.
Yeah.
SPEAKER_02 (10:37):
Well, I think the reason why I'm good at dealing
with people in denial, becausemy whole career, people that
come sit in an addictioncounselor's office don't usually
want to be there.
They're usually leveraged in bysomeone or they don't think they
have a problem, or they're justdoing it to get out of some
trouble or something.
And so I've had to learn to workwith that.
So when someone, it's the samequestion I ask.
When someone tells me that, I'mlike, good, you're in the right
place.
I'm gonna get you out of thismess.
(10:59):
When I'm on your side, I'mliterally like, what do you
need?
You need to do something?
Let me write you a letter, we'regonna get you out of trouble.
And then they see me as alignedwith them.
And now we can be a team and wecan figure out this problem as a
team.
SPEAKER_01 (11:11):
Yeah, it's interesting.
I do a lot of educating parentson how to talk to their kids
about drugs and alcohol.
And there's three situations welook at.
The my kid's doing fine, I justneed to teach them.
I'm worried about my kid andoops, I found my kid using.
And the advice I give theparents around the I found my
kids using is to sit down andask legitimate questions with
(11:33):
genuine curiosity to try tounderstand them.
Same thing, your same idea,different framework.
This makes perfect sense.
SPEAKER_02 (11:40):
Yeah.
If you're working in this field,this is what you've been doing
all these years.
So I'm just basically teachingfamily members how to do this
because sometimes you can't getyour person to sit in front of a
professional.
It'd be great, yeah, send themover to Amber and you can do it
for me.
But what if you can't get themto see Dr.
Grover or Amber, whatever?
You're the only one.
You're the front line.
And honestly, it's not reallythat complicated, really.
(12:00):
It's it's just against yourinstincts.
But once you understand theprinciples of it and what you're
doing, then you can help movethat person along in their
stages of change.
SPEAKER_01 (12:09):
How do you navigate difficult history between a
loved one to help them be ableto start being genuinely
curious?
SPEAKER_02 (12:18):
If you got a lot, and you usually do, of like bad
blood or distrust on both sides,one of the quickest ways you can
get yourself out of the villainroll is just admit it.
So if you can say, I've beendoing a lot of thinking about
it, or I went and saw somebodyand I realized I've been
handling this all wrong, and Ihave not been helpful to you at
all.
And I'm gonna rein that in.
(12:38):
I've been trying to control it,I've been critical of you.
Like whatever it is that theythink you've been doing, you own
it.
Call it an accusation audit.
Think of what they would accuseyou of and give it, give them
all the leeway, all you know,and use their words and say,
you're right, I've been doingthis and this, and that's not
even helpful.
And then they're all of a suddenpaying attention to you, and now
you got their attention.
(12:58):
Now you have to consistently bedifferent, but that's a good way
to get them to shift faster.
SPEAKER_01 (13:04):
I think I'm gonna have trouble articulating my
question, but what's the mostnumber of years you've seen a
couple, brother, sister, parent,child, have the person with
addiction, bad guy role make thepositive change to no longer
being the bad guy and startingto be on the person with
addiction side?
What's the quickest or what'sthe what's the longest period of
(13:27):
bad blood before they startedusing your framework that you
saw at work?
SPEAKER_02 (13:31):
Oh my gosh, I don't know.
Any number of years.
Depends on how old they are whenthey come to see me.
Like they could have beenmarried 40 years.
They could have been parentingthis kid 30 years.
It depends.
SPEAKER_01 (13:42):
Do you find that there's like a certain amount of
time of the bad blood years, ifyou will, that makes it harder
for them to work with you anduse your framework?
SPEAKER_02 (13:51):
Yes, but it's not really the amount of years, it's
the amount of hurt feelings andemotional damage more from the
family member's role than fromthe addict's role.
Like the family member has ahard time getting past their own
hurt feelings to do what I'mtelling them to do.
And I don't blame them.
It is completely unfair.
And that's what I say.
Everything I tell you is gonnabe totally unfair.
Let's just say it, but it'sgonna work.
(14:13):
I'm not about what's fair, I'mabout what's gonna work.
And this is what you want tohappen.
And I'm very directive becausewhen people are in crisis,
they're like, what do I do?
What do I say exactly?
Say this at this moment you'regonna do this, and it's gonna
work.
But it's hard to hold back allthose things you want to say.
SPEAKER_01 (14:28):
And is your practice more with families or with
people with addiction or both?
SPEAKER_02 (14:33):
Both.
The way that I've done practicesince I've been in private
practice is I usually see theperson who has an addiction, and
I have other counselors orcoaches who work with the family
members.
And instead of doing it all inthe same room, we do it
separately.
So on the back end, I would havethe family counselors working
with the family members while Iwork with the person, and that
(14:54):
sort of expedites the wholeprocess.
SPEAKER_01 (14:57):
Do you find that transition to being on someone's
side is more complicated when,say, the person with addiction
is a teenager and you're workingwith their parents?
SPEAKER_02 (15:05):
I I think it it's not really any more complicated
in that the strategies work justas well, but it is more
complicated in that when you'reminor, your person under 18 is
doing things that are illegal,and then you feel like you have
certain responsibilities as aparent that you really just
can't quite take your hands offof.
There's some complications withthat.
Just as far as like what's yourliability, what are your
(15:28):
responsibilities, and that sortof thing.
SPEAKER_01 (15:31):
Because I find with my teenage patients, they come
in with their parents and I playref.
Mom and dad are upset, and thenthe patient's upset, and then
mom and dad are upset, and it'struly I am the referee.
SPEAKER_02 (15:42):
That's why I don't put them in the same room.
I can't do it.
I hate it.
SPEAKER_01 (15:46):
Interesting.
I've not done that.
SPEAKER_02 (15:48):
No, that's why everybody gets their own person.
We call it lawyering.
And I'm always the defenseattorney.
And so when I see one person,it's my job to get you out of
trouble.
What we need to do.
And uh sometimes we'll meet allin the same room, but not until
we're ready.
And when we do, the family comeswith their person.
I go with my person, likeliterally, like you're going
with your advocate.
Because then you feel like youhave someone on your side.
(16:09):
Because if it's just one person,both sides are just trying to
convince you to tell the otherside that they're wrong.
And I hate that.
SPEAKER_01 (16:16):
100%.
Yes, happens all the time.
SPEAKER_02 (16:18):
Hate it, hate it.
I'm just not good enough to dothat kind of family counseling,
I think.
SPEAKER_01 (16:23):
So let me just make sure I get this straight.
So you're saying that yourmodel, first don't be a villain,
next, get credit with them,works best when the person with
addiction has their counselor,the family has their counselor,
and then you all, when you allmeet together, the counselors do
basically the negotiation.
SPEAKER_02 (16:40):
Yeah, and a lot of the negotiation happens behind
the scenes, just like court,right?
A lot of times the lawyers workit out.
It might be like, I want my momto quit reading my journal
behind the scenes.
We hash it out and we say,Listen, I need your person quit
doing this.
Listen, I need your person tounderstand this, and we kind of
like help that happen.
And these days, because I'm onYouTube and I teach families
(17:01):
this on YouTube, like they'realready doing it long before
they ever even see us or anybodyfor that sake.
So it's already like when theperson gets to me now that the
family's been doing that allalong, they come in ready.
They're like, Amber, got a bigproblem.
You gotta help me.
And I've been treating my familyterrible, and I gotta stop doing
that, which is completelydifferent than like most of my
(17:22):
career, which is I'm herebecause my wife made me, I'm
here because, you know, thenorm.
SPEAKER_01 (17:28):
Yeah.
Okay.
So we've got step one and steptwo.
What's the next?
SPEAKER_02 (17:32):
Okay, so as you're building credit and you're not
being the villain, your personis probably gonna move into the
fancy word, be contemplationstage, but I call it bargaining.
So before a person decides theyneed to stop completely, they're
gonna try to cut it back orcontrol it, and they're gonna
try a lot of bargains.
(17:52):
And as the family member, if youjust understand that this
actually is good news because itmeans they're trying to figure
out what they need to do tochange, but they're gonna try a
lot of wrong things first.
So I teach families, it's yourjob to help that go faster.
You can't make someone skipthat.
And maybe they say they're gonnaonly drink this much or they're
only gonna smoke that much orwhatever.
(18:13):
That's not true.
It's your job to say, okay,let's try that.
That'd be good.
And then let that person fail.
And then we move to the nextbargain, next bargain.
And that's how we get to thepoint of what old school
recovery would callpowerlessness.
You're not gonna get to that, Igotta let go of this completely
until you've tried all thethings.
And so we teach family membersto say, let's try that.
(18:34):
Okay, let's try that.
Well, that doesn't work, let'stry that, but if that didn't
work, let's try this to help aperson move through that faster.
You can expedite it.
SPEAKER_01 (18:43):
How long does that bargaining phase usually last?
SPEAKER_02 (18:47):
I don't, that's hard for me to say.
I feel like when people startusing our strategies, I'd say
within, I want to say for themost part, within six months to
a year, sometimes faster.
SPEAKER_01 (18:57):
Yeah, that makes perfect sense.
So I'm just thinking about thiswith my patients.
Interesting.
Okay.
Do you have your patients keep awritten ledger?
Like you literally write downthe idea and it didn't work,
cross it out just so they don'tgo back to the same idea before.
SPEAKER_02 (19:10):
No, because they will go back to the same idea
before.
They'll try it a few timesbecause what will happen is
they'll say, let's say I'm justgonna drink beer, not liquor, or
something like that.
Or I'm just gonna smoke weed,I'm not gonna do cocaine
anymore.
It doesn't matter, whatever thething is.
They'll probably be successfulat that for a little bit, and
then they'll fall off the cliff.
And then they'll think, I justgotta go back.
I was doing really good.
So they'll try it more thanonce.
(19:33):
So it's not a matter of, okay,try it, check it off.
It's let me try that again.
And you gotta give people roomto do that.
But while they're doing that, Iplant some seeds.
I say, yeah, let's try that,then that'd be good.
Say a lot of times people end upfiguring out that actually
easier to do none than a little,but it's really different for
everybody.
So let's try that.
If it doesn't work, don't worry.
We got plan B, C, D, E.
(19:55):
We're gonna figure this out.
So that way when it doesn'twork, they come, they don't have
an issue coming to me saying, Itried it, it didn't work, or it
worked for this long and then itdidn't, because we're just
problem solving it together.
And then they come to theconclusion that it really is
easier to do nothing than alittle.
Because I plant these seeds, Isay, no, like even if you can
pull it off, is it really evenworth it to drink two beers?
(20:19):
What's that gonna do but makeyou thirsty?
And so we have these funconversations along the way.
I'm sending these, this couldhappen to you, but I'm not
saying this will happen to you,I'm saying this could.
It plants a seed and then theyfigure that out fast.
SPEAKER_01 (20:32):
And how do you support the family member who
wants immediate change to beokay being patient?
SPEAKER_02 (20:40):
I just tell them that they couldn't want that all
day long, but as if they'retrying to force it, they're
slowing down the process.
And I'm just if they just lookback at their own experience,
they're gonna know I'm they'regonna know it's true because
they've been trying that beforethey got to me for a long time.
So I'm like, you're just slowingit down.
We could get to this faster.
SPEAKER_01 (20:59):
So it almost seems like by trying to rush it, they
go back to being the villain.
SPEAKER_02 (21:03):
That's right.
But it's in patience, is what itis.
It's I want them to figure itout faster, but there's a
process of figuring it out.
And I also teach them how tolook for the winds that things
are actually moving alongdifferently, and then it helps
the family tolerate it.
So, like I'll say, when yourperson comes to tell you, I'm
(21:26):
just gonna smoke on theweekends, and then we're two or
three weeks in and they'resmoking on Monday and Tuesday.
I don't want you to be upset.
I want you to be like, thankgosh, because we gotta prove
this theory wrong quickly.
And then I'll say, whatever youdon't remind them and tell them
they said they were only gonnado it this much and they need to
do it this much.
Because the whole pulling itback thing is never gonna work
anyway.
(21:46):
So you want not to be upset whenthat happens, but rather be
like, okay, good.
Okay, good.
Now, like they're learningfaster.
And then you tolerate it betterbecause you see it more as
movement rather than as they'renot trying or they lied or
they're never gonna figure itout.
You see it as, oh, that that'swhat we need to happen.
SPEAKER_01 (22:04):
Do you teach the family member specific scripting
of, hey, I see you're smoking ona Monday.
It sounds like our plan didn'twork.
What's next?
Do you teach them how to not getupset and be able to, again,
build credit, maintain creditwhile they say, hey, this didn't
work?
SPEAKER_02 (22:20):
Sometimes it if I'm working directly with them, it
depends on their loved one andwhat I know about their
situation.
If that relationship couldtolerate that, or if I know that
relationship, if the person isjust extremely defensive and
would just get super mad.
So I would case by case basisabout whether you brought it up
and how to bring it up.
SPEAKER_01 (22:41):
How does it go when someone's life is on the line
because of their addiction?
Let's say somebody has advancedcirrhosis from alcohol, and
maybe we don't have a yearbefore their liver's gonna give
out.
SPEAKER_02 (22:51):
In that case, you're not dealing with someone in
denial.
That's a harder case.
I always say dealing with peoplein denial, it's not that hard.
That's dealing with somebodywho's just given up.
If you've got advancedcirrhosis, you might be
minimizing it to someone elseout loud, but in your head, you
know.
And so that's actually harder, Ithink.
When I'm talking about denial,I'm talking about like literally
(23:12):
this person does not know.
Not they're denying it to you,of course they're doing that,
but like they're denying it tothemselves.
When you're dealing with someonewho's super far in like that,
like into stage four, like tothat level, they probably know
the issue there is probably morethey're telling themselves
something like, just screw it.
If I'm this far, or I'm nevergonna get better, or that's just
who I am.
(23:33):
Like, that's a different line ofthinking, I think.
SPEAKER_01 (23:36):
Usually let me just see if I can process that.
I'm thinking of a case where agentleman just seemed completely
oblivious to the fact that hewas going to die of hysterosis
if he kept drinking and heeventually just stopped seeing
me.
Yeah, interesting.
So it sounds like this worksbest when there isn't an urgent
health matter as a consequenceof the addiction complicating
(23:56):
the situation.
SPEAKER_02 (23:59):
This is the technique to get someone out of
denial, even if that's the case.
I just find that usually if thatsomeone's that far gone, they
may be denying it to otherpeople out loud because they
don't want to hear it.
But there's a level of knowing,I think.
But regardless, this is thething that's gonna work.
Even if this person's gonna diein six months.
(24:19):
Coming at it another way from afamily member perspective might
not work.
If you're in a situation wheresomeone's like overdosing a lot
or something like that, youmight want to do like an old
school type of intervention.
That can work with someone whoknows they have a problem but
can't stop or just has giveninto it or something like that.
(24:40):
Because when you force someonelike that into treatment,
sometimes, you know, when theirbrain clears up enough, they
decide to get sober.
I don't have a problem withthat.
Like sometimes these people justneed to get sober long enough.
But if they truly do not thinkthey have a problem, I don't
care how long you force them inthere, if they're not done with
their bargains, they're not donewith their bargain.
And I know it's scary because itcould be like super obvious.
(25:01):
It's it's just the way thepsychology of it works, in my
experience.
SPEAKER_01 (25:05):
And let me ask a clarifying question.
So is your model specificallyaround getting people to admit
they have a problem, or is it tomotivate people to change, or is
it both?
SPEAKER_02 (25:16):
Both.
They can admit it or not admitit.
The point is for them to decideto do something about it.
And so it depends on howstubborn headed they are, you
know, what the dynamic of therelationship is.
Because what family owners don'tknow is actually they've
probably been trying to solvethis problem for a long time,
but they haven't told you thatbecause they haven't admitted it
to you because they don't wantto be backed into a corner and
(25:38):
they're not sure if they can doit, and they're not sure if they
want to do it, and they don'twant to say, I'm trying to stop.
They'll secretly try to stopbecause they don't want to hear
it from you.
SPEAKER_01 (25:48):
Makes perfect sense.
Okay, so we talked about notbeing the villain.
We talked about building credit,and we're talking about
bargaining.
Tell me about how the bargainingphase of the process wraps up
and segues into the next bit.
SPEAKER_02 (26:01):
Because eventually you figure out either this
doesn't work or it's too mucheffort to make this work.
That's what I do a lot oftalking to people.
How much energy do you have todo thinking about trying to keep
this under control?
And then you're planning andyou're scheming, and so they
just eventually figure out it'snot worth it or it doesn't work.
And then the next thing I do, ifa person is still not all the
(26:24):
way there, then what I'll do isI'll have them do a trial sober
run.
And I try to get them to do atleast 30 days because you feel
worse for the first two or threeweeks.
So that's not a good sober runbecause you don't get a good
take on what being sober is, youget a good take on what being a
withdrawal is.
So I'm like, I could be wrong.
I think you're gonna feelbetter, I think it's gonna be
(26:45):
easier.
Let's just test.
After we've done somebargaining, try to get them to
do 30 days, or if you can getmore than 30 days, it's even
better.
But I feel like we got to get to30 days for them to start
feeling better.
And that's the key because evenif they go back to using or
drinking after 30 days, ifthey've experienced it and we've
set the stage right, now theyknow what it feels like over
(27:07):
here, what life feels like overhere, and they have a much
better comparison.
So they probably almostcertainly will go back to using
after 30 days or 60 days,however.
And then they're gonnaimmediately find that they're
right back in the samesituation.
Now the dots start connecting somuch better.
SPEAKER_01 (27:24):
So, do you find that people sometimes after failed
attempts come to their ownconclusion?
I'm ready for sobriety.
And on the flip side, ifsomebody just keeps failing,
it's your job as the counselorto say, why don't we just try
being sober and see whathappens?
Yeah.
Yeah, it makes perfect sense.
Yeah.
SPEAKER_02 (27:41):
Yeah, it's just a learning process.
And it's really just helpingpeople move through that
learning process.
And the biggest key is tryingnot to make someone defensive
because that just slowseverything down.
And so once you know where theyare, you can figure out how to
not step on them.
You can step around them.
SPEAKER_01 (27:57):
And do you ever get someone who when you suggest a
trial of sobriety, they say no?
Oh, yeah, sure.
What do you do?
SPEAKER_02 (28:06):
I'll say okay, whatever they're wherever
they're at, and I'll put it outthere, even ahead.
I'll say this doesn't work, wecan try that.
And they may skip around, buteventually they come to that and
they'll try that.
And and I'll set the stage, I'llsay, don't feel I always tell
them the truth.
You're gonna feel real bad for aweek.
That don't count because you'rein withdrawal, and then this, so
that they they have a realisticexpectation of what that's gonna
(28:30):
be like.
And then as all this is goingon, I'm planting these little
seeds in their head about whatit feels like to be sober, like
sober sober.
I'm like, oh my gosh, so mucheasier.
You don't have no complications,you have more energy, and so I'm
like subliminally putting thesein there.
(28:50):
So they start to see itdifferently.
You know, they want to start tosee the substance more
accurately.
SPEAKER_01 (28:57):
How much medical support do your patients need
when they start getting sober?
SPEAKER_02 (29:02):
It depends.
Like sometimes they need detoxsupport, depending on what
they're using.
Sometimes they don't need detoxsupport, but sometimes they need
help with depression or anxietyor some other kind of issue.
So I would say prettyfrequently, but less they're
drinking too much for a longtime, I'll say, I want to at
least see your doctor and talkabout something for sleep or
something just to get us throughthis period to make it doable.
SPEAKER_01 (29:25):
Yeah, the majority of medications I prescribe are
mental health medications.
Insomnia, anxiety, depression,PTSD, all of that comes out when
the substance goes away.
SPEAKER_02 (29:34):
And sometimes people say, Well, that's cheaty.
I'm like, that's ridiculous.
I'm gonna do whatever it takes.
I'm gonna be this thing.
What do I need to do?
Like that's you literally likepulling all the tools out of the
toolbox.
SPEAKER_01 (29:44):
Yeah, that that strikes a nerve with me given
I'm a physician.
Here's how I describe it topeople, right?
Addiction is using substances tochange how you feel, and the
goal is to feel good and notneed anything.
Medicines, substances, andmedications are like a bridge.
unknown (29:59):
Yeah.
SPEAKER_01 (30:00):
Help the transition work better and you don't need
them forever.
Because a lot of my patientstell me, like, okay, I stopped
the cannabis, but I don't wantto be on Lexapro for forever.
SPEAKER_02 (30:08):
Yeah, I don't want to be dependent.
SPEAKER_01 (30:10):
Yeah.
Yeah.
So that's usually how I frameit.
Yeah.
Is medicine facilitates theprocess.
Okay.
SPEAKER_02 (30:15):
Honestly, it cracks me up when you get that.
And you get it a lot.
I don't want to take a medicine.
I'm like, and you're puttingwhat in your body?
It's just, it's kind of it'stotal cognitive dissonance.
SPEAKER_01 (30:24):
My favorite.
I have one page.
I just love her.
She's so funny.
And she was so afraid to takeany of my meds.
She has horrible PTSD.
Was using fentanyl and meth.
And, anyways, her dealer lacedsomething horrible in there.
And she looks at me, she goes,Dr.
Grover, my drug dealer is sounreliable.
And we had a laugh about it.
And then finally she startedtaking her meds for PTSD.
(30:46):
And I saw her this week.
She's like, Dr.
Grover, I feel so much better.
unknown (30:48):
I know.
SPEAKER_01 (30:49):
Yeah.
SPEAKER_02 (30:49):
I know you've got people pouring all these like
poisons in themselves, but theydon't want to take an
antipressant.
I'm like, Yeah.
And I use a lot of humor.
And sometimes I just joke withthem like that and just help
them see it funny.
SPEAKER_01 (31:00):
I laugh with my patients all the time and it
really helps.
Yeah.
Yeah.
Okay.
So we've working on bargaining.
What's the path from bargainingto the next step?
SPEAKER_02 (31:10):
You have to go through all those bargains.
Then you sometimes people justgo from bargaining to okay,
you're right, let's just bedone.
Then sometimes people do the30-day period or the 60-day
period.
They will go back after that.
If they're telling you I'm justgoing to do a sober period, dry
January, so work time, whateverit is, they will go back.
And so I try to help the familymember be prepared for that so
(31:30):
that they're not freaked out.
What we're trying to do is justget them to see what life is
like when you don't have to beon that merry-go-round, when
you're not running on thattreadmill, when you feel better
and you think clearer.
Because when you're doing atrial period, sometimes you're
just trying to get them to seethe difference.
And then when they go back,they're going to see it more
(31:52):
clearly.
Because when they go back,they're going to tell
themselves, okay, I'm going todrink again or I'm going to use
again, but I'm not going to dolike I did before.
I'm just going to do a littlebit.
So they'll be back into thebargain.
And then the bargain won't work.
And the good news is it won'twork very quickly, it won't
work.
And so the truth just becomesharder and harder to not see.
And so that moves people out ofdenial.
SPEAKER_01 (32:14):
Okay, and then once they're out of denial, what's
next?
SPEAKER_02 (32:17):
Then I'll say, What do you need to do to get sober?
And I'll let them tell me.
And they may say, What do youthink I should do?
I don't know what I don't findthat it's about telling people
how to get sober.
And most people they may trysome different things as far as
staying sober.
They may do a little bargainingwith that.
Maybe I don't like this or likethat or whatever.
(32:38):
And that's okay too.
But I try not to be super pushyon how people get sober.
SPEAKER_01 (32:45):
I joke with my patients all the time, and
they'll have an idea of whatthey want to do.
And I said, you know what?
If you told me, Dr.
Grover, when I put mayonnaise onmy left ear, I am sober.
What do you think I would tellyou to do?
And the answer is put mayonnaiseon your left ear because it
works.
Yeah, exactly.
Truly to your point, it soundslike your work is let's motivate
(33:06):
people to get ready for changeand be ready to accept what they
need to do to get sober.
And then the process of workingwith someone like myself or
whatever program you work with,it just becomes easier because
they're motivated.
And then, yes, I totally agree.
Everyone's ultimate path tosobriety is different.
SPEAKER_02 (33:21):
Right.
And it once you get someone whodecides that's what they want to
do and they're gonna do, they'llfigure that out for themselves.
In fact, they've probablyalready known the whole time.
They just hadn't decided thatthey wanted to do that.
And I can give people tips onhow to manage a craving or basic
stuff, but I don't push peopledown any certain path.
(33:41):
There is a there is anotherpiece that I probably haven't
elaborated on, but a lot of whatI do is I look for this person's
sort of natural gifts andstrength and I focus on seeing
that.
Like when I say you have to helpsomeone understand them, like I
see them like, oh, you are likethe master.
And I start planting these seedsabout all the things that
(34:03):
they're missing.
And we're talking about that allalong.
And then I do a lot of talking,it's like you need to use your
superpower for the good.
SPEAKER_01 (34:09):
That's almost like contingency management is giving
them some positive affirmationsto work towards.
SPEAKER_02 (34:14):
And it has to be true things, like I have to like
see them and hear who they areand be able to reflect that to
them.
And then they're like, You'reright.
And then they just get excitedabout it.
One of the things I teach familymembers to do is to decide what
is your person's values.
How do they want to be seen byother people?
How do they see themselves?
(34:35):
And instead of trying to tellthem, You're a terrible father,
what you say is I've alwaysappreciated how you've put
priority in the kids.
You're reminding them of theirvalues.
That creates that dissonance,and they start to see the
difference.
SPEAKER_01 (34:51):
Interesting.
One thing that I say a lot to mypatients is they'll start after
about three to four months ofsobriety being like, hey, I
think I want to get a peersupport specialist class, and I
think I want to be a drug andalcohol counselor.
And this is something I use alot, and it I get goosebumps
every time I say it.
But addiction is a disease ofshame and stigma.
(35:12):
And my patients have done somehorrible things.
And what's amazing is when theytransition from living with
addiction to recovery andworking to help others, all
those skeletons in their closetnow become their superpower.
SPEAKER_00 (35:25):
That's right.
Yeah.
SPEAKER_01 (35:26):
And it's the coolest thing to watch when they realize
like the fact that I used to dothis could help people.
And I'm like, yes.
SPEAKER_02 (35:34):
Yeah.
I heard somebody this past yearsay, and I hadn't heard it
before, they turn your mess intoyour message.
SPEAKER_00 (35:41):
Ooh, that's like that.
That is great.
SPEAKER_02 (35:44):
Yeah.
No, totally.
Some form of purpose has to comein, whether it's I want to help
other people or there's biggerthings in store for me.
But it's that purpose piece, soimportant.
SPEAKER_01 (35:56):
Yeah.
What uh what's your success ratewith this approach?
SPEAKER_02 (35:59):
I don't know because I don't measure.
SPEAKER_01 (36:01):
Anecdotally?
SPEAKER_02 (36:03):
People that come see me usually get sober.
Reason is because my focus isn'treally on trying to make them
get sober.
My focus is making them have apleasant experience.
If they like me, they'll keepcoming in.
And if they keep coming to seeme, I'm gonna get you there.
SPEAKER_01 (36:15):
Yeah, it's just I've said that so often.
If someone's not ready to getsober on the first visit, I'm
like, you know what?
Let's just book a follow-up.
I'd love to see you again.
100%.
If they like the experience,they come back.
Yeah.
Our practice, there are fivephysicians and I think eight
peer support specialists.
So these are all folks who livedexperience.
And addiction is a verytraumatizing disease.
A lot of my patients havedifficult homes or abusive
(36:38):
family members.
And sometimes we just tellpeople, like, just come hang out
in the waiting room.
Just come hang out with us.
And yes, you are spot on withthat to try to make them have a
good experience and feelrespected is so important.
SPEAKER_02 (36:48):
Right.
And they feel safe.
They know you're not trying topush them.
And then I build the creditscore as we go along.
And then I just basically waittill they get themselves in a
mess.
And then I'm like, oh, maybe youshould try this.
They're like, yeah, let's dothat.
I'm gonna get out of trouble.
And then I like I said, thenthey're like, oh, thank you so
much.
Versus feeling like someone madethem.
SPEAKER_00 (37:07):
Hmm.
I want to unpack that.
I want to get you out oftrouble.
SPEAKER_01 (37:11):
How does that usually land with your patients?
SPEAKER_02 (37:15):
It depends on what kind of trouble they're in.
If they're in, let's say theyhave a D UR or something, I'll
say, Let me write a letter toyour lawyer saying you're
coming, you're compliant, comingevery week, you're working,
you're doing all these things.
Great.
If they're in trouble with theirspouse, that's easy because I
got the family counselor onthem.
Let me fix that for you.
Like, whatever it is, if there'ssomething that I can help make
better for them, I I do.
SPEAKER_01 (37:36):
Is that usually what you open with in your first
meeting with a person?
I think you said that I'm yousaid, like, hey, I'm Amber, I
want to get you out of trouble.
Go ahead.
SPEAKER_02 (37:46):
Oh, I just say, Hey, I'm here on be on your side.
Whatever happens, I'm youradvocate.
So you I'm not the principal,you I'm not against you, I'm
your person.
They're there to be on yourside.
So I set it up that way.
Sometimes it takes me a minuteto figure out what that
something is that they need helpwith.
Sometimes it's pretty immediateand urgent, and then sometimes
(38:07):
it may just come along the way.
SPEAKER_01 (38:10):
Do you have a particularly memorable case of
where this worked really well ina family that was particularly
frustrated or at wit's end?
SPEAKER_02 (38:18):
I see it a lot, especially when I I used to deal
a lot more with like teens, kidsstill living at home or young
adults, like college kids andstuff.
And getting their parents toback up off of them is super
helpful and they're superappreciative.
But I'm funny about it.
I'm gonna say, listen, I'm gonnamake that happen for you.
In fact, actually, the familycounselor's gonna make that
happen for you.
(38:38):
So, but I'm just gonna tell youa secret right now.
You're gonna think that they'rejust oblivious and they're not
even paying attention andthey're like fine with it.
Let me tell you what's reallyhappening.
That family counselor's overthere giving them a strategy and
they're just waiting and lettingyou mess up.
So I'm just telling you, they'rejust gonna let you figure this
(38:59):
out the hard way.
So fair one it.
And they're like, okay, great.
SPEAKER_01 (39:04):
In the era of fentanyl, when the risk of
overdose and lace drugs is somuch higher, have you had to
change your approach?
SPEAKER_02 (39:12):
I don't know that I would change that approach,
really.
If someone is in that phase, Imight talk to them about um a
buprenorphine medicine, asuboxone, something like that.
Just depends on where they'reat.
But I don't know that approachwould be different.
I know that there's an urgencythat's there more.
And I wish you could make itfaster.
This is the fastest way to getthere.
(39:34):
Like it really is.
It doesn't feel fast enough,maybe to the family members, but
I'm like, this is the fastest.
SPEAKER_01 (39:40):
Yeah, I guess maybe it was a read-my-mind question,
but I think about someone usingcannabis, really can't overdose
on it.
Sure, you can get sick.
It's going to cause mentalhealth symptoms over time.
But we have some time, we havesome breathing room.
SPEAKER_00 (39:52):
Yeah.
SPEAKER_01 (39:53):
But with fentanyl, it's just so urgent.
Here in California, we've gottenplenty of these fentanyl
analogs, acryl, fentanyl,acetyl, fentanyl, paraflora
fentanyl.
I'm sure they're in SouthCarolina too.
But it just feels like thestakes are so much higher in the
era of fentanyl.
And I wasn't sure if you had tochange how you do things just to
help communicate that urgency.
SPEAKER_02 (40:13):
I think that the family already understands that
urgency.
The person knows what they'redoing and they know that it's
risky.
So it's not like I can sayyou're playing with life and
death.
When someone's that far intoaddiction, there's passively
suicidal anyway.
So that whole this is gonna killyou thing is just not that
powerful because there's thispart of them that's like
(40:36):
sometimes wishes they wouldn'twake up.
They may not be activelysuicidal with a plan, but
they're miserable and unhappyand trying to not be sick all
the time.
And in the back of their mind,it wouldn't be the worst thing.
So that whole like trying topress, you're gonna kill
yourself.
I just haven't found that works,even though I want to do that
(40:56):
because it's scary.
I just don't know that it iseffective.
SPEAKER_01 (41:00):
Yeah, it's funny.
When I was in my training and Itrained at a very good
institution, I did my residencyat Stanford in the emergency
department.
We would literally write, youneed to stop drinking in their
discharge instructions.
And oh, I'm such a good doctor.
They didn't teach us anything.
SPEAKER_02 (41:14):
I told them to stop.
SPEAKER_01 (41:16):
Yeah, yeah.
My very lovely and veryintelligent spouse and
colleague, Dr.
Reb Close.
We've been married for 18 years.
We've been practicing addictionmedicine together for three or
four years.
SPEAKER_02 (41:26):
That's really cool.
SPEAKER_01 (41:27):
Yeah.
So she did emergency medicine.
I did emergency medicine.
Between the two of us, 15 yearsof medical education at UC Land
Stanford.
We got an entire hour in 15years of training on addiction.
SPEAKER_02 (41:38):
Wow.
That's crazy.
SPEAKER_01 (41:40):
So, yes, we've learned all this after the fact
and gone through the AmericanBoard of Preventative Medicine's
practice pathway for addictionmedicine, and now we're both
certified.
But yeah, for years I just toldpeople like you need to stop
using.
And that's what I thought waswhat they needed.
And clearly that was not thecase.
I just wonder if there's somesignal around fentanyl
specifically, just doing maybesome psychoeducation on specific
(42:02):
risks just to let them know theurgency, but in a supportive,
empathetic way.
SPEAKER_02 (42:08):
If I'm talking to someone who doesn't know that,
then I probably would.
But I haven't ran across someonethat's using that kind of drug
that doesn't know that already.
SPEAKER_01 (42:16):
I guess that's a good point.
SPEAKER_02 (42:17):
I might do a lot of education with their family and
I might get them to get an Arcanand I might do some things like
that, and I might talk to themabout Suboxone or something and
say, hey, like I know you'restuck on this four-hour
treadmill and that's miserable.
And I might work that angle ofsaying, man, this would
stabilize you.
This would make it where youcould go to work and you
wouldn't have to like constantlybe stealing or hiding or you're
(42:40):
spending all your money.
But I don't know, that's adifferent technique.
SPEAKER_01 (42:44):
Okay.
So in other words, people knowthe harms, and part of what the
family members do in gettingcredit is to acknowledge that
their loved one is intelligentand understands what they're
doing and they need to work onfinding the why.
SPEAKER_02 (42:56):
If they're 14 or 15 years old, maybe they don't.
I don't even know about that.
I if you're that far in, but youmay be like, whatever, it's not
gonna happen to me.
It's not that you don't know it.
So I tell families, do not sendno medical article to your
person about this is your lungs.
Do not send, do not do it.
Because that's it just and Idon't do that either.
(43:18):
They know that.
SPEAKER_01 (43:18):
On the flip side, do you have the loved ones send
maybe information aboutaddiction or brain science or
new treatments as a way to besupportive?
Hey, what do you think?
SPEAKER_02 (43:28):
Not until the person is expressing some sort of
change talk.
And depending on what sort ofchange talk, I tell the family
members I train them to behaving some resources in their
back pocket and like findingones that their loved one will
go for.
And that could just be apodcast, that could be a book,
that could be anything, like afriend that's in recovery, and
(43:50):
to wait for the right moment toplay that card.
Because if you play that cardtoo soon, someone's in denial
and they don't think they have aproblem and you're constantly
talking to them about going totreatment, you've destroyed your
credit rating.
You're just an idiot who doesn'tknow what you're talking about.
And then everything you say,you're just overreactor.
So I encourage them to findresources that the person will
(44:11):
go for.
If the person's not religious,it needs to be a not religious
one.
If their person's an outdoorsone, it needs to be an
outdoorsman and be waiting,sitting on ready till they get
their moment.
And then say, and then I teachthem to say, I don't really know
if this is for you or not.
I don't know.
I thought you might like itbecause it's outdoors.
I call it the leave it on thecoffee table method.
Someone's like more likely tolook at it if they don't feel
(44:34):
pushed.
SPEAKER_00 (44:36):
That is a beautiful pearl right there.
SPEAKER_01 (44:39):
Okay, is there any part of your approach we haven't
gone over yet?
SPEAKER_02 (44:42):
Those are the basics of it.
That's the big outline.
SPEAKER_01 (44:45):
And did you come up with it yourself?
SPEAKER_02 (44:48):
Yeah, trial and error, figuring it out.
Because when you go tocounseling school, I guess you
get more than doctors.
We got a course on it, but thecourse entails go to three
12-step meetings and come backand report to us what it was
like.
That's it.
And they put the disease modelcurve up on the whiteboard.
SPEAKER_01 (45:06):
That's it.
Have you published this like ina book or a scientific article?
SPEAKER_02 (45:10):
No, I'm thinking about writing a book.
I have an online course calledThe Invisible Intervention.
I have a little workbook, but Ihaven't decided if I want to go
the writing route.
I'm I do better talking.
SPEAKER_01 (45:21):
So Yeah.
Thus, thus YouTube and podcasts.
Okay.
As we get to the end of thehour, is there anything else you
wanted to add that we missed?
SPEAKER_02 (45:30):
I don't think so.
I just want to say I appreciatethe work that you're doing.
SPEAKER_01 (45:35):
So, yes, I'm very proud.
I got a minute to brag.
We have a five physicianaddiction medicine practice in
little old Monterey, California.
And it's great.
Yeah, we can get people in thesame day.
We have four pillars to ourmedical approach.
It's kindness and respect, it'slow barrier to entering
treatment.
It's really emphasizing the roleof peer support and those with
(45:57):
lived experience, supporting aperson wanting to get sober and
then using long-actinginjectable medications.
So the way I say it is let's sayyou're on Suboxone, you're on it
three times a day, you've got tomake what over 900 choices a
year to make sure you take yourmeds.
And once we get you on aonce-a-month injection, you just
have to come see me 12 times.
Yeah.
SPEAKER_02 (46:18):
And how easy is it to talk to people into doing
that?
SPEAKER_01 (46:22):
It's an interesting question.
So same thing that you weretalking about is trying to
understand the why.
I mentioned what do I do in myfirst appointment?
What makes you want to change?
And for a lot of people, it's myhealth.
I lost my kids.
I'm going to face jail time.
And I really look at it, again,back to my man is on the ear
(46:43):
joke.
What for them feels easiest?
Some of my patients are superdiligent.
I prescribe it, they don't missa dose.
All of us are humans.
Some people really struggle withremembering medications.
And so some people hear thatthere's a once-a-month shot and
they're like, oh, thankgoodness, it'd be so much
easier.
And they want to go for that.
Others, to your point, we trynot doing it and it doesn't
(47:04):
work.
And I'm finally like, okay,we're if we're here in the next
month, I think we should try theinjection.
SPEAKER_02 (47:09):
And it's a good idea.
The bargaining working up to it.
Same thing, same thing.
Yeah.
SPEAKER_01 (47:13):
Yeah.
SPEAKER_02 (47:13):
So do you find that people, because one of the ways
I sell, I don't do sublica, butI sell people on the idea of
sublicate a lot, is I'll say, ifyou ever decide you want to come
off, it's so much easier to comeoff of subplica than it is
Suboxone.
And then I explain all that tothem.
Maybe you don't need to comeoff.
But if you decided you wantedto, people say that they can
slow down on this and come offwithout feeling anything.
SPEAKER_01 (47:35):
You are correct.
I do it all the time.
We give them four to six shotsof sublicade.
It builds up in their system.
There's a depot of it, and thenthey don't kick.
It is unbelievable.
SPEAKER_02 (47:46):
Isn't it?
I know.
And once people like can startto think about that way, they're
like, yeah.
SPEAKER_01 (47:53):
Totally.
Usually my conversation withthem is look, let's get you on
Suboxone.
I promise I can get you off ofit, and it's no big deal.
And when they hear that, they'relike, okay, I'm ready.
SPEAKER_02 (48:01):
Yeah.
I love it.
My my experiences is that mostpeople that are in our field use
these same techniques, butsometimes we don't have words on
them.
We just know we just do them.
Like because we've just beendoing them forever.
I think teaching YouTube ortalking to families has forced
me to have to figure out what isit that I do?
Can I put some names on thosesteps or whatever?
(48:23):
But you inherently figure thisout.
SPEAKER_01 (48:26):
Yeah.
And part of why I have a podcastis one of my patients will be
like, Dr.
Grover, what do I do?
And I'm like, wait, I have anepisode for you.
And then I just email them thepodcast episode, they'll listen
to it.
And then it's almost like I canget work done with my patients
in between our visits by havingpodcast episodes that they can
listen to.
SPEAKER_02 (48:42):
And I think you can get work done even more because
when you're telling someonesomething face to face, their
walls are up a little bitbecause they're just not sure
and they feel pushed.
And when they're just listeningand they just know you're
talking to the world, theirwalls are down and they actually
absorb it better that way, Ithink.
SPEAKER_01 (48:58):
I would agree.
Yeah.
So, Amber, if someone wants tolearn more about your work,
where can they find you?
SPEAKER_02 (49:03):
Best place to find me is on YouTube.
Put the shovel down.
Whether you are a personthinking about getting sober in
early recovery, you have a lovedone who needs to think about it.
We have every kind ofinformation for every angle.
SPEAKER_01 (49:18):
Fantastic work.
I will be sending this to somany of my patients' family
members as soon as it is live.
So, Amber, I have to say thankyou so much for coming on my
podcast and teaching me.
SPEAKER_02 (49:27):
Thanks for having me.
Appreciate it.
SPEAKER_01 (49:32):
Before we wrap up, a huge thank you to the Montage
Health Foundation for backing mymission to create fun, engaging
education on addiction.
And a shout out to the nonprofitCentral Coast Overdose
Prevention for teaming up withme on this podcast.
Our partnership helps me get theword out about how to treat
addiction and prevent overdoses.
(49:54):
To those healthcare providersout there treating patients with
addiction, you're doinglife-saving work and thank you
for what you do.
For everyone else tuning in,thank you for taking the time to
learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together, we can make it happen.
(50:15):
Thanks for listening.
And remember, treating addictionsaves lives.
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