March 19, 2025 • 49 mins
On this episode of NP Pulse: The Voice of the Nurse Practitioner®️, we dissect the pervasive stigma surrounding substance use disorders, tracing its historical origins and critiquing past punitive measures through compelling firsthand accounts. It’s a urgent call to shift perspectives and adopt a more effective, compassionate approach — prepare to be engaged and inspired.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:13):
- From the American Associationof Nurse Practitioners,
I'm your host, nurse practitioner
and AANP educationspecialist, Michele McKay.
And this is NP Pulse, the voiceof the nurse practitioner.
Welcome to NP Pulse. AANP’s official podcast,
(00:34):
bringing you uniquenurse practitioner voices
and expertise on issues that matter to NPs
and to our patients.
NP Pulse podcast listenersmay claim AANP CE credit
for this program through March, 2026.
After you listen to the podcast, simply go
to a aanp.org/cecenter.
(00:55):
Register for this activity,enter the participation code,
and then complete thepost-test and evaluation.
In this episode, we'repeeling back the layers
of the effects of stigma
in substance use disorders,tracing their historical roots
and questioning the effectiveness
of punitive approaches used in the past.
Brace yourself for a compellingargument on why a shift in
(01:19):
our attitude and mindset is imperative.
In tackling the pervasive issue of stigma
and substance use disorder. We're about
to shine a spotlight on acritical, often overlooked aspect
of substance use disorder treatment.
The stigma the individualsbattling drug misuse face within
the very system designed to help them.
(01:40):
You'll hear firsthand accounts
that will challenge your perceptions
and make you rethink thecurrent state of healthcare
and how people with substanceuse disorders are treated.
Get ready to dive deep into thesocial norms, knowledge gaps
and fears that fuelthis stigma. We’ll dissect
how these factors impactcare and recovery,
and more importantly, we’ll arm you
(02:01):
with practical strategies you can use
to make a real difference.
This isn't just a podcast,it's a call to action.
Join us as we challenge long held beliefs
and pave the way for a more compassionate,
effective approach tosubstance use disorders.
Whether you are a healthcareprofessional, someone affected
by a substance use disorder,
(02:22):
or simply a concerned citizen,
this episode promises insightsthat will stay with you long
after you finish listening.
This episode isn't just eye-opening,
it's potentially life-changing.
Are you ready to be a partof the change that's needed?
Well, now I'm gonna turnit over to Marissa Abram,
Dana Murphy-Parker, Robert Deforde,
(02:42):
and Rachel Shuster
as they delve into theirpersonal experiences with stigma,
discuss how healthcaresettings can be leveraged
for positive change,
and share practical strategies
to enhance patient-centeredcare and to support recovery.
- Welcome to the podcast on building trust
and reducing stigma insubstance use disorder,
patient clinician interactions.
(03:04):
My name is Marissa Abram
and I'm an assistant professorat the Duke University School
of Nursing and Secretaryof the Global Board
of the International NursesSociety on Addictions.
I'm a PhD prepared nursepractitioner supporting the health,
wellbeing, and recovery ofpersons with substance use
for the past 20 years.
- I’m Robert Deforde, program managerwith Shatterproof,
(03:25):
a national nonprofitorganization dedicated
to reversing the addictioncrisis in the United States.
And I'm also a personin long-term recovery
for the past 13 years.
- Hi everyone. My name is Rachel Shuster.
I am a certifiedaddictions registered nurse
and a person in long-termsustained remission from
opioid use disorder.
(03:47):
I am also the president-elect
of the USA chapter
of the International NursesSociety on Addictions.
- Hi everyone. My nameis Dana Murphy-Parker.
I'm currently the president
of the International NursesSociety on Addictions,
sometimes refer to it as INSA Global.
(04:07):
I am also a psychiatricnurse practitioner.
I am a certified addictionsregistered nurse advanced
practice, and I am aclinical practice faculty
at the University ofColorado College of Nursing.
I'm gonna give you some historyof substance use disorders
and addictions in the United States.
(04:29):
For many years, the underlying assumptions
of current alcohol
and drug policies in the UnitedStates have been based on
prohibition, criminalization,
and a drug-free society ideology,
also xenophobia and racism.
Eleanor Sullivan, who wrote thefirst nursing book on caring
for people with substance usedisorders in 1995 discussed
(04:53):
how the Harrison NarcoticAct passed in 1914 attached
criminal consequences
to drug addiction in the United States.
This law cast a long
and chilling shadow over the development
of progressive treatmentprograms for substance misuse.
That's what it was calledin the US at the time.
(05:15):
In the book MotivationalInterviewing Miller
and Rolnick state thatthe belief is that people
with alcohol and drug problemsneeded harsh confrontation.
They were talking about thehistory, not what they believe,
but they talked about harsh confrontation
and therapy group approaches.
For example, the Synanon therapycommunity employed tactics
(05:38):
such as attack therapy, the hot seat
and the emotional haircutin trying to get a person
with an alcohol, a drug problem
to admit their personality flaws
and break through theirdenial of the problem
to change their behavior.
In an 1983 Wall Street Journal article,
this describes aconfrontational intervention
(06:00):
with an executive.
This is the quote (06:02):
They called a surprise meeting,
surrounded him with colleaguescritical of his work
and threatened to fire him ifhe didn't seek help quickly.
When the executive tried to deny
that he had a drinking problem,
the medical director camedown hard, shut up and listen,
he said. Alcoholics are liars,so we don't want to hear
(06:24):
what you have to say. Inanother quote in the book,
an example of the therapygroups, this was written.
Now Buster, I'm goingto tell you what to do
and I'll show you.
You either do it
or you get the hell offof Synanon property,
you shave off themustache, you attend groups
(06:45):
and you behave like a gentleman.
As long as you livehere, you don't like it.
Well, God bless you, then I'llgive you the same good wishes
that I gave other people,like when they went
and went off to jail.
That's the way we operate here in Synanon.
You see, you get alittle emotional surgery.
If you don't like the surgery, fine, go
(07:05):
and do what you have to do.
Maybe we'll see you againwhen you get out of the penitentiary
or you get a drug overdose.
Addicts always say, nobodytells me what to do.
Yeah, nobody in the world says
that except dingbats likedope fiends, alcoholics
and brushed face coveredEl Gatos like you.
It was President DwightEisenhower whose establishment
(07:28):
of the US interdepartmentalCommittee on narcotics in 1954,
first literally called for a war on drugs.
The war on drugs began in 1971when President Richard Nixon
declared drug abuse to bepublic enemy number one
and increased federal fundingfor drug control agencies
(07:49):
and drug treatment efforts.
It was President Ronald Reagan in 1981
who greatly expanded thereach of the drug war
and his focus was on criminalpunishment over treatment,
which led to a massiveincrease in incarcerations
for nonviolent drugoffenses from 50,000 in 1980
(08:12):
to over 400,000 in 1997.
In 1994, his wife Nancy Reagan,
spearheaded anotherfacet of the war on drugs
with her just say no campaign.
It was the belief thataddictions could be controlled
by willpower, and thefailure to do so was simple
(08:33):
and bad and wrong behavior.
That's where we are coming from in terms
of our history over a hundred years,
and I think it does stillperpetuate the stigma
that we see in society for people
who do have substance use disorders.
- Wow. Dana, thank you so much for sharing
(08:54):
that history with us.
This is a legacy that reallyhaunts us today in addiction
treatment, these punitivestrategies, criminalization,
and just that lack of apublic health approach.
So our goal today is to address the stigma
that an individual with druguse experiences when they enter
the healthcare system, for example,
settings like primarycare, which is so important
(09:16):
when we think about primarycare, it's that first place
that you go for medical care.
It helps us catch healthproblems early, manage them
through regular checkups, screenings
and monitoring of ongoing conditions.
This way it can keep an individual healthy
and really prevent seriousillnesses from getting
worse and progressing.
But this is not limited to primary care.
(09:38):
That being said, therereally is no wrong door
to engage an individual with drug use.
So thinking about stigma,what is it really?
Stigma is when peoplehave negative attitudes
or beliefs about someone
because of a particularcharacteristic like using drugs.
And this can lead to unfairtreatment and discrimination.
(10:00):
Individuals with addictionexperience health inequities.
These are unfair, unjust, preventable,
harmful health outcomes andstigma really drives this.
And then, you know, you spokeof these historical facets
and we know that stigma oftencomes from social norms,
which are the unwritten rules about
(10:21):
how people should behave in society.
So let's think aboutstigma and how it works.
And as we do that, let's thinkabout how we can intervene
as nurse practitioners inthe areas that I'm going
to discuss and really thinkabout how we can leverage them
as opportunities for change.
So lack of knowledge drives stigma,
and this occurs when peoplemay not understand the reasons
(10:43):
behind certain behaviors like drug use
and make really unfair judgements.
Stereotypes drive stigma.
And this is when societyoften has fixed ideas about
how certain people should behave
and anyone who doesn't fit that mold,
they're stigmatized, they're considered
to be on the outside.
(11:03):
And then fear, and this is ahuge one, sometimes people fear
what they don't understand,
and this leads to negative attitudes.
All of these factors combinedtogether to create stigma,
which leads to discrimination
and on unfair treatment.For people who use drugs.
Stigma in healthcare has serious effects,
(11:24):
and I'd like to sharethree of those with you.
Avoiding care. Theseindividuals may avoid going
to their healthcare providerbecause they fear being judged
or being treated badly.
Poor treatment. If
and when these individualsdo decide to seek help,
they may not get the samequality of care as others,
and healthcare providers mightspend less time with them
(11:47):
or may not take theirhealth concerns seriously.
And then last but notleast, mental health,
constantly facing stigmacan harm one's mental health
and particularly for individuals
with substance use can makethem feel ashamed or unworthy.
We know that stigma can prevent people
who use drugs from gettingthe help that they need
(12:08):
to stay healthy.
And so, Rachel, I know you'veexperienced some instances
of stigma on horizontal violence.
- Yeah, so I had mentioned thatI am in this unique position
of being both a healthcareprovider as well as a person
with lived experience.
My personal substanceuse was during the time
(12:31):
that I was already a registered nurse
and my substance use led me
to experiencing anopioid overdose as well.
And when I overdosed, I wasworking the night shift at,
at the hospital where I was employed,
and I didn't want to be admitted
to the hospital where I worked.
(12:51):
Recognizing the challengethat that puts my peers in
taking care of me, perhaps, you know,
there would be a lot moregossiping going on than, you know,
taking care of me or things like that
because you know, there was a code
that was called in a staff bathroom.
Everyone wanted to know whathappened to one of their own.
(13:12):
And so I was transferredto a different hospital
and I don't necessarily know,you know, the exact details of
how my case was reported out on from shift
to shift from provider to provider,
but I could sense thisoverwhelming feeling
of just a different energy
with my healthcare provider team compared
(13:35):
to my dietary aide.
And the only thing I canexplain that with is, you know,
perhaps my dietary aidewas not privy to all
of the information thatperhaps my nursing staff was.
And it's something that really, you know,
affected me psychologically,especially as I debriefed from
that entire experience andhow scary it was for me.
(13:57):
- Well, thank you for sharing that
and I know Robert, thishas had some personal
impact on you as well.
- Thanks Marissa, and thanksRachel for sharing your story.
I, I think when I, I try tolook at what my experience
with stigma in healthcarehas been like, I, I look back
to January of 2020.
I just
(14:17):
before the vaccine hadcome out for covid I
unfortunately I got covid and,
and I got really, really, really sick
and you know, I luckily Irecovered, wasn't hospitalized
or anything and about four months later
I started experiencingrapid heart rate increase.
I'd be walking around
and all of a sudden my heartrate would be 180 200 sitting
(14:39):
down eating dinner.
My blood pressure spikes
and I had no idea whatwas causing any of it.
So I did what any other person would do
and I make an appointmentat a cardiologist.
And I think it's reallyimportant in recovery that
I'm extremely open
and transparent with anydoctor that I encounter.
So I go in for that first visit.
I fill out all the information,
(15:00):
I immediately tell the doctor, you know,
I've been in recovery for,
I think at the time itwas like eight years.
And so he immediatelydidn't test anything.
Oh, it's 'cause of your past drug
use that's causing all this.
You did this to yourself.
And I walked around leavingthat appointment with
so much shame that I had,
(15:20):
I had thought I had done everything right
and somehow now I'm stillliving the effects of,
of my past drug use all theseyears later, come to find out,
you know, I go to other doctors and,
and I was suffering fromlong covid the whole time
and I needed to be puton heart medication.
I needed to be put onmedication for the brain fog
and I needed inhalers for my lungs.
(15:42):
But if I had stopped atthat one experience with
that one doctor, I would'venever gotten the treatment
that I actually needed.
And it was all based onhis assumption of who I was
and my level of honestybecause I chose to go in
and try to be transparentwith this doctor.
And, and that shows the, thepervasiveness of stigma that
that leads all the waydown to the health outcomes
(16:03):
for individuals, not justthis one singular experience
and the shame that it causes,
but then the the laterhealth outcomes as well.
- Wow. I'm so sorry thatthat happened to you
and that you were disregarded.
We all know that as nurses we try
to provide patient-centered care.
We need to listen to ourpatients and respect them.
(16:25):
And so why that should thatbe different for somebody
who has a history of using substances?
- And it's very scary bringing that up
with a healthcare provider, right?
It's intimidating becausewe often forget the innate
hierarchy that exists.
The healthcare provider,
the nurse is in a position of power.
(16:48):
- And I think this powerreally, really speaks to
how we can leverage
and change our behaviorswithin the healthcare setting
to provide higher qualitycare for individuals
who use substances.
Dana, you've had instances where
as a psychiatric nurse practitioner,individuals that you've
(17:08):
provided long-term care to
that have been stable whenyou've transferred them into
care, they've experiencedharm to their health.
- Yes. Thank you Marissa.
This is an experience that I carry with me
'cause it happened about three years ago,
but I was working in a MAT clinic
as a psych NP in a MAT clinic,
(17:29):
of course medicated assisted treatment.
And I had a couple who came to me
after they had bothgotten out of treatment
for their opioid use disorder
and we started 'em onbuprenorphine, then they had
to make a, a geographic move.
So they looked for another provider.
By the time they werefinishing their work with me,
(17:50):
they were both onbuprenorphine, doing very well,
hadn't relapsed in a very, very long time,
and they were married andhad a little 2-year-old.
He was in school, youknow, she was staying home.
I also treated them for bipolar disorder
and she had pretty severe anxiety as well.
But they were, they were doing well
(18:10):
and they had to change providers.
And I want you to keep in mind
that when they changed providers,they went to a psych NP
who worked in another MAT clinic.
And what he said to themwhen they first went in was,
your provider, Dana hasn'tbeen doing you any favors.
She should have tapered you off
(18:31):
of buprenorphine a long time ago.
We need to start taperingyou off of this medication.
And they were immediately resistant
and said, please don't do that.
We're doing well.
We know that if we come down off of it
or totally off of it, we'regoing to start craving again.
We're afraid we'll relapse.
And she actually said, she started to cry
(18:52):
and said, please don't do that.
This nurse practitioner,
psych nurse practitioner looked at them
and said, oh, now you'rejust talking like an addict.
So I just think, wow.
I mean that if, if that's
what people are facing whenthey go in for help, obviously
that is not very helpfuland it is extremely shaming.
(19:15):
And, and this is what,what happens with people
who have stigma, oftentimesthey don't go for help
because they do feel likethere's something terribly,
terribly wrong with me
and I don't want anybody to know that.
So that is a harm reduction approach to me
that we use the right kind of language
and the right kind of communication.
- I'm glad you mentionedlanguage there and,
(19:37):
and you know, reallyunderstanding how the role
and that we can play in
how we talk aboutbehavioral health challenges
and the impact that it can have.
It's so significant not onlyin our approach to patients,
our nonverbal communication,but also not just what we say
but how we say it.
(19:58):
And that's something that I'vereally championed over time
is shifting our language
to non-stigmatizingalternatives based off of
what we have in the bodyof research right now.
And you know, a lot of peoplesay, is this just semantics?
Why does this matter?
We have research that shows
(20:19):
that the way in which peopleare described can actually
impact the quality of care that's being
provided. In a study
where individuals in a casevignette were described very
differently, there were higherlevels of stigma displayed
by healthcare providersthat had the scenario read
(20:39):
to them describing individualsin a more stigmatizing way.
So oftentimes you'll hearindividuals encourage folks
to shift into person firstlanguage examples, like a person
with a substance use challenge
or a person with a substanceuse disorder, a person
with opioid use disorder,a person in remission
(21:00):
or a person in recovery.
But I think it's alsoimportant to recognize
that while person firstlanguage is encouraged,
especially when we're talking about others
as healthcare providers,
individuals should be affordedthe autonomy to identify
as they see fit.
And that would be known asidentity first language.
And we see this in other cases
(21:20):
and not just substanceuse disorder, we see it
with individuals who wanna be identified
as autistic versus a person with autism
or a person who is blind,who wants to be identified
as blind rather than a personwith vision impairment.
We see it as someone whowants to be identified
as an amputee versus aperson with an amputation.
And so there are scenariosin which it's appropriate
(21:43):
and when we're interactingwith our patients,
that's something that we needto take into consideration
to be trauma informed andto be culturally competent.
However, when we're documentingin the medical record,
it's important to adhere toclinical terms instead of saying
that someone popped hoton their drug screen
or that they failed theirdrug screen as if it is a test
that they can pass.
(22:04):
Instead we say things likethey’re positive for X, Y,
Z on their drug screen, which is expected
or unexpected wasdisclosed or undisclosed.
And so really looking at our patients
with unconditional positive regard,
- I think it's so important, Rachel,
what you mentioned about giving autonomy
back over to the patient.
I think about how when wego into a medical office
(22:27):
and we fill out our paperwork,
there's always a section there for
what pronoun do wewanna be referred to by.
But there's no sectionthat I can sit there
and put, how do I wanna referto my substance use disorder?
You know, I came through12 step recovery and,
and that's where I found success.
And I find it empowering torefer to myself as an alcoholic.
(22:48):
That's something that thatmakes me see how far I've come.
And for others it may not be that way,
but when I go into adoctor's office, that's
how I want it referred to.
And so to, to defer to the patient
and allow them to decide how they want
to identify themselves is so important.
I also think about in2023, Shatterproof worked
(23:09):
with Compass Ethics todevelop a conversation guide
for healthcare providers.
And we have this quoteat the beginning from Dr.
Katherine Dong who's anaddiction medicine specialist.
And she says, how you talk with patients
who use substances matters as much as
what procedures you can perform
or what medications you can prescribe.
(23:31):
Sometimes it matters more.
Your words and actionscan create a safe space
where patients will return
for care even when thingsdon't go as planned.
And I just think that that'sso important to realize
that we're not justtrying to set ourselves up
for success in, in this appointment and
and related to theirsubstance use disorder,
(23:51):
but about anything that they'recoming to the doctor for.
So preparing for whenthings don't go as planned.
- You know, Robert, youused the word matter
and mattering to us as humansor it's, it's so important.
There was this really greatarticle in Scientific America a
few years back by Francine Russo
and it spoke about theimportance of mattering
(24:13):
to wellbeing and health.
And really that camedown to feeling valued
and seen by others as important.
And one of the things that thatreally strikes me as, as you
and Rachel shared your stories
and Dana you too was just the
disregard, right?
And, and that communicatingof you don't matter.
(24:35):
And I think for us inthe nursing profession,
when we think about our ethical code,
patient autonomy reallyranks very highly up there.
And that inherent respectfor humans, right?
Or for an individual's humanity.
And so what stigma says isit says you don't matter.
And that's the message we give individuals
(24:57):
who use drugs when we don't listen to them
and when we don't value them.
- And I think what Marissais saying is, is true.
I mean, one of the thingsthat we've always learned
and we say as nurses is meet the patient
where the patient is at.
Okay, it's about them, not about us.
And even something likethink about motivational
(25:19):
interviewing, we've alllearned about motivational
interviewing skills asa means of communication
and understanding at whatstage the person is at
with the behavior that we'retrying to help them to change.
And they're trying tohelp themselves to change.
But if somebody is pre-contemplative
and they're, you know, in denial,
(25:40):
and as we say, denial isnot a river in Africa, it is
what it says it is, people are in denial.
They actually have no awareness
that this substance isimpacting, you know, some
of the things that aregoing on in their life.
And so if we try to getthem to be into the prepared
to change stage
and they're in denial, we'rejust miscommunicating with them
(26:03):
and they're not hearing us andthey'll be resistant to that
because we're not hearing what it is
that they came in for us to hear.
- So when we think aboutus as healthcare providers
and not listening, I think that, you know,
thinking about matteringagain, Robert, thank you
for sharing that is is reallyus having an awareness,
(26:23):
and this comes from Gregory Elliot, right?
Are we paying attention to our patients?
Are we communicatingthat they're important?
And this is in healthcare,it's taking a real interest in
who they are and listening
to them when they tellus what their needs are.
And again, reliance is reallyimportant in mattering.
Do our patients feel comfortablecoming to us for help
(26:47):
and support as healthcare providers?
So I think what we need to do
as healthcare providers isreally reflect on those questions
and those are alsoopportunities for change.
- Something else that comes
to mind when we're talkingabout stigma is oftentimes
how we treat one another as peers as well.
(27:10):
During my substance use challenges
and experiences with chaotic
and unhealthy use, I was working
as a registered nurse inthe intensive care unit
and I would oftentimes havepatients who were going
through DTs, patients
with substance usechallenges of their own.
And seeing the way in whichmy peers spoke about those
(27:34):
patients inadvertently
and maybe even unknownto me at the time, kind
of flagged in my mind, they'renot safe for you to turn to,
you have to keep this hidden.
And so I stayed stuck longer.
You know, perhaps if someone had been able
to recognize those signs
or if I felt comfortableapproaching a peer to talk about
(27:56):
where I was, I could havechanged the trajectory
and the outcomes of, of theadditional challenges I had
to face following my overdose
and following, beingenrolled with the state board
of nursing in their monitoring program.
So how we talk about ourpatients can impact our peers
and their wellness as well.
- You know, thank you forbringing that up Rachel.
(28:17):
I just wanna add here, we simply,
because of our history, I think our,
our history in the United States
and where we've come from, wehaven't really thought about
substance use disordersas a healthcare issue.
And we know that they are,
substance use disorders area chronic brain disorder,
just like other chronic disordersof the respiratory system
(28:38):
or the cardiac system.
But we have not includedit in nursing education.
And so I think that leads
to nurses not really knowing
and sometimes not evenreally knowing what to do.
So they don't do anything
or they carry their ownexperiences, you know, outside
of even their profession of howthey have experienced people
(29:00):
with substance use disorders
and they may think aboutthem negatively that way.
We have a lot to do whenit comes to education
of chronic medical disordersuch as substance use disorders.
- Thank you Dana. As we know that lack of
of knowledge really does drive stigma.
And so with that I thinkit's really important
(29:22):
that we think about waysthat we can make that shift
and change our culturetowards providing high
quality healthcare.
And so I think one of the thingsthat, that we've discussed
so far was the importance oflanguaging and words matter.
So thank you Rachel for that.
You know, when we think aboutcommunication strategies,
(29:42):
there is also the nurse technique.
And the nurse technique canbe used when we identify
that an individual is using substances.
And so N is to name or mirror the emotion
or language that the patient is using.
U, understand the emotion, payattention to the situation.
(30:06):
R, respect the patient.
S, support the patient using powerful words
and E, explore the emotion further.
And so Robert, this is a part
of the Shatterproof provider pathway.
- Thank you Marissa, formentioning a provider's pathway.
Shatterproof has workedfor the last 18 months
(30:28):
to develop this free e-learning curriculum
for healthcare providers thatoffers free CEUs accredited
by ASAM or the AmericanSociety of Addiction Medicine.
There are modules on SUD 101, substance use disorder
stigma, clinical applications like MOUD
or medications for opioid use disorder,
(30:50):
other harm reduction tactics,patient-centered care
and culturally competent care.
And, and that's really wherewe can touch on the nurse
technique and understand different avenues
for communication techniqueswhen we have a patient
that's presenting withsubstance use disorder
or maybe they're using drugs
and it's having adverseeffects on their life.
(31:11):
And this is a great opportunityfor us to employ some
of these other techniques
to create a safe non-stigmatizingspace for a patient
to be open and transparent with us.
- Thank you for sharingabout the provider's pathway.
Robert, it really is awonderful program that
that lays out information
to help an a healthcarepractitioner really build knowledge
(31:34):
sequentially and
and provide high quality careby, by fighting against stigma
and really listening to their patients
and really movingtowards patient centered,
patient informed care.
- It makes me think whenwe're talking about, you know,
certainly language and listening
and meeting the where the patient is at
and everything that you'retalking about, Robert, in terms
of mattering, you know,
(31:55):
we all learned therapeuticcommunication techniques most
of us in our firstundergraduate psychiatric mental
health class.
And you know, you thinkabout Hildegard Peplau said
that is the therapeutic use of self.
So that we are the therapeutic tool
and how we communicate withsome of these techniques such
(32:16):
as exploring
and you know, restating,giving general leads,
broad openings, reflecting those types
of things can help thepatient to communicate in,
in the way that we hopethat we're able to get them
to have trust with us so theycan tell us what is going on
with them at the time.
(32:36):
- I think looking atnon-stigmatizing language
and communication techniquesis really only one piece
of the puzzle or part of thetoolkit that we're trying
to develop here for nurses.
And I think one of the major pieces
that in the last decade we'vereally started to look at
as a society rather than beingsomething that sits just kind
(32:58):
of on the periphery is harm reduction.
And I think Marissa
and Dana, y'all can reallytalk a bit more about harm
reduction, what it is and howdoes it fit into this toolkit.
- When I think about harm reduction,
harm reduction is healthpromotion and disease prevention.
It really is a core functionof who we are as nurses.
(33:19):
And harm reduction reallygoes beyond what we think
of it traditionally, likesyringe exchange programs, right?
It at the core of harm reduction,
it is meeting the patients where they are.
Dana, would you like to add?
- Yes, I would. Thank you,Marissa. Harm reduction.
You know, I think a lot of times it seemed
(33:39):
for a long time the word harmreduction was almost taboo in
the United States becausepeople equated it to,
oh you just wanna legalize drugs
and that's not at all
what harm reduction is aboutharm reduction actually started
in Europe with the HIVepidemic when they realized
that it was sharing needleswas causing such an epidemic
of HIV and AIDS.
(34:01):
But I have a quote that I read
and I, I think this quotesays everything to me about
what harm reduction is when it comes
to substance use disorders.
Harm reduction is not abouthaving the person stop the
substances, but it's abouthelping the person to live.
I just wanna say that again,
it's not about stopping theperson from using the substances
(34:24):
but helping the person to live.
And we have just lost somany people, you know,
with the opioid epidemic still to alcohol
and tobacco in our country
and anything we can do tominimize the harms that go to
that is certainly within the nursing role.
- Yeah. So especially whenthese are evidence-based
(34:46):
strategies that are very practical,
they're very costeffective, easy to implement
and oftentimes give us thetools that in this sector
of healthcare oftentimes feelslike at times we just don't
have as many as the othertraditional western medicine
interventions and whatnot.
(35:06):
So I think that harm reductiontruly bridges the gap
that we have betweenpeople who use substances
and the traditional treatment system
where if a treatment facilityis requiring abstinence
to even be admitted forinpatient treatment,
then the individual's never going to go.
Meanwhile they wannawork on their alcohol use
(35:27):
but they're not willing togive up their cannabis, right?
So being able to work withpeople is really important so
that we can reduce thenegative consequences
associated with drug use.
And also remembering
that the nursing model isvery unique in and of itself.
We work under a bio-psychosocialmodel, so remembering
(35:48):
that it's more than justwhat's in front of us.
These are very much peoplethat come with very full lives
and very full experiences.
And so harm reduction is alsoa move for social justice
that believes in
and respects the rightsof people who use drugs.
- Absolutely. Rachel, sobeautifully said, harm reduction
(36:10):
to me really showsresilience of individuals
who use drugs, right?
This year harm reduction willbe celebrating a hundred years
as a grassroots movement ofindividuals who use substances,
really trying to find spaceswhere they could be well
and they could be healthy
and not being able to findthat within healthcare.
And so again, this isanother opportunity for us
(36:32):
as healthcare providers tointegrate these strategies again
to promote wellness and prevent disease.
- Can I also add herein terms of the toolbox,
we're nurse practitioners,we prescribe medications
and certainly medicationssuch as buprenorphine
and methadone, particularly
for opioid use disorderare very important.
(36:52):
Research shows over
and over again that peoplewho get on buprenorphine
and methadone will will stay away from the
opioids longer than peoplewho do not have them.
And so that's important.
And buprenorphine is somethingthat we can all prescribe,
you know, they did awaywith the waiver, you know,
(37:14):
you do have to have like eight hours
of opioid use education,
but as long as you have acontrolled substance license you
can prescribe buprenorphine.
Whereas methadone's a little harder
and in some states therearen't methadone clinics.
But getting the person on
that medication is veryimportant to help them
to work towards the thingsMarissa just mentioned,
(37:36):
which is the goal is to lead a fulfilling
and a productive lifeand have relationships
and all the things that allof us want to enjoy in life.
- Yeah. And thosemedications do just that.
The amount of friends
and colleagues in fact thatI've had on buprenorphine
or methadone is astronomical.
(37:58):
And these medicationsreduce all cause mortality
and it's very individualized.
People may utilize them short term
and people may utilize 'em the long term.
There's no date or timelimit that people need
to be cut off.
You know, this is reallyabout supporting wellness
and enabling life.
(38:19):
- And that really just goesback to what Dana was saying.
Addiction is a chronic illness.
And so if an individual with diabetes
or hypertension needed medications, right,
we would tailor our treatmentplan to our patient's needs
and we would support that plan
with maybe additional thingslike wellness, things like
(38:39):
nutritional referrals for example, right?
And so again, when we thinkabout medications, Rachel,
to your point, there's no hard stop on it.
It is based on what an individual needs.
- And further to that point,there's also, you know,
the same concept of ifwe're working with someone
and treating their diabetes,we may prescribe medications,
(39:02):
we may do nutritioncounseling, we may do a lot
of different interventions.
- Absolutely, absolutely.
- Everything that youjust said, Rachel is part
of harm reduction.
You know, addressing thevariables that are around,
you know, the use.
I have a saying that I, Ilearned from taking care
of this couple who this one NPwanted to take 'em off simply
(39:25):
because they thought they'dbeen on buprenorphine too long.
And in discussion with someother nurse practitioners,
I had another nursepractitioner who said to me,
I don't even bring up the word taper
unless the patient does.
So when the patient is ready
and meeting the patientwhere the patient is,
I think that's key.
- Again, getting back towhat you said, Rachel,
(39:45):
would we taper our patient off
of their hypertension medications
for no clinical indication?
Absolutely not. We wouldn'teven think about that
as a healthcare provider.
- Right? And remembering too
that these medications areFDA approved specifically
for opioid use disorder.
So if our patients are exhibiting signs
and symptoms of othersubstance use disorders,
(40:08):
these medications shouldn'tbe necessarily seen as,
you know, treatment forthose, there may have
to be other things going on
to help the individual reach their goals
- And they shouldn't be denied treatment
as well if they areusing another substance.
- Yes.- So we've had some really,
really good conversation on this today.
(40:29):
I think one of the most alarming things is
that we know that individualswho use substances
do not get the treatment that they need.
We know that about 10% of people
who need treatment get treatment.
And as discussed during thispodcast, the individuals
who do come into treatment,they experience mistreatment
(40:52):
and discrimination.
And so as healthcare providers,we have to do better.
- Yes. And we have toalso do better taking care
of each other as well.
We have been strained immensely
as a profession from theexperiences of horizontal violence
or bullying, the experiences of having
(41:13):
to meet certain outputs atour jobs, whether it's related
to the number of patientswe see, our quality ratings,
the projects or otherproductivity metrics.
We went through a pandemic together.
Everyone is dealing withtheir own perceptions of
how they feel about the world around us
and recognizing that we are also human
(41:34):
as individuals.
And trying to intervenein a process of cascading,
worsening this of a disorderis really important so
that we don't end up having a more severe
and difficult to treat disorder.
While also remembering thateven the most difficult
to treat substance usedisorders are treatable
(41:54):
and people do recover.
There is hope.
- And let's think that we'retalking about something that
affects almost everyone.
I, I remember when 9/11happened, you couldn't talk
to anyone who didn't know someoneor had a family member or,
or was affected somehow bywhat happened on 9/11.
(42:17):
I think the same thingis going on particularly
with opioid use disorder.
'cause there's been moreof a raised awareness about
substance use disordersbecause of opioid use disorder.
But I don't think we shouldforget other substances
that can be lethal likealcohol and tobacco too.
But we're talking about people
who are sons, daughters,brothers, sisters,
(42:40):
parents.
It's a human face that we have to see
and we have to think of
and we have to do whatever wecan do to minimize the harm
and the deaths that are going on
with substance use disorder.
And certainly we know thattreatment is really important.
In the latest publication
of the SAMHSA survey on druguse treatment in households in
(43:05):
the United States, this iswhat we know in terms of
who gets treatment
and who needs treatment. From 12 years old
and older, 54.2 millionpeople needed treatment,
but only 12.8 million received treatment.
From ages 12 to 17,
(43:27):
2.9 million people needed treatment,
but only 1.1 million received treatment.
From 18 to 25,
9.8 million people needed treatment,
but only 1.6 receive treatment.
From ages 26 and older,
24.2 million people needed treatment.
(43:51):
But out of those 24.2 million,
only 10 million get treatment.
So the treatment needs are
certainly huge in our country
and nurse practitioners havea great role to, you know,
help people
and decrease what we've been seeing
with these epidemics going on.
(44:13):
- I totally agree, Dana, tobe able to increase the amount
of treatment options for peoplewhile decreasing the amount
of barriers, we can increasethe amount of people
who receive help.
And I think that, you know,sometimes it feel sincredibly daunting
to try to tackle somethingas large as stigma
(44:35):
because what can I doas just an individual?
And you know, we recognizethat folks may avoid care even
for disorders
or conditions that are not related
to behavioral healthif they have something
in their history.
And so by being more welcoming, more open,
(44:55):
more non-judgmental with folks,we can decrease the barrier
to care that they experience
by experiencing stigmawithin a healthcare system.
I also want to just mention
because I had shared thatI am the president-elect
of the IntNSA USA chapter. IntNSA has plenty
to offer our members
(45:17):
from the conference toeducational webinars
that offer CEUs. We would love
to have your involvement in ourleaderships, our committees,
and please get involved.
You do not have to just workin addictions, you don't have
to just work in behavioral health.
We really want those broadperspectives recognizing
that our caregiving
(45:38):
and our helping willtouch these patients across
all environments.
- It's really been good to be here
with my American Association
of Nurse Practitioner colleagues
and I am a member of of AANP for a number of years.
I'd also like to just take the opportunity
to have you take a look atthe International Nurses
Society on Addictions.
(45:59):
We are a organizationthat our, our mission is
to educate nurses
and other health allied professionals
as well about substance use disorders
as a medical disorder.
So I invite you to look at our website.
We would love to see you atour 2026 International Nurses
(46:19):
Society on Addictions Conference.
- I think we've coveredso much ground today.
We've talked a lot aboutthe importance of language
and using non-stigmatizinglanguage with patients.
The options
of using different communicationtechniques like the nurse
technique to put patientsat ease so that they feel
that they can be more transparent,
(46:41):
they can increase the chance
of having a better health outcome.
Talked about the importanceof harm reduction and,
and the spectrum that that provides
and treating every patient with dignity.
We've also referenced Provider’s Pathway,
a Shatterproof curriculumavailable free of charge
to any healthcare provider
that offers free CEUs accreditedby the American Society
(47:04):
of Addiction Medicine.
And I think something I wasreally reflecting on is this
conversation has taken place is the,
the core commitment in healthcare
that all persons are inherently valuable
and worthy of dignified
and respectful treatmentregardless of their history,
choices or behaviors.
And I, that really hitshome on the reality
(47:26):
of the statistics ofsubstance use disorder,
48.7 million people with anSUD, 108,000 deaths per year
that these are not justnumbers on a piece of paper,
but they're brothers,sisters, mothers, fathers.
They are people in our lives.
I, I think back when we weretalking about harm reduction
(47:47):
that, you know,
eight years ago last week Ilost a dear friend of mine
and had we just done, you know,
something different ratherthan pushing only one pathway
of recovery, maybe it would'veplayed out differently.
And so I think that we'vereally set everybody up here
for success with being ableto employ different techniques
(48:08):
and to try somethingdifferent with their patients
and increase the chances that,
that they can find theirown pathway to recovery
and what that may look like for them.
Thank you all for joining us.
- Thank you Marissa,Dana, Robert and Rachel.
It's been an absolute pleasurelistening to your stories
and insights today
(48:29):
and your perspectiveshave added immense value
to this discussion.
To our listeners, rememberthat you may claim CE credit
for this program through March, 2026
by logging into the CE center at
aamp.org/ce center.
Register for this program,enter stigma in the code prompt,
and then complete thepost-test and evaluation.
(48:51):
Thank you for tuning in
and as always, be kind,be safe, be effective,
and be the voice ofthe nurse practitioner.
- From the American Associationof Nurse Practitioners,
I'm your host, nurse practitioner
and AANP educationspecialist, Michele McKay.
And this is NP Pulse, the voiceof the nurse practitioner.
Welcome to NP Pulse. AANP’s official podcast,
(00:34):
bringing you uniquenurse practitioner voices
and expertise on issues that matter to NPs
and to our patients.
NP Pulse podcast listenersmay claim AANP CE credit
for this program through March, 2026.
After you listen to the podcast, simply go
to a aanp.org/cecenter.
(00:55):
Register for this activity,enter the participation code,
and then complete thepost-test and evaluation.
In this episode, we'repeeling back the layers
of the effects of stigma
in substance use disorders,tracing their historical roots
and questioning the effectiveness
of punitive approaches used in the past.
Brace yourself for a compellingargument on why a shift in
(01:19):
our attitude and mindset is imperative.
In tackling the pervasive issue of stigma
and substance use disorder. We're about
to shine a spotlight on acritical, often overlooked aspect
of substance use disorder treatment.
The stigma the individualsbattling drug misuse face within
the very system designed to help them.
(01:40):
You'll hear firsthand accounts
that will challenge your perceptions
and make you rethink thecurrent state of healthcare
and how people with substanceuse disorders are treated.
Get ready to dive deep into thesocial norms, knowledge gaps
and fears that fuelthis stigma. We’ll dissect
how these factors impactcare and recovery,
and more importantly, we’ll arm you
(02:01):
with practical strategies you can use
to make a real difference.
This isn't just a podcast,it's a call to action.
Join us as we challenge long held beliefs
and pave the way for a more compassionate,
effective approach tosubstance use disorders.
Whether you are a healthcareprofessional, someone affected
by a substance use disorder,
(02:22):
or simply a concerned citizen,
this episode promises insightsthat will stay with you long
after you finish listening.
This episode isn't just eye-opening,
it's potentially life-changing.
Are you ready to be a partof the change that's needed?
Well, now I'm gonna turnit over to Marissa Abram,
Dana Murphy-Parker, Robert Deforde,
(02:42):
and Rachel Shuster
as they delve into theirpersonal experiences with stigma,
discuss how healthcaresettings can be leveraged
for positive change,
and share practical strategies
to enhance patient-centeredcare and to support recovery.
- Welcome to the podcast on building trust
and reducing stigma insubstance use disorder,
patient clinician interactions.
(03:04):
My name is Marissa Abram
and I'm an assistant professorat the Duke University School
of Nursing and Secretaryof the Global Board
of the International NursesSociety on Addictions.
I'm a PhD prepared nursepractitioner supporting the health,
wellbeing, and recovery ofpersons with substance use
for the past 20 years.
- I’m Robert Deforde, program managerwith Shatterproof,
(03:25):
a national nonprofitorganization dedicated
to reversing the addictioncrisis in the United States.
And I'm also a personin long-term recovery
for the past 13 years.
- Hi everyone. My name is Rachel Shuster.
I am a certifiedaddictions registered nurse
and a person in long-termsustained remission from
opioid use disorder.
(03:47):
I am also the president-elect
of the USA chapter
of the International NursesSociety on Addictions.
- Hi everyone. My nameis Dana Murphy-Parker.
I'm currently the president
of the International NursesSociety on Addictions,
sometimes refer to it as INSA Global.
(04:07):
I am also a psychiatricnurse practitioner.
I am a certified addictionsregistered nurse advanced
practice, and I am aclinical practice faculty
at the University ofColorado College of Nursing.
I'm gonna give you some historyof substance use disorders
and addictions in the United States.
(04:29):
For many years, the underlying assumptions
of current alcohol
and drug policies in the UnitedStates have been based on
prohibition, criminalization,
and a drug-free society ideology,
also xenophobia and racism.
Eleanor Sullivan, who wrote thefirst nursing book on caring
for people with substance usedisorders in 1995 discussed
(04:53):
how the Harrison NarcoticAct passed in 1914 attached
criminal consequences
to drug addiction in the United States.
This law cast a long
and chilling shadow over the development
of progressive treatmentprograms for substance misuse.
That's what it was calledin the US at the time.
(05:15):
In the book MotivationalInterviewing Miller
and Rolnick state thatthe belief is that people
with alcohol and drug problemsneeded harsh confrontation.
They were talking about thehistory, not what they believe,
but they talked about harsh confrontation
and therapy group approaches.
For example, the Synanon therapycommunity employed tactics
(05:38):
such as attack therapy, the hot seat
and the emotional haircutin trying to get a person
with an alcohol, a drug problem
to admit their personality flaws
and break through theirdenial of the problem
to change their behavior.
In an 1983 Wall Street Journal article,
this describes aconfrontational intervention
(06:00):
with an executive.
This is the quote (06:02):
They called a surprise meeting,
surrounded him with colleaguescritical of his work
and threatened to fire him ifhe didn't seek help quickly.
When the executive tried to deny
that he had a drinking problem,
the medical director camedown hard, shut up and listen,
he said. Alcoholics are liars,so we don't want to hear
(06:24):
what you have to say. Inanother quote in the book,
an example of the therapygroups, this was written.
Now Buster, I'm goingto tell you what to do
and I'll show you.
You either do it
or you get the hell offof Synanon property,
you shave off themustache, you attend groups
(06:45):
and you behave like a gentleman.
As long as you livehere, you don't like it.
Well, God bless you, then I'llgive you the same good wishes
that I gave other people,like when they went
and went off to jail.
That's the way we operate here in Synanon.
You see, you get alittle emotional surgery.
If you don't like the surgery, fine, go
(07:05):
and do what you have to do.
Maybe we'll see you againwhen you get out of the penitentiary
or you get a drug overdose.
Addicts always say, nobodytells me what to do.
Yeah, nobody in the world says
that except dingbats likedope fiends, alcoholics
and brushed face coveredEl Gatos like you.
It was President DwightEisenhower whose establishment
(07:28):
of the US interdepartmentalCommittee on narcotics in 1954,
first literally called for a war on drugs.
The war on drugs began in 1971when President Richard Nixon
declared drug abuse to bepublic enemy number one
and increased federal fundingfor drug control agencies
(07:49):
and drug treatment efforts.
It was President Ronald Reagan in 1981
who greatly expanded thereach of the drug war
and his focus was on criminalpunishment over treatment,
which led to a massiveincrease in incarcerations
for nonviolent drugoffenses from 50,000 in 1980
(08:12):
to over 400,000 in 1997.
In 1994, his wife Nancy Reagan,
spearheaded anotherfacet of the war on drugs
with her just say no campaign.
It was the belief thataddictions could be controlled
by willpower, and thefailure to do so was simple
(08:33):
and bad and wrong behavior.
That's where we are coming from in terms
of our history over a hundred years,
and I think it does stillperpetuate the stigma
that we see in society for people
who do have substance use disorders.
- Wow. Dana, thank you so much for sharing
(08:54):
that history with us.
This is a legacy that reallyhaunts us today in addiction
treatment, these punitivestrategies, criminalization,
and just that lack of apublic health approach.
So our goal today is to address the stigma
that an individual with druguse experiences when they enter
the healthcare system, for example,
settings like primarycare, which is so important
(09:16):
when we think about primarycare, it's that first place
that you go for medical care.
It helps us catch healthproblems early, manage them
through regular checkups, screenings
and monitoring of ongoing conditions.
This way it can keep an individual healthy
and really prevent seriousillnesses from getting
worse and progressing.
But this is not limited to primary care.
(09:38):
That being said, therereally is no wrong door
to engage an individual with drug use.
So thinking about stigma,what is it really?
Stigma is when peoplehave negative attitudes
or beliefs about someone
because of a particularcharacteristic like using drugs.
And this can lead to unfairtreatment and discrimination.
(10:00):
Individuals with addictionexperience health inequities.
These are unfair, unjust, preventable,
harmful health outcomes andstigma really drives this.
And then, you know, you spokeof these historical facets
and we know that stigma oftencomes from social norms,
which are the unwritten rules about
(10:21):
how people should behave in society.
So let's think aboutstigma and how it works.
And as we do that, let's thinkabout how we can intervene
as nurse practitioners inthe areas that I'm going
to discuss and really thinkabout how we can leverage them
as opportunities for change.
So lack of knowledge drives stigma,
and this occurs when peoplemay not understand the reasons
(10:43):
behind certain behaviors like drug use
and make really unfair judgements.
Stereotypes drive stigma.
And this is when societyoften has fixed ideas about
how certain people should behave
and anyone who doesn't fit that mold,
they're stigmatized, they're considered
to be on the outside.
(11:03):
And then fear, and this is ahuge one, sometimes people fear
what they don't understand,
and this leads to negative attitudes.
All of these factors combinedtogether to create stigma,
which leads to discrimination
and on unfair treatment.For people who use drugs.
Stigma in healthcare has serious effects,
(11:24):
and I'd like to sharethree of those with you.
Avoiding care. Theseindividuals may avoid going
to their healthcare providerbecause they fear being judged
or being treated badly.
Poor treatment. If
and when these individualsdo decide to seek help,
they may not get the samequality of care as others,
and healthcare providers mightspend less time with them
(11:47):
or may not take theirhealth concerns seriously.
And then last but notleast, mental health,
constantly facing stigmacan harm one's mental health
and particularly for individuals
with substance use can makethem feel ashamed or unworthy.
We know that stigma can prevent people
who use drugs from gettingthe help that they need
(12:08):
to stay healthy.
And so, Rachel, I know you'veexperienced some instances
of stigma on horizontal violence.
- Yeah, so I had mentioned thatI am in this unique position
of being both a healthcareprovider as well as a person
with lived experience.
My personal substanceuse was during the time
(12:31):
that I was already a registered nurse
and my substance use led me
to experiencing anopioid overdose as well.
And when I overdosed, I wasworking the night shift at,
at the hospital where I was employed,
and I didn't want to be admitted
to the hospital where I worked.
(12:51):
Recognizing the challengethat that puts my peers in
taking care of me, perhaps, you know,
there would be a lot moregossiping going on than, you know,
taking care of me or things like that
because you know, there was a code
that was called in a staff bathroom.
Everyone wanted to know whathappened to one of their own.
(13:12):
And so I was transferredto a different hospital
and I don't necessarily know,you know, the exact details of
how my case was reported out on from shift
to shift from provider to provider,
but I could sense thisoverwhelming feeling
of just a different energy
with my healthcare provider team compared
(13:35):
to my dietary aide.
And the only thing I canexplain that with is, you know,
perhaps my dietary aidewas not privy to all
of the information thatperhaps my nursing staff was.
And it's something that really, you know,
affected me psychologically,especially as I debriefed from
that entire experience andhow scary it was for me.
(13:57):
- Well, thank you for sharing that
and I know Robert, thishas had some personal
impact on you as well.
- Thanks Marissa, and thanksRachel for sharing your story.
I, I think when I, I try tolook at what my experience
with stigma in healthcarehas been like, I, I look back
to January of 2020.
I just
(14:17):
before the vaccine hadcome out for covid I
unfortunately I got covid and,
and I got really, really, really sick
and you know, I luckily Irecovered, wasn't hospitalized
or anything and about four months later
I started experiencingrapid heart rate increase.
I'd be walking around
and all of a sudden my heartrate would be 180 200 sitting
(14:39):
down eating dinner.
My blood pressure spikes
and I had no idea whatwas causing any of it.
So I did what any other person would do
and I make an appointmentat a cardiologist.
And I think it's reallyimportant in recovery that
I'm extremely open
and transparent with anydoctor that I encounter.
So I go in for that first visit.
I fill out all the information,
(15:00):
I immediately tell the doctor, you know,
I've been in recovery for,
I think at the time itwas like eight years.
And so he immediatelydidn't test anything.
Oh, it's 'cause of your past drug
use that's causing all this.
You did this to yourself.
And I walked around leavingthat appointment with
so much shame that I had,
(15:20):
I had thought I had done everything right
and somehow now I'm stillliving the effects of,
of my past drug use all theseyears later, come to find out,
you know, I go to other doctors and,
and I was suffering fromlong covid the whole time
and I needed to be puton heart medication.
I needed to be put onmedication for the brain fog
and I needed inhalers for my lungs.
(15:42):
But if I had stopped atthat one experience with
that one doctor, I would'venever gotten the treatment
that I actually needed.
And it was all based onhis assumption of who I was
and my level of honestybecause I chose to go in
and try to be transparentwith this doctor.
And, and that shows the, thepervasiveness of stigma that
that leads all the waydown to the health outcomes
(16:03):
for individuals, not justthis one singular experience
and the shame that it causes,
but then the the laterhealth outcomes as well.
- Wow. I'm so sorry thatthat happened to you
and that you were disregarded.
We all know that as nurses we try
to provide patient-centered care.
We need to listen to ourpatients and respect them.
(16:25):
And so why that should thatbe different for somebody
who has a history of using substances?
- And it's very scary bringing that up
with a healthcare provider, right?
It's intimidating becausewe often forget the innate
hierarchy that exists.
The healthcare provider,
the nurse is in a position of power.
(16:48):
- And I think this powerreally, really speaks to
how we can leverage
and change our behaviorswithin the healthcare setting
to provide higher qualitycare for individuals
who use substances.
Dana, you've had instances where
as a psychiatric nurse practitioner,individuals that you've
(17:08):
provided long-term care to
that have been stable whenyou've transferred them into
care, they've experiencedharm to their health.
- Yes. Thank you Marissa.
This is an experience that I carry with me
'cause it happened about three years ago,
but I was working in a MAT clinic
as a psych NP in a MAT clinic,
(17:29):
of course medicated assisted treatment.
And I had a couple who came to me
after they had bothgotten out of treatment
for their opioid use disorder
and we started 'em onbuprenorphine, then they had
to make a, a geographic move.
So they looked for another provider.
By the time they werefinishing their work with me,
(17:50):
they were both onbuprenorphine, doing very well,
hadn't relapsed in a very, very long time,
and they were married andhad a little 2-year-old.
He was in school, youknow, she was staying home.
I also treated them for bipolar disorder
and she had pretty severe anxiety as well.
But they were, they were doing well
(18:10):
and they had to change providers.
And I want you to keep in mind
that when they changed providers,they went to a psych NP
who worked in another MAT clinic.
And what he said to themwhen they first went in was,
your provider, Dana hasn'tbeen doing you any favors.
She should have tapered you off
(18:31):
of buprenorphine a long time ago.
We need to start taperingyou off of this medication.
And they were immediately resistant
and said, please don't do that.
We're doing well.
We know that if we come down off of it
or totally off of it, we'regoing to start craving again.
We're afraid we'll relapse.
And she actually said, she started to cry
(18:52):
and said, please don't do that.
This nurse practitioner,
psych nurse practitioner looked at them
and said, oh, now you'rejust talking like an addict.
So I just think, wow.
I mean that if, if that's
what people are facing whenthey go in for help, obviously
that is not very helpfuland it is extremely shaming.
(19:15):
And, and this is what,what happens with people
who have stigma, oftentimesthey don't go for help
because they do feel likethere's something terribly,
terribly wrong with me
and I don't want anybody to know that.
So that is a harm reduction approach to me
that we use the right kind of language
and the right kind of communication.
- I'm glad you mentionedlanguage there and,
(19:37):
and you know, reallyunderstanding how the role
and that we can play in
how we talk aboutbehavioral health challenges
and the impact that it can have.
It's so significant not onlyin our approach to patients,
our nonverbal communication,but also not just what we say
but how we say it.
(19:58):
And that's something that I'vereally championed over time
is shifting our language
to non-stigmatizingalternatives based off of
what we have in the bodyof research right now.
And you know, a lot of peoplesay, is this just semantics?
Why does this matter?
We have research that shows
(20:19):
that the way in which peopleare described can actually
impact the quality of care that's being
provided. In a study
where individuals in a casevignette were described very
differently, there were higherlevels of stigma displayed
by healthcare providersthat had the scenario read
(20:39):
to them describing individualsin a more stigmatizing way.
So oftentimes you'll hearindividuals encourage folks
to shift into person firstlanguage examples, like a person
with a substance use challenge
or a person with a substanceuse disorder, a person
with opioid use disorder,a person in remission
(21:00):
or a person in recovery.
But I think it's alsoimportant to recognize
that while person firstlanguage is encouraged,
especially when we're talking about others
as healthcare providers,
individuals should be affordedthe autonomy to identify
as they see fit.
And that would be known asidentity first language.
And we see this in other cases
(21:20):
and not just substanceuse disorder, we see it
with individuals who wanna be identified
as autistic versus a person with autism
or a person who is blind,who wants to be identified
as blind rather than a personwith vision impairment.
We see it as someone whowants to be identified
as an amputee versus aperson with an amputation.
And so there are scenariosin which it's appropriate
(21:43):
and when we're interactingwith our patients,
that's something that we needto take into consideration
to be trauma informed andto be culturally competent.
However, when we're documentingin the medical record,
it's important to adhere toclinical terms instead of saying
that someone popped hoton their drug screen
or that they failed theirdrug screen as if it is a test
that they can pass.
(22:04):
Instead we say things likethey’re positive for X, Y,
Z on their drug screen, which is expected
or unexpected wasdisclosed or undisclosed.
And so really looking at our patients
with unconditional positive regard,
- I think it's so important, Rachel,
what you mentioned about giving autonomy
back over to the patient.
I think about how when wego into a medical office
(22:27):
and we fill out our paperwork,
there's always a section there for
what pronoun do wewanna be referred to by.
But there's no sectionthat I can sit there
and put, how do I wanna referto my substance use disorder?
You know, I came through12 step recovery and,
and that's where I found success.
And I find it empowering torefer to myself as an alcoholic.
(22:48):
That's something that thatmakes me see how far I've come.
And for others it may not be that way,
but when I go into adoctor's office, that's
how I want it referred to.
And so to, to defer to the patient
and allow them to decide how they want
to identify themselves is so important.
I also think about in2023, Shatterproof worked
(23:09):
with Compass Ethics todevelop a conversation guide
for healthcare providers.
And we have this quoteat the beginning from Dr.
Katherine Dong who's anaddiction medicine specialist.
And she says, how you talk with patients
who use substances matters as much as
what procedures you can perform
or what medications you can prescribe.
(23:31):
Sometimes it matters more.
Your words and actionscan create a safe space
where patients will return
for care even when thingsdon't go as planned.
And I just think that that'sso important to realize
that we're not justtrying to set ourselves up
for success in, in this appointment and
and related to theirsubstance use disorder,
(23:51):
but about anything that they'recoming to the doctor for.
So preparing for whenthings don't go as planned.
- You know, Robert, youused the word matter
and mattering to us as humansor it's, it's so important.
There was this really greatarticle in Scientific America a
few years back by Francine Russo
and it spoke about theimportance of mattering
(24:13):
to wellbeing and health.
And really that camedown to feeling valued
and seen by others as important.
And one of the things that thatreally strikes me as, as you
and Rachel shared your stories
and Dana you too was just the
disregard, right?
And, and that communicatingof you don't matter.
(24:35):
And I think for us inthe nursing profession,
when we think about our ethical code,
patient autonomy reallyranks very highly up there.
And that inherent respectfor humans, right?
Or for an individual's humanity.
And so what stigma says isit says you don't matter.
And that's the message we give individuals
(24:57):
who use drugs when we don't listen to them
and when we don't value them.
- And I think what Marissais saying is, is true.
I mean, one of the thingsthat we've always learned
and we say as nurses is meet the patient
where the patient is at.
Okay, it's about them, not about us.
And even something likethink about motivational
(25:19):
interviewing, we've alllearned about motivational
interviewing skills asa means of communication
and understanding at whatstage the person is at
with the behavior that we'retrying to help them to change.
And they're trying tohelp themselves to change.
But if somebody is pre-contemplative
and they're, you know, in denial,
(25:40):
and as we say, denial isnot a river in Africa, it is
what it says it is, people are in denial.
They actually have no awareness
that this substance isimpacting, you know, some
of the things that aregoing on in their life.
And so if we try to getthem to be into the prepared
to change stage
and they're in denial, we'rejust miscommunicating with them
(26:03):
and they're not hearing us andthey'll be resistant to that
because we're not hearing what it is
that they came in for us to hear.
- So when we think aboutus as healthcare providers
and not listening, I think that, you know,
thinking about matteringagain, Robert, thank you
for sharing that is is reallyus having an awareness,
(26:23):
and this comes from Gregory Elliot, right?
Are we paying attention to our patients?
Are we communicatingthat they're important?
And this is in healthcare,it's taking a real interest in
who they are and listening
to them when they tellus what their needs are.
And again, reliance is reallyimportant in mattering.
Do our patients feel comfortablecoming to us for help
(26:47):
and support as healthcare providers?
So I think what we need to do
as healthcare providers isreally reflect on those questions
and those are alsoopportunities for change.
- Something else that comes
to mind when we're talkingabout stigma is oftentimes
how we treat one another as peers as well.
(27:10):
During my substance use challenges
and experiences with chaotic
and unhealthy use, I was working
as a registered nurse inthe intensive care unit
and I would oftentimes havepatients who were going
through DTs, patients
with substance usechallenges of their own.
And seeing the way in whichmy peers spoke about those
(27:34):
patients inadvertently
and maybe even unknownto me at the time, kind
of flagged in my mind, they'renot safe for you to turn to,
you have to keep this hidden.
And so I stayed stuck longer.
You know, perhaps if someone had been able
to recognize those signs
or if I felt comfortableapproaching a peer to talk about
(27:56):
where I was, I could havechanged the trajectory
and the outcomes of, of theadditional challenges I had
to face following my overdose
and following, beingenrolled with the state board
of nursing in their monitoring program.
So how we talk about ourpatients can impact our peers
and their wellness as well.
- You know, thank you forbringing that up Rachel.
(28:17):
I just wanna add here, we simply,
because of our history, I think our,
our history in the United States
and where we've come from, wehaven't really thought about
substance use disordersas a healthcare issue.
And we know that they are,
substance use disorders area chronic brain disorder,
just like other chronic disordersof the respiratory system
(28:38):
or the cardiac system.
But we have not includedit in nursing education.
And so I think that leads
to nurses not really knowing
and sometimes not evenreally knowing what to do.
So they don't do anything
or they carry their ownexperiences, you know, outside
of even their profession of howthey have experienced people
(29:00):
with substance use disorders
and they may think aboutthem negatively that way.
We have a lot to do whenit comes to education
of chronic medical disordersuch as substance use disorders.
- Thank you Dana. As we know that lack of
of knowledge really does drive stigma.
And so with that I thinkit's really important
(29:22):
that we think about waysthat we can make that shift
and change our culturetowards providing high
quality healthcare.
And so I think one of the thingsthat, that we've discussed
so far was the importance oflanguaging and words matter.
So thank you Rachel for that.
You know, when we think aboutcommunication strategies,
(29:42):
there is also the nurse technique.
And the nurse technique canbe used when we identify
that an individual is using substances.
And so N is to name or mirror the emotion
or language that the patient is using.
U, understand the emotion, payattention to the situation.
(30:06):
R, respect the patient.
S, support the patient using powerful words
and E, explore the emotion further.
And so Robert, this is a part
of the Shatterproof provider pathway.
- Thank you Marissa, formentioning a provider's pathway.
Shatterproof has workedfor the last 18 months
(30:28):
to develop this free e-learning curriculum
for healthcare providers thatoffers free CEUs accredited
by ASAM or the AmericanSociety of Addiction Medicine.
There are modules on SUD 101, substance use disorder
stigma, clinical applications like MOUD
or medications for opioid use disorder,
(30:50):
other harm reduction tactics,patient-centered care
and culturally competent care.
And, and that's really wherewe can touch on the nurse
technique and understand different avenues
for communication techniqueswhen we have a patient
that's presenting withsubstance use disorder
or maybe they're using drugs
and it's having adverseeffects on their life.
(31:11):
And this is a great opportunityfor us to employ some
of these other techniques
to create a safe non-stigmatizingspace for a patient
to be open and transparent with us.
- Thank you for sharingabout the provider's pathway.
Robert, it really is awonderful program that
that lays out information
to help an a healthcarepractitioner really build knowledge
(31:34):
sequentially and
and provide high quality careby, by fighting against stigma
and really listening to their patients
and really movingtowards patient centered,
patient informed care.
- It makes me think whenwe're talking about, you know,
certainly language and listening
and meeting the where the patient is at
and everything that you'retalking about, Robert, in terms
of mattering, you know,
(31:55):
we all learned therapeuticcommunication techniques most
of us in our firstundergraduate psychiatric mental
health class.
And you know, you thinkabout Hildegard Peplau said
that is the therapeutic use of self.
So that we are the therapeutic tool
and how we communicate withsome of these techniques such
(32:16):
as exploring
and you know, restating,giving general leads,
broad openings, reflecting those types
of things can help thepatient to communicate in,
in the way that we hopethat we're able to get them
to have trust with us so theycan tell us what is going on
with them at the time.
(32:36):
- I think looking atnon-stigmatizing language
and communication techniquesis really only one piece
of the puzzle or part of thetoolkit that we're trying
to develop here for nurses.
And I think one of the major pieces
that in the last decade we'vereally started to look at
as a society rather than beingsomething that sits just kind
(32:58):
of on the periphery is harm reduction.
And I think Marissa
and Dana, y'all can reallytalk a bit more about harm
reduction, what it is and howdoes it fit into this toolkit.
- When I think about harm reduction,
harm reduction is healthpromotion and disease prevention.
It really is a core functionof who we are as nurses.
(33:19):
And harm reduction reallygoes beyond what we think
of it traditionally, likesyringe exchange programs, right?
It at the core of harm reduction,
it is meeting the patients where they are.
Dana, would you like to add?
- Yes, I would. Thank you,Marissa. Harm reduction.
You know, I think a lot of times it seemed
(33:39):
for a long time the word harmreduction was almost taboo in
the United States becausepeople equated it to,
oh you just wanna legalize drugs
and that's not at all
what harm reduction is aboutharm reduction actually started
in Europe with the HIVepidemic when they realized
that it was sharing needleswas causing such an epidemic
of HIV and AIDS.
(34:01):
But I have a quote that I read
and I, I think this quotesays everything to me about
what harm reduction is when it comes
to substance use disorders.
Harm reduction is not abouthaving the person stop the
substances, but it's abouthelping the person to live.
I just wanna say that again,
it's not about stopping theperson from using the substances
(34:24):
but helping the person to live.
And we have just lost somany people, you know,
with the opioid epidemic still to alcohol
and tobacco in our country
and anything we can do tominimize the harms that go to
that is certainly within the nursing role.
- Yeah. So especially whenthese are evidence-based
(34:46):
strategies that are very practical,
they're very costeffective, easy to implement
and oftentimes give us thetools that in this sector
of healthcare oftentimes feelslike at times we just don't
have as many as the othertraditional western medicine
interventions and whatnot.
(35:06):
So I think that harm reductiontruly bridges the gap
that we have betweenpeople who use substances
and the traditional treatment system
where if a treatment facilityis requiring abstinence
to even be admitted forinpatient treatment,
then the individual's never going to go.
Meanwhile they wannawork on their alcohol use
(35:27):
but they're not willing togive up their cannabis, right?
So being able to work withpeople is really important so
that we can reduce thenegative consequences
associated with drug use.
And also remembering
that the nursing model isvery unique in and of itself.
We work under a bio-psychosocialmodel, so remembering
(35:48):
that it's more than justwhat's in front of us.
These are very much peoplethat come with very full lives
and very full experiences.
And so harm reduction is alsoa move for social justice
that believes in
and respects the rightsof people who use drugs.
- Absolutely. Rachel, sobeautifully said, harm reduction
(36:10):
to me really showsresilience of individuals
who use drugs, right?
This year harm reduction willbe celebrating a hundred years
as a grassroots movement ofindividuals who use substances,
really trying to find spaceswhere they could be well
and they could be healthy
and not being able to findthat within healthcare.
And so again, this isanother opportunity for us
(36:32):
as healthcare providers tointegrate these strategies again
to promote wellness and prevent disease.
- Can I also add herein terms of the toolbox,
we're nurse practitioners,we prescribe medications
and certainly medicationssuch as buprenorphine
and methadone, particularly
for opioid use disorderare very important.
(36:52):
Research shows over
and over again that peoplewho get on buprenorphine
and methadone will will stay away from the
opioids longer than peoplewho do not have them.
And so that's important.
And buprenorphine is somethingthat we can all prescribe,
you know, they did awaywith the waiver, you know,
(37:14):
you do have to have like eight hours
of opioid use education,
but as long as you have acontrolled substance license you
can prescribe buprenorphine.
Whereas methadone's a little harder
and in some states therearen't methadone clinics.
But getting the person on
that medication is veryimportant to help them
to work towards the thingsMarissa just mentioned,
(37:36):
which is the goal is to lead a fulfilling
and a productive lifeand have relationships
and all the things that allof us want to enjoy in life.
- Yeah. And thosemedications do just that.
The amount of friends
and colleagues in fact thatI've had on buprenorphine
or methadone is astronomical.
(37:58):
And these medicationsreduce all cause mortality
and it's very individualized.
People may utilize them short term
and people may utilize 'em the long term.
There's no date or timelimit that people need
to be cut off.
You know, this is reallyabout supporting wellness
and enabling life.
(38:19):
- And that really just goesback to what Dana was saying.
Addiction is a chronic illness.
And so if an individual with diabetes
or hypertension needed medications, right,
we would tailor our treatmentplan to our patient's needs
and we would support that plan
with maybe additional thingslike wellness, things like
(38:39):
nutritional referrals for example, right?
And so again, when we thinkabout medications, Rachel,
to your point, there's no hard stop on it.
It is based on what an individual needs.
- And further to that point,there's also, you know,
the same concept of ifwe're working with someone
and treating their diabetes,we may prescribe medications,
(39:02):
we may do nutritioncounseling, we may do a lot
of different interventions.
- Absolutely, absolutely.
- Everything that youjust said, Rachel is part
of harm reduction.
You know, addressing thevariables that are around,
you know, the use.
I have a saying that I, Ilearned from taking care
of this couple who this one NPwanted to take 'em off simply
(39:25):
because they thought they'dbeen on buprenorphine too long.
And in discussion with someother nurse practitioners,
I had another nursepractitioner who said to me,
I don't even bring up the word taper
unless the patient does.
So when the patient is ready
and meeting the patientwhere the patient is,
I think that's key.
- Again, getting back towhat you said, Rachel,
(39:45):
would we taper our patient off
of their hypertension medications
for no clinical indication?
Absolutely not. We wouldn'teven think about that
as a healthcare provider.
- Right? And remembering too
that these medications areFDA approved specifically
for opioid use disorder.
So if our patients are exhibiting signs
and symptoms of othersubstance use disorders,
(40:08):
these medications shouldn'tbe necessarily seen as,
you know, treatment forthose, there may have
to be other things going on
to help the individual reach their goals
- And they shouldn't be denied treatment
as well if they areusing another substance.
- Yes.- So we've had some really,
really good conversation on this today.
(40:29):
I think one of the most alarming things is
that we know that individualswho use substances
do not get the treatment that they need.
We know that about 10% of people
who need treatment get treatment.
And as discussed during thispodcast, the individuals
who do come into treatment,they experience mistreatment
(40:52):
and discrimination.
And so as healthcare providers,we have to do better.
- Yes. And we have toalso do better taking care
of each other as well.
We have been strained immensely
as a profession from theexperiences of horizontal violence
or bullying, the experiences of having
(41:13):
to meet certain outputs atour jobs, whether it's related
to the number of patientswe see, our quality ratings,
the projects or otherproductivity metrics.
We went through a pandemic together.
Everyone is dealing withtheir own perceptions of
how they feel about the world around us
and recognizing that we are also human
(41:34):
as individuals.
And trying to intervenein a process of cascading,
worsening this of a disorderis really important so
that we don't end up having a more severe
and difficult to treat disorder.
While also remembering thateven the most difficult
to treat substance usedisorders are treatable
(41:54):
and people do recover.
There is hope.
- And let's think that we'retalking about something that
affects almost everyone.
I, I remember when 9/11happened, you couldn't talk
to anyone who didn't know someoneor had a family member or,
or was affected somehow bywhat happened on 9/11.
(42:17):
I think the same thingis going on particularly
with opioid use disorder.
'cause there's been moreof a raised awareness about
substance use disordersbecause of opioid use disorder.
But I don't think we shouldforget other substances
that can be lethal likealcohol and tobacco too.
But we're talking about people
who are sons, daughters,brothers, sisters,
(42:40):
parents.
It's a human face that we have to see
and we have to think of
and we have to do whatever wecan do to minimize the harm
and the deaths that are going on
with substance use disorder.
And certainly we know thattreatment is really important.
In the latest publication
of the SAMHSA survey on druguse treatment in households in
(43:05):
the United States, this iswhat we know in terms of
who gets treatment
and who needs treatment. From 12 years old
and older, 54.2 millionpeople needed treatment,
but only 12.8 million received treatment.
From ages 12 to 17,
(43:27):
2.9 million people needed treatment,
but only 1.1 million received treatment.
From 18 to 25,
9.8 million people needed treatment,
but only 1.6 receive treatment.
From ages 26 and older,
24.2 million people needed treatment.
(43:51):
But out of those 24.2 million,
only 10 million get treatment.
So the treatment needs are
certainly huge in our country
and nurse practitioners havea great role to, you know,
help people
and decrease what we've been seeing
with these epidemics going on.
(44:13):
- I totally agree, Dana, tobe able to increase the amount
of treatment options for peoplewhile decreasing the amount
of barriers, we can increasethe amount of people
who receive help.
And I think that, you know,sometimes it feel sincredibly daunting
to try to tackle somethingas large as stigma
(44:35):
because what can I doas just an individual?
And you know, we recognizethat folks may avoid care even
for disorders
or conditions that are not related
to behavioral healthif they have something
in their history.
And so by being more welcoming, more open,
(44:55):
more non-judgmental with folks,we can decrease the barrier
to care that they experience
by experiencing stigmawithin a healthcare system.
I also want to just mention
because I had shared thatI am the president-elect
of the IntNSA USA chapter. IntNSA has plenty
to offer our members
(45:17):
from the conference toeducational webinars
that offer CEUs. We would love
to have your involvement in ourleaderships, our committees,
and please get involved.
You do not have to just workin addictions, you don't have
to just work in behavioral health.
We really want those broadperspectives recognizing
that our caregiving
(45:38):
and our helping willtouch these patients across
all environments.
- It's really been good to be here
with my American Association
of Nurse Practitioner colleagues
and I am a member of of AANP for a number of years.
I'd also like to just take the opportunity
to have you take a look atthe International Nurses
Society on Addictions.
(45:59):
We are a organizationthat our, our mission is
to educate nurses
and other health allied professionals
as well about substance use disorders
as a medical disorder.
So I invite you to look at our website.
We would love to see you atour 2026 International Nurses
(46:19):
Society on Addictions Conference.
- I think we've coveredso much ground today.
We've talked a lot aboutthe importance of language
and using non-stigmatizinglanguage with patients.
The options
of using different communicationtechniques like the nurse
technique to put patientsat ease so that they feel
that they can be more transparent,
(46:41):
they can increase the chance
of having a better health outcome.
Talked about the importanceof harm reduction and,
and the spectrum that that provides
and treating every patient with dignity.
We've also referenced Provider’s Pathway,
a Shatterproof curriculumavailable free of charge
to any healthcare provider
that offers free CEUs accreditedby the American Society
(47:04):
of Addiction Medicine.
And I think something I wasreally reflecting on is this
conversation has taken place is the,
the core commitment in healthcare
that all persons are inherently valuable
and worthy of dignified
and respectful treatmentregardless of their history,
choices or behaviors.
And I, that really hitshome on the reality
(47:26):
of the statistics ofsubstance use disorder,
48.7 million people with anSUD, 108,000 deaths per year
that these are not justnumbers on a piece of paper,
but they're brothers,sisters, mothers, fathers.
They are people in our lives.
I, I think back when we weretalking about harm reduction
(47:47):
that, you know,
eight years ago last week Ilost a dear friend of mine
and had we just done, you know,
something different ratherthan pushing only one pathway
of recovery, maybe it would'veplayed out differently.
And so I think that we'vereally set everybody up here
for success with being ableto employ different techniques
(48:08):
and to try somethingdifferent with their patients
and increase the chances that,
that they can find theirown pathway to recovery
and what that may look like for them.
Thank you all for joining us.
- Thank you Marissa,Dana, Robert and Rachel.
It's been an absolute pleasurelistening to your stories
and insights today
(48:29):
and your perspectiveshave added immense value
to this discussion.
To our listeners, rememberthat you may claim CE credit
for this program through March, 2026
by logging into the CE center at
aamp.org/ce center.
Register for this program,enter stigma in the code prompt,
and then complete thepost-test and evaluation.
(48:51):
Thank you for tuning in
and as always, be kind,be safe, be effective,
and be the voice ofthe nurse practitioner.
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I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com