Natalie Brousseau: Stigma, Social Support & Opioids

Episode Transcript
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Valerie Earnshaw (00:09):
I'm Valerie Earnshaw.

Carly Hill (00:13):
I'm C arly Hill

And this is sex drugs and science.

Carly Hill (00:17):
Today's conversation is with thee Natalie Brousseau.

Natalie Brousseau!

Carly Hill (00:24):
Dr.
Excuse me,

recent Doctor!

Carly Hill (00:27):
I-- t here's so many other things to be amazed with
Natalie about an d s o proud ofher for that somehow that that
es caped m y mind.
But more importantly, Natalie'sresearch focuses on how stigma
and other social determinants ofhealth impact treatment outcomes
among people living with HIV andsubstance use disorders.

So maybe you can tell from our high levels of
enthusiasm that Natalie recentlygraduated from our lab.
So Kylie and I have been workingwith Natalie for the past four
years as she got both hermaster's and then her doctoral
degree.
And we are, oh, terribly sad tosee her go.

Carly Hill (01:03):
devastated, I think is the word that I would use.

Okay.
We're devastated to see Nataliego.
But she is off to reallytremendously great things.
She has the postdoctoralfellowship lined up at the
university of Connecticut withDr.
Lisa Eaton and Seth Kalichmanfrom season two.
So we are also tremendouslyexcited for all of the great
things in her future.

Carly Hill (01:25):
Right?
But as if letting Natalie go,wasn't sad enough, we also have
to let our listeners know thatthis is our last episode of the
season.
So if you want to stay updatedabout future episodes, please
follow us on Instagram@sexdrugsscience, and hit the
subscribe button on whatever appyou're using to listen.

We very much hope that you enjoy this
conversation with NatalieBrousseau.
We hope that you enjoyed theseason and we hope to connect
with you next summer for anotherseason of Sex, Drugs, and
Science.
Dr.
Brousseau, welcome to the show.

(02:05):
Carly and I have an ongoing jokethat you have listened to zero
of the podcast episodes.
Despite being in our lab.
Zero of, I guess we have 13 or14 hours.

Dr. Natalie Brousseau (02:15):
Okay.
I've had, I've definitely hadfour.

four in the tank.
All right.

Carly Hill (02:20):
Well, I feel like 14 hours of podcasting is a lot
when you're working on bustingout your doctorate too.

Hey, that's true.
Yeah.
Also like, I can't imagineanyone would want to listen to
14 hours of their dissertationadvisor talking to them or
talking in the background.
They're like enough already.

Carly Hill (02:37):
The last thing Natalie wants to do in her
leisure time.

Yeah.
Fair, fair.
Well, Dr.
Brousseau, doctor, as of liketwo weeks ago, you just defended
your dissertation.
So this is like a celebrationpodcast recording.
So I'm super excited.
We have gotten several requestsfrom folks Who to talk more
about the work that our labdoes, which formed part of the

(03:04):
basis for your dissertation.
So we're going to use today'sepisode as a little bit of an
opportunity to introduce you tothe Dr.
Natalie Brousseau.
And also talk a little bit moreabout what our lab does.
So, starting with Dr.
Brousseau, so you were born andraised in Delaware, Native
Delawarean.

Yeah.
Native here.
Yeah.
It was amazing.
And there's no better place inDelaware.
Everybody knows everyone.

Carly Hill (03:31):
Yeah, that is true.

I've been in my comfort zone.
Just kind of stuck around.

Okay.
Yeah.
You went to university ofDelaware for undergrad.

I did.
Yep.
So went there.
I think I did early decision.
That was when they were startingto say, oh, it's getting hard to
get into U of D.
It's not a guarantee anymore.
So I did that and I got in withpsychology and pretty much stuck

(04:03):
with that.
Oh, well eventually my secondyear in, they got like speech
path and.

oh yeah.
Okay.

Kind of broadened their scope.
So I switched to cognitivescience.
So that's where my BS is in CogPsy.
But I also have a psychologyunder the umbrella of like
linguistics too, like a wholebig meld of fun thing.

A lot of brain , a lot of brain science.
Yeah.
So at some point in the mix, oneof my favorite stories about you
as an undergrad is you go tomeet the Roberta Golinkoff, who
is a big deal researcher incollege of education, human
development, which is ourcollege's school of ed.

(04:44):
And you are a research assistantin her lab for, I don't know.
How long was that it was atleast a semester, Right?

Oh no, no.

Okay.

It started Sophomore year and
worked till after I graduated.
So it was like,Probably threeyears.
And it was great.
That was because of my dad readher book and was like,"look, you
have like a bad-ass atuniversity of Delaware who is
doing big, big things.
Like you said, I think she's thehead of education.

(05:15):
She's also in psychology.
She's in Cog Psy where I was inlinguistics." So she just has,
she did all the things I did.

She does it all.

I went to her lab and wrote her a little
email, informal as a sophomore.
I had no clue.
And she said, come in, I'llinterview you.
I went in and like the summersat down with her.
She was so nice in her New Yorkaccent.
And she's had this lab sincelike the seventies called the

(05:45):
Infant Language Project.
Well now it's called.

Child's Play Learning and Development Lab
today.

Speaker 4 (05:50):
Yeah.
Childs Play DevelopmentLearning, exactly what they did
there.
Yeah.
So just kind of focusing onchildren, how they develop and
all their social interactionsand things they do with play and
fun, things like that.
So it was, it was eye-opening tosee research in this background

(06:11):
of things you're not alwaysexposed to.
So she really started me on mypath of research.
She told me"you're going to be,you're going to be a doctor.
You're going to do it.
You should really look into it."She was just a great mentor in
the background, encouragingeverything.

That's pretty amazing.
I mean, Roberta Golinkoff iswonderful.
She's like a great mentor to meas well, as like a newer faculty
member at the university.
But she is not telling everyundergraduate that she sees that
they are going to be a doctor.
So to have this BFD Researchertell you that like you're going
to be a doctor is prettyincredible.

I know.
So we used to have weeklymeetings and we were all sitting
around this huge table with allher post-docs and a few
doctorate students.
And like, she had the bestpostdocs.
Like she, you know, she hadpeople flying all the time and
there's just a few of usundergrad.
And she was like,"I want towrite a paper, you know, about

(07:08):
X, Y, and Z".
I forget what it is.
And she's like,"who's going todo it with me".
And I was the only one to raisemy hand as like a sophomore
undergrad and had no clue what Iwas taking on.
And she looked around the tablelike,"Really?
This is the only one who wantsto help me out here?" She's
like, all right, we're going todo it.

(07:29):
It was like a rejoinder forsomething wrong with the paper
she read.

Oh, okay.
So you, I didn't realize this soyou worked on a paper with
Roberta when you were anundergrad.

I just worked on it.
I don't know what happened toit.

you don't know what happened to it, Okay.

It could have been that bad that she was
like,"yeah, that's not goinganywhere"

Well we're all super grateful that she
encouraged you, because then youstuck with the University of
Delaware and you joined ourdepartment, Human Development,
Family Sciences.
And I actually remember meetingyou.
I don't know if you rememberthis, but I came to do my
interview and that was likeApril, 2016.
I gave my talk and then you andanother graduate student came up

(08:11):
after and introduced yourselves,which was really neat.
Especially, you know, those,those interviews are like two
days of, of a whole lot of,

Carly Hill (08:20):
torture?

Yeah.
So they're long.
So that's always a nice littlebreak.

yeah.
Just wanted to meet people wholike, want to work with you

And yeah, it was cute.

It was nice.
I totally remember that.
And that was something I was soexcited about to have you come
in because our department wasreally in its infancy, in my
interests, especially aroundlike substance use disorder.
And you were bringing stigmainto the mix and these are all
things that were so interestingand exactly what we needed in

(08:52):
our department to kind ofbroaden from just child
development to human developmentin general, and social
determinants of health and allthese things.

Well, I'm going to cry soon.
Waterworks of an episode.
Well, that's really nice.
Yeah.
So for folks who aren't asfamiliar with our department as
others are, I can't imagine whynot?
We have a really strong programin early childhood.
Yeah.
So I would be a little bit of adifferent duck coming in.

Carly Hill (09:20):
The wild card.

So it was within my first year there also
that I like, I snagged you.
So by the end of that year, Isnagged you for some summer
work.
And you and Carly start on yourfirst team science activity,
which was interviewing people,living with HIV, through the
state of Delaware about theirexperiences with stigma.

Carly Hill (09:43):
Right.
And I was saying to Valerieearlier that I don't know if you
remember it, but we hadn'tactually met yet, but we knew
that we were doing the work.
And I was like,"well, I'mstaying at my grandparents'
beach house.
If you want to come." And thenlike, as soon as you were like,
"yeah, that's cool." I was like,"oh my God, wait, what if she's
terrible?
And now I still talk with herand I don't know this person at
all." Like what if I just comehome from a long day and don't

(10:04):
want to see her at all.
But it ended up being actuallysuper fun.
It was like adult camp.
We did fun things during theday, ate way too much pizza at
night.

Like all the activities,

Carly Hill (10:14):
So many activities were done.
So that was also our originstory as well.
I just thought the listenerswould--

Oh the little princess?

Carly Hill (10:24):
Oh my God.
No, it was the Secret Gardenthough.

Yeah.
Right.

Carly Hill (10:29):
Oh, that's such an odd.
That is such an odd movie thatwe both somehow had in our
childhood.
She was like,"wait, do you, byany chance, want to watch this?"
I was like,"oh my God.
No.
But yes." And it was as bad aswe remember it being

It was VHS also.

Carly Hill (10:44):
it was, we had to rewind.
Yep, sure was.

make sure you rewind it every time

Carly Hill (10:50):
Just in case anyone else wants to watch the Secret
Garden.

I just really love the idea of Natalie, like
transitioning from like thechild's play lab to HIV stigma,
Delaware, because it's a verydifferent population that you're
working with.
And I think this was also yourfirst time doing qualitative
interviews, right?

Yeah.
Yeah.
It was,

Carly Hill (11:10):
It was both of ours actually.

Yeah.
So what was that like?
Cause we did some training, butthen you guys, then it was all
you with a new population offolks to work with through the
state.

Carly Hill (11:19):
I remember, I was really nervous.
I was like, I don't know what Ithought it was going to be like,
but I remember thinking like,the same level of like nerves as
a job interview, did you havethe same experience at all?

Yeah.
I definitely think going in andlike sitting down in our back
room, whatever was available andtelling nurses before, you know,
everybody kind of walk in like,Hey, we're from university of
Delaware and where we're allowedto be here.

Carly Hill (11:48):
Exactly.
Yeah.
And then you have all thesepeople that you have to go over
to recruit and be like,"Tell mehow you feel about living with
HIV.
Do you mind?" Like, it feelssuper weird to do if you've
never done it before.

Yeah.

Carly Hill (12:01):
And we nailed it.

That was pretty great.

Carly Hill (12:04):
I mean, I think we did a pretty great job..

The best thing about this team is how modest we
are.

I mean, for two people that have never
done it like It went all right.

A lot of people opened up to both of you.
I mean, it was, it's pretty cool.
Incredible.
Yeah.

Carly Hill (12:18):
Some people opened up more than I think we would
would've liked to have had themopen up, but It was a good time.

Y eah.
Super interesting to talk to andhad some emotional and great
experience to share and somegood stories.

Carly Hill (12:34):
Yeah.
That's true.
Like the one where yeah.
We had a woman that when weasked her the question about
sexual orientation was like,what did you just ask me?
Like all sorts of insulted.
So I had to try and explain itto her.
And afterwards she was like, ohno, no, no, no.
I just use my toys.
You can just write that.
And this was on our first day,the first day of data
collection, I was just like,"Idon't, this was not one of the

(12:57):
curve balls.
Dr.
Earnshaw threw me, when we weretraining for this uh, all right.
I'll just end the record now."

I f y ou're like toys, I guess that w ill be
"other", for sexual orientation.

Carly Hill (13:07):
Prefers to self describe.
Yeah.

Well that was only the beginning of, of long
several years Carly, for youhaving to like break down the,
these questions and surveys thatI've included and, and try to be
like, well, this is what thismeans, or

Carly Hill (13:22):
I know.
Well, luckily I had Natalie forall that too.

Who would have known that in this
emotional survey of yourexperiences or stigmatizing
responses and the hardestquestion was"what's your sexual
orientation?"

Carly Hill (13:40):
How did that throw people?
Yeah.
Race actually does also, butsexual orientation people are
like, I don't know if they thinkwe're asking for sexual history.
I don't know what it is, but forsome reason, I mean, you'd be
surprised at how much thatquestion does not land.
Like people get so offended.

You mentioned.
Yeah.
Yeah.
I need to take it back for morelike revising.
I was about to say what's themeter.

Carly Hill (14:02):
Once I explain it people are like"Oh!" But you
know usually that's more wherelike, even on the iPad, they're
like"what?"

"sexual, w hat?
Excuse me now." That's Funny.
Y eah.
Y eah.
A ll right.
Well that was also though, youknow, as I'm thinking about it,
Natalie, l ike the first papersthat you wrote with o ur, o r
like data with our group, youhad already written another
paper, but it was one of thefirst times where you, you took

(14:31):
things that we were studying andy ou put on this like HDFS human
development and family sciences,like lens to it, applying the
stuff you were learning in classand blew my mind because you did
a really nice job.
D elaware i s a retirementstate, and you did a really nice
job looking at the differencesbetween the experiences of older
people, living with HIV andyounger people.

(14:51):
And one of the things that ourcommunity partners talk a lot
about is like, you know, folksare asking for these social
support groups and then no one's ever showing up for them.
And some of your analyses endedup landing on the observation or
the insight that, you know,older folks living with HIV,
where we're asking for moresocial support and social
connected with other folksliving with HIV.

(15:13):
But younger people living withHIV w ere like, Nope, got it.
Like they had their own friendnetwork or networks.
They don't really feel likemaybe they are connected with
people living with HIV, but theycertainly don't feel like the
organizations need to furtherconnect them.
And I thought that was a greatobservation b ecause it helps to
explain why some people aren'tshowing for that when it is

(15:35):
offered.

Yeah.
I mean, age is one of thosethings that you don't really
think about as a researcher.
You just kind of have it as acontrol or a covariate in the
background.
But if you think about thedevelopment of HIV as a disease
and what these people wentthrough 20 plus years ago and
being diagnosed versus beingdiagnosed today, when it's

(15:58):
treatable, it's not a deathsentence.
It makes sense that theirexperiences are just totally
different.
That's definitely what we'reseeing.

Carly Hill (16:07):
Yeah.

All right.
Well, this study with folksliving with HIV in Delaware ends
up then hopefully being like anice setup or training ground
for you to level up intoUDisclose, which is the primary
study that the two of you havebeen working on for.
I think it's been three, threeyears.

Carly Hill (16:27):
It has, I thought, yeah.
Something like that.
2017, 2018, somewhere thereabouts.

Yeah, it was right after you graduated.

Carly Hill (16:37):
And I don't remember what year that was.

It's been work.

Carly Hill (16:41):
Yeah.
It's been a while.
Yeah.

All right.
So I thought I'd give a littlebit of a background on this
study for folks.
So I started doing work relatedto stigma and substance use
disorders and a little bitaround disclosure and disclosure
is, as we've defined it in ourstudy, sharing something new
about yourself with someone elsefor the first time.

(17:03):
And in this context, it's thatyear in recovery from a
substance use disorder, or thatyou have a history of a
substance use disorder or you'rein treatment really like
anything related to substanceuse or substance use disorder.
So this was something that Ibecame interested in when I was
working in Boston before I gotto Delaware and I was doing

(17:26):
really like a stigma focusstudy.
But within that, we would alwaysask people,"well, who knows
about your substance usedisorder or your treatment." And
then we would go on ask them,like,"how did they respond to
you?
Are you getting stigmatizingreactions or social support or
supportive reactions?" And sothe disclosure, wasn't a focus

(17:47):
of this study.
It was kind of like alongside,but...
We asked people about it just asa way to get to stigma.
But as we were talking topeople, I was like, experiences
of disclosure are all over theboard.
Like some of them, some of themdidn't go so well.
And at the same time that I wasdoing that, I had a friend who

(18:10):
disclosed to me that they weregoing into treatment and it was
like a textbook disclosure.
They said,"your friendship meansa lot to me.
I'm going into treatment.
I'm telling you because I wantyour support." And it blew my
mind because I was like,"didsomeone teach you how to do
this?"

Carly Hill (18:26):
And it set you up for such a home run there.

Yeah.
There's like nothing.
Yeah.
Yeah.
There's nothing you can do.
Yeah.
There's nothing you can do inresponse to that.
After being told what a goodfriend you are, how supportive
you are, but be supportive andfriendly.
So it made me think like,"oh,wow maybe this is something that
we can teach people to do." Andwhen would someone have learned

(18:51):
how to do this?
You know, like this, isn'tsomething you're going to get
like in middle school, or Idon't know you're gonna get this
in other places.
So I wrote a grant to study howit is that people disclose that
they have a substance usedisorder or that they're in
treatment.
And then part two was to developa little baby intervention to
help people to do it.

(19:12):
So that study got funded inDelaware.
And luckily we had already donethis study together with people
living with HIV.
I knew what good research chopsyou both had.
And I recruited you into thestudy, which we called
UDisclose, because I thinkNatalie, was it you who pointed
out how we need to name things?

(19:33):
Do you wanna explain that?

That was coming from-- that was an
experience from Roberta too,just learning how to brand
things and making your studyrecognizable.
So we put U D for University ofDelaware, and we're trying to
think of a U D word.
So UDisclose.

It was perfect.

Carly Hill (19:52):
It was Natalie's idea.

Like all the best things in our studies, are
Carly we're so tanked for herleaving Oh my gosh.
Okay.
Just a little bit of background,because what we're gonna do is
walk through the findings fromNatalie's study, which, you
know, we're about a week or twoout from her dissertation
defense.
So hopefully she hasn't likecompletely wiped out the past

(20:16):
four years.
But the way that this went waswas you two camped out,
essentially at our localsubstance use disorder treatment
clinics, right?
These are places where peopleare going in to receive
medications, mostly for opioiduse disorders.
So they're going in either everyday, once a week or monthly.

(20:38):
And so you're camped out and youwould ask someone, or people
were eligible to participate, ifthey were planning to tell
someone new in the next threemonths, you know, anything
related to their substance usedisorder treatment.
And so then essentially theywould go into back room with one
of you two.

Carly Hill (20:55):
Sometimes both of us,

sometimes the closet.

Carly Hill (20:59):
literally sometimes a closet or the lunch room,

the lunch room.

Carly Hill (21:03):
Yeah.

They'd answers some questions, some survey
questions like on an iPad, andthey would have a conversation
with you.
They would do a qualitativeinterview to tell you about how
they think it was going to go,why they were thinking about
disclosing.
And then after three months theywould come back and they would
tell us about whether or notthey disclosed.
And if they did disclose how itwent.

(21:27):
And so they did a bunch of, theydid like a combination of
surveys and interviews.

Carly Hill (21:31):
Yes.
It is like a little bit of aback and forth there.
Yeah.
It was good though.

I mean, it is good.
They kept you on your toes.

Carly Hill (21:39):
They kept us on our toes.
Yeah.
Actually Natalie stopped me fromgetting beat up once.

Oh no.

Carly Hill (21:48):
Yeah.
Cause I, I got a little saucyback with someone that was
getting saucy with me and thenquickly regretted that decision.
And Natalie was like,"I'll beright there." And like came in
and saved the day.

Yeah! Because she wasn't, I remember this too,
because Natalie, I thoughtNatalie wasn't at the clinic.
You called her.
Okay.
First off, let's all reflectthat when stuff is happening
during data collection, Carlydoes not call me.
She calls Natalie, like,"I needbackup".

Carly Hill (22:18):
I needed, y ou k now, b ackup for a fight with
all due respect, I'm going withNatalie.

Yeah.
That's fair.
I see that now.

Carly Hill (22:30):
It was just also Natalie.
I t was closer.

Yeah, sure.

Carly Hill (22:33):
That's what it was, also, you don't want to have to
call your boss and be like,"Imessed up to such a degree that
someone's about to hit me." Socall the one boss right below
that.
See how that goes.

So always an adventure at the clinic.
But my impression is though thatoverall lots of fun.
You're happy to be back thereright?
After a year away, during COVID.

Carly Hill (22:56):
like the best time I've ever had.
It's such an amalgam ofbeautiful people and like
beautiful, different, suchdifferent experiences.
But like, yeah, exactly.
Every day is totally different.
I have never, ever been at workthere and thought,"man, this is
boring".
Like that's never been.
That has come across at all.

(23:16):
And it's not, it's just soexciting and changes all the
time and you get to meet newpeople.
And the other unique part isbeing a Delaware resident my
whole life also is that like yousee people that are actually in
your community and you get toserve them or at least feel like
you're helping them out too.
So even if you know, there arepeople you don't know, if still
feels like just cool work.

(23:37):
I just love it.

Some of these people, this is like the
worst day of their life.
And they're taking time to talkto you and you feel like you are
helping, right?
Like any little bit of help islike doing something for them.
And they love just being able totalk to somebody who wasn't like
jumping down their throat orjudgmental.

Carly Hill (23:57):
Yeah, exactly.
Yeah.
And actually I was tellingValerie earlier this week, so
for the listeners, we had apause between phase one and
phase two, we'll call it.
And so I wasn't in the clinicfor awhile.
And when I came back, it's likeevery day someone comes up and
they're like,"cool, but where'sNatalie".
I'm like, she's actually adoctor now.
And I'm serious.
And so many people are like, Ialways say, I'm like,"um, she's

(24:21):
a doctor now." So she's offdoing these big things like, you
know, and they're all so happy,but it's cool.
I mean, you know, you can'thelp, but sort of-- people see
your face and you're talking tothem about some things, you
know, like if the disclosuredoesn't go very well and you're
talking to someone about thingsthat are pretty personal,

it brings you together.

Carly Hill (24:39):
like yeah, it really does.

We were familiar faces like greeting.
We were kind of the greeters, wegreeted at-- the desk was in the
center of the room that theywalked into first.
So we knew names.
We knew people coming in and wewere just kind of high and
mighty at our desk.

Carly Hill (24:59):
They'd know our names If I ever remembered to
wear my nametag.

Name tags! Yeah.
Well, it's so interestingbecause you both just kind of
like hung out there for awhile.
The first time it took like along time, like we were slow to
start recruiting and that makestotal sense.
Like, you're two new people youhad to, you want to have people
tell you about-- you're right.
I mean, this could be the worstday of their life.

(25:25):
And then maybe you're wanting totalk to them about like, for
example, their mom calling theman asshole and kicking them out
of the house for being intreatment, you know?
And so like, yeah, that takeslike a lot of trust and a
relationship.
And so what's been reallyinteresting though, Natalie, is
that so took you guys, you know,a little bit of time to get

(25:48):
folks to warm up, but Carly wasin there for like two days and
has already like enrolled like15 people for the new phase of
our study.

Carly Hill (25:58):
It helps because all of our old friends, well, yeah,
a few repeats, but all of ourpast participants are like,"oh,
Carly!", You know?
So people are like, oh, how dopeople know you?
What are you doing?
Why are you sitting at the frontdesk before?
So yeah.
It's definitely quicker.

Yeah.
They recognize the new face.

Carly Hill (26:17):
We also showed up.
I mean like, just about as greenas green could be like, I'm
pretty sure I had a leatherbriefcase.

oh my gosh, you did.

Carly Hill (26:25):
in like a wholel ass business suit was just like,
"would you guys like to tell meyour secrets?" And they were
like,"no, not at all.
Like avoid that girl at thefront desk"

This FBI looking girl.

Carly Hill (26:36):
Right.
Yeah.
So we toned it down, wore somejeans it got there.
Yeah.

I'm just really enjoying this y this
vision of you in a suit with abriefcase asking for people's
secrets.

Carly Hill (26:48):
Seriously yeah, that's basically what we're
doing.

I'm like, yeah.
She, she'll take you secretsover here, come with us to this
creepy closet in the back.

Carly Hill (27:02):
We don't work here.

We may or may not work here...
It's fine.

All right.
Well, nonetheless, we got somegood data.
Yeah.
Which informed Natalie'sdissertation.
So for folks who aren't familiarwith the process, if you're a
PhD student, you take a bunch ofclasses you take, uh, maybe a
comprehensive exam, which isessentially like an exam on
everything.
And Natalie did so well heryear, her semester that there

(27:32):
was like ringing endorsementfrom the faculty about how much
she rocked it, which was verycool.
You don't always get that.
And then you do a big researchstudy.
So what Natalie did was to writethree different papers or
basically do three differentanalyses with the data.
And then that becomes herdissertation.

(27:54):
So the first study was aboutlike disclosure experiences to
focus specifically on methadone.
And this was a qualitativestudy.
So you were focused more on thedata from the interview portion
when people were talking to youand to Carly.
Right.
So do you want to talk a littlebit about what you expected and

(28:16):
what you found?

Yeah, so I was looking basically at
people who disclose theirmedication use.
So, or people who don't knowwhen you are living with an
opioid use disorder, a lot ofpeople here were taking
methadone or some type ofmedication that could help them
buy some time, establish newlife patterns, re- establish

(28:41):
their relationships.
And this was kind of theirtreatment.

I'll just say too, that we talked a bunch
about these differentmedications on the episode with
Scott Hadland.
So I'll plug that a little bit,but yeah.
I just want to underscore that,that withdrawing from an opioid,
like heroin or fentanyl, ormaybe a prescribed opiate is
really, really rough.
And so these medications can behelpful to prevent withdrawal

(29:08):
symptoms and yeah, just kind ofease people into recovery.
So methadone has been around fora lot, for a long time and it's
been well-researched

Yes.
Yeah.
So clearly Scott Hadland was notone of my four episodes of the
podcast.
He's next!

Well, I would not have expected you to be
plugging the other episodes.
That's Carly's and my job.
I know you haven't listened toany, you don't have to pretend.

So people were, some people were
disclosing that they were intreatment and other people were
disclosing that they're takingthis medication either methadone
or kind of an, a newer versioncalled Buprenorphine.
So that was kind of what wetalked about.

(29:56):
What I got their experiencesfrom was just to characterize
what these disclosures look likeand if they were different.
And so we expected that theywere probably going to be a bit
different because of theirmedications.
Methadone has been kind ofestablished and there's some
literature that it's highlystigmatized against, but this

(30:18):
newer kind of drugBuprenorphine, we don't know as
much about, although we thinkit's kind of similarly
stigmatized.
It could also be for some peopleseen as maybe a better
alternative because of some ofthe components that can make it
so that-- the methadone doesn'thave.
So basically we wanted to see ifthey were different, how these

(30:40):
disclosures looked and whetherpeople knew what these k ind o f
medications were and were ableto be supportive.

And I think that one of the reasons we were
interested in not only becausethere's like a decent literature
on people's responses tomethadone and how bad that is.
But I think even as you weretalking to participants that
some participants disclose--even if they were taking
methadone, they told people theywere on Suboxone or sorry
buprenorphine as you'rereferring to it, because they

(31:11):
like expected it would gobetter.
S o based on the literature,based on like some of our
observations with participants,we all thought,"okay, maybe
people have better experienceswith disclosing this new
medication."

Carly Hill (31:24):
Yeah.
Yeah.
And I think a lot of that too,is like, you have to go to the
methadone clinic and there'slike a stigma with that.
And like waiting in the lineevery day versus Suboxone is
easier.
I guess maybe just in Delawarefor doctors, you can have like
your primary care prescribeSuboxone in some cases.
And so that kind of, I thinkcarries a stigma whether or not
you have to like show uppublicly to a place every day
and like wait in a line or is itlike a private thing you can

(31:46):
just do in your home.

Yeah.
It has this kind of addedcomponent that you can't
overdose on Suboxone versusmethadone.
So people feel comfortable withgiving you 30 day prescription
versus showing up every day at5:00 AM just to interview them.

As much as we love that.
All right.
So we had some reasons to study.
Yeah.
We had some expectations thatpeople might have better
reactions to one medicationversus the other.
What did you find Dr.
Brousseau?

Well, we did have some people who kind of
confirmed our suspicions.
They have the same suspicionsthat maybe Booper nephron or
Suboxone would be an easierdisclosure.
One of the quotes I have infront of me is a man, I remember
interviewing, he was talkingabout disclosing to his friend

(32:36):
that he was using methadone.
And for him, it wasn'tnecessarily telling his friend
that he used heroin that was thebad part, It was saying that he
was treating this withmethadone, that his friend like
hated.
And so he said"the methadonepart was the hard part for me.
He thought it was just basicallyheroin that I was taking".
And let's say if I was onSuboxone or Buprenorphine, I

(32:59):
wonder what he would have saidthen.
So we found that, although wehad these kind of sneaking
suspicions and some people diddisclose that they were on
Buprenorphine because theythought it would kind of fly
better or it would be a biteasier or their families would
be more positive.
They really kind of look thesame, families just seem to be

(33:22):
misinformed about both of thesemedications equally.

Yeah.
It was no good all around.
Yeah.
There was, there were really nota lot of bright spots.

No, there wasn't.
And it seems like a lot of thesestigmatizing reactions were born
from this just misinformedresponses that were coming
behind these medications.
And so it was definitely a biglearning experience for me to
see how people approach them.

(33:53):
You know, like I'm so familiarwith these things.
It was good to be able to seethis misinformation and how it
was stemming from thesemedications.
And they were very similar.
So we had a few different areasthat they were the same.
We had a lot of people talkingabout their family members or
friends saying either methadoneor this buprenorphine Suboxone

(34:16):
is just the same thing as thedrug.
It's kind of this governmentsubsidized drug taking.

Carly Hill (34:21):
Yeah.
Substituting one drug foranother, I think, has to be the
line we heard the most.

It really does.
It really does kind of carrythese preconceptions of like
seediness.
So a lot of people saying, well,you know,"my mom said,
methadone's the same thing asheroin.
I'm basically substitutingbecause now I'm on legal heroin.
I feel just as stigmatized nowthat I'm getting treatment and

(34:48):
doing better versus using", andyou can see how that may impact
your behaviors going forward.
I mean, what a huge leap youmade to go out there to get
treatment to better yourself.
You're waking up at 5:00 AMbefore work every day.

Carly Hill (35:06):
Yeah.
You have to jump through hoopsevery day to get there.
Like it's not a walk in thepark.
It's not like...

To get accosted by us.

Be just swept into a closet in the back of the
room with a recorder.

tell us all your secrets!

Carly Hill (35:23):
Yeah.

No, I think about that a lot too.
Just how hard it is to be onthis medication and how you
really have to want this foryour health and your wellbeing.
And then when you go to tellsomeone about it, for that to be
the recation that you get, Imean, it's just.
Reading those is like superheartbreaking it's, yeah.

So I mean, how many people who have a
similar chronic disease outthere with cancer or something
if they told their parents, likeI'm getting treatment, I'm on
chemotherapy and that's likething.
Oh my God.

Carly Hill (35:57):
"why can't you just q uit the cancer cold turkey." Y
eah.
Seriously.
T hat's w hat, it's this.

Yeah.
I disclose to people that I'm ona pretty heavy duty medication
that, you know, I have to go inonce a month and get an
infusion, which you know, is howthey deliver chemo as well.
And then I'm always in theposition of like managing other
people's like emotions about itand they feel sorry for me, or
they want to like help.
And I'm like, usually this leadsme to joking around that, like,

(36:24):
"don't worry, I'm just gettinginfused with a superhero power
and waiting for it ot work" LikeI have to manage them.
But I can't imagine having anexperience where I'm telling
people and they're just like,well, why can't you just get
your immune system to stopattacking itself on its own?
Yeah.

And another thing that I found is
exactly what Carly wasmentioning kind of the building
and coming into methadone.
So a lot of people mentioned thetreatment atmosphere was highly
stigmatized.
And just, just going into thatbuilding or being seen outside
of it was something they didn't,they didn't want to do.

(37:02):
Like somebody gave me a quotethat their friend felt like, you
know, every day they're liningup to get their fix or
something, or, you know, anotherwoman had disclosed to her
daughter that she was coming tothis building, getting
methadone.
And her, her daughter said thatshe doesn't want her making

(37:22):
friends there, don't think thatshe's going to fit in.
"She doesn't fit in with theclassless people going to this
clinic and, and please, God,don't bring them home because
they'll steal all our stuff." Ohmy God.
So that's something where you'relike,"oh, okay, I'm in this
crowd.
And this building signifiesexactly that to everyone", so

(37:42):
why would I want to go to thattreatment, right?

Yeah, yeah, no, I mean, there's no better
way to make you feel like shitfor going in and getting medical
care for yourself to...
yeah.

And that even translated on them.
Like some people were like,yeah, this is a such a sad way
to spend government money.
Just weird.
If you hear that constantly fromother people to just kind of
internalize it.

Carly Hill (38:10):
Right?
Yeah.
Like you're not worth the help.

Yeah.
I think this qualitative studyin particular has me super fired
up to figure out how to do morework with families in Delaware.
And because you know, our nextstep for this project is to help
people navigate disclosure,which we can come back to.
But more than anything, this hasme fired up about like, let's do

(38:34):
some light education aboutmedication! You can only go up.
Essentially what we were seeing.

I did not expect so many people to not
know and to not be willing tolearn what these kind of
medications were.

Yeah.
And I should say earlier, Isaid, I kind of framed it as
like a short term thing, liketransition into recovery.
But I should also just say forfolks who are listening and who
may not be familiar with thesemedications, that some people
are on these for a long time inthe same way that I'm on a
medication for a chronic illnessfor a long time and are rocking
it.
So if you have a family memberwho is on one of these

(39:11):
medications and has been on themfor years, like A+ to them for
being in recovery and for beingable to, you know, stick with
their meds.
And so it's not for everybodylike a medication that you take
for a short term, for somepeople, they take it longer and
that's totally fine.
So, you know, it's between themand their doctor,

Their doctor knows more than their
family

Just wanted to do that real time fact check.
So, okay.
So that was study one.
So study two focused a bit onlooking at predictors or things
that were associated with orrelated to concurrent opioid use
during treatment.
Right.
So you were looking at why aresome people continuing to use

(39:56):
opioids even when they are intreatment or receiving
medications for this opioid usedisorder?
And so they may be using heroinor fentanyl or something else.
So what did you find for thatstudy?

Yeah, so that one was really interesting.
I don't think we expected tohave so many people kind of
readily admit or talk to usabout how they're still using
heroin while they're also takingtheir methadone, which is
another thing that is superstigmatizing.
It can also be a predictor ofeventually just kind of dropping
out of treatment,

right.

Using the heroin.
That's eventually going to kindof win out as a better option.
Why are you even doingtreatment?

Carly Hill (40:41):
Well, cause you don't have to wake up at 5:00 AM
and show up and get judged byeveryone in your life.
Use heroin.

So yeah.
Your mom told you that you'rereplacing one drug for another,
so why not just stick with yourone drug?
Yeah.
Okay.
Yeah.

So it was good to kind of look at that as
our outcome.
And in looking at that, we kindof wanted to see if some of
these other factors like stigmaand depressive symptoms, gender,
outness, which is kind of thedegree to which you are out or
tell people that you're livingwith an opioid use disorder,

(41:15):
whether these had an impact onthis concurrent opioid use over
time.
So for this study, actually wefound some interesting things.
One thing we found that I thinkis pretty known is that OUD
outness had basically people whowere more out about their OUD

(41:36):
actually had a negative impacton their concurrent opioid use.

Uh, basically people who told more people that
they're in recovery or that theyhave a history of opioid use yep
.
That they were engaging in lessconcurrent opioid use over time.
Yeah.
Sometimes we always joke aroundlike positive and negative is
hard to interpret.
So, but yeah, no, I mean,basically that's by some
indications, maybe that's a goodthing.

(42:03):
I don't know.
But yeah.
So this association between likeif more people in your life know
about your recovery or youropioid use disorder, you're
probably going to be engaging inless opioid use while you're in
treatment.
So yeah, that was, that was avery interesting one.

Yeah.
And that's one we hadn't reallyfound before and really does
kind of highlight how thesesocial relationships can be
highly protective and thingsthat really help us in recovery.
And then we also found thatthose who are going into their
disclosure anticipating morestigma or expecting that their

(42:39):
brother who they're about totell is really going to
stigmatize their methadone useor their treatment or whatever
it is.
Those who had this higher kindof amount of anticipated stigma
are engaging in more concurrentopioid use.
So more stigma, more concurrentopioid use.
Um, we can clearly see thisconnection between the two.

Yeah.
And I think there's probably a,you know, there could be a lot
of different reasons for that.
You did control for like theseverity of someone's opioid use
disorder, which helps a littlebit with, you know, it, it, it
could be that people who have amore severe opioid use disorder
are more worried about stigmaand those people are also

(43:23):
engaging in more concurrentopioid use.
But you did, you did control forthat a little bit.
If it's a stigma process, itcould be that if you're thinking
about disclosing to someone,which is when we caught people
and you're worried that they'regoing to treat you negatively,
then you're stressed out aboutthat.

Carly Hill (43:41):
Right.

It's super stressful to be walking around,
waiting to have thatconversation.
And for some people, you know,their coping mechanism is
substance use.
So it can be a lot of things.
I think we have to keep digginginto it.
But that was a reallyinteresting finding.
We haven't seen that one before,either.

And then yeah.
Out of those other kind ofcontrols or covariates people
who had greater severity ortheir opioid use was very
severe, they had more concurrentopioid use, which we were to
expect.
And then kind of the youngerpeople had more concurrent
opioid use, which is anotherthing that kind of changed.

Yeah.
Yeah.
Age Mattering.

It matters.

All right.
All right.
So then for your third study,you looked at associations
between social support andcommitment sobriety.
And so to set up for the methodshere, people would disclose to
somebody, and then they wouldtell us about who that person

(44:41):
is.
So how close am I to that personhas that person, you know,
[inaudible] our used substances.
And then they would also tell usabout whether they received
social support from the personafter they, after they had
disclosed.
So you found this sort of reallyinteresting finding, and very

(45:03):
nuanced finding, but one thatalso like makes perfect sense.
I mean, in the literature, justfor folks like to know more
broadly, when we study socialsupport, we usually find social
supports, like always related tothe good thing.
So social support is related toliving longer, to like taking
your medication more in a lot ofdifferent chronic disease

(45:25):
contexts it's associated withlike all sorts of indicators of
wellbeing.
And so here we're looking at issocial support related to more
commitment to sobriety amongfolks in this population.

Yeah.
And it was definitely more of anuanced look, we're kind of
looking at social support fromwho, from who, which
relationships, is this socialsupport super beneficial, or
maybe not.
And that was kind of what, whatcame back.
One of the first things I thinkwe looked at was kind of
closeness.
So if I'm disclosing to mybrother and I'm very close with

(46:01):
him, this closeness kind ofreally mattered.
So higher closeness, bettercommitment to sobriety, which is
something you would kind ofexpect.
But then we also had this morenuanced kind of three-way
interaction, which was superdelightful to interpet.

It's complication station for your
dissertation.
You don't want to have athree-way interaction to
interpret for your dissertation,but there you were!

There I was, working my way through it
between social sport closeness,and then the other thing that
was in that interaction waslooking at this disclosure
recipient.
So, you know, my brother who Idisclosed to, whether that
person used substances.
So it was kind of a combinationof, okay, me and my brother had
used before and my brother maycurrently have a problem with

(46:51):
opioid or some type of substanceuse disorders.
So we wanted to know whether wealready knew closeness mattered
and that better closeness withsomebody getting social support
from them was a good thing.
But what about getting socialsupport and being close with
somebody who, who is also using,or you've used with, is this, is
this always a good thing?
So we found that typically beingclose to somebody who doesn't

(47:18):
use is, you know, what we'dexpect, this is a good thing for
us having high closeness,getting social support from
them,"they don't use, thisincreases my commitment to
sobriety" over the time periodthat we looked.
So that was something we wouldexpect.

And you started-- sorry to interrupt--
but you started to describe thisperson is like, yeah, like maybe
your brother who doesn't usesubstances, like maybe a family
member, a close person hasn'tused substances.
Okay.
All right.
Continue.
Sorry.

So no, that's a good idea to put kind
of labels on them.
Okay.
So the next person we looked atwould be this kind of low
closeness, but they do use, solet's imagine maybe a friend,
somebody in my peer supportgroup or in my therapy group,
they're in AA with me.
We're not as close.
We're not, you know, I don'tknow where they live and I go to

(48:08):
their house and we hang out allthe time and they have used in
the past, you know, they'recurrently dealing with some type
of substance use disorder, butthat closeness again, kind of
dictated how this relationshipwent.
So for them, interacting withthem, getting social support
from them was also a good thing,which is kind of surprising.

(48:28):
But in going back and kind ofwondering over this
relationship, we figured, allright, well maybe it's because
this is somebody you're not asclose to.
They're not somebody who theirbehaviors really kind of impact
your life.
They're just there to give yousocial support and give you
enough social support so thatyou can kind of enhance your

(48:51):
commitment to sobriety.

Yeah.
I think when you describe it,cause this was a
counterintuitive finding, wewere like,"uhhh" Yeah.
But when you landed on thinkingthat this is probably someone
who you know from AA, alcoholicsanonymous or narcotics or
narcotics anonymous(NA) likefrom a recovery community is
where you sort of landed at.
And that makes a whole lot ofsense.

(49:14):
Like this is someone who Iprobably am not going to
necessarily disclose as beingsuper close to yet.
I mean, maybe you will become,but yeah.
Receiving social support fromsomeone in AA or NA, it should
definitely be increasing yourcommitment to sobriety over
time.
So that makes a lot of sense.

Yeah.
So those are two instances thatwe really want, especially with
the person who we're close with,they don't use, this was a great
person to disclose to they hadall the things that could help
you with your commitment to yoursobriety.
And then this kind of finalpathway or interaction that we
found was people of highcloseness.
So let's say my brother again,but my brother does use, he's

(49:55):
used in the past.
He's currently living with asubstance use disorder.
Getting social support from mybrother who I'm very close to
and he uses was a bad thing.
It lowered my commitment tosobriety over time.
Which made a lot of sense whenyou think about it, you know,
maybe I'm always dropping in onmy brother.
I'm hanging out with him and hisbehaviors are kind of

(50:19):
influencing me.
Maybe I stop in one day and he'susing, you know, it does make
sense that we saw this veryminute between types of social
support and which relationshipdifferences might matter.

I think intuitively it makes so much
sense that, you know, in anycommunity, but particularly this
community where people's socialnetworks, like the people that
they're connected with mightreally be shifting as they go
into recovery.
You know, transitioning frompeople who might also have
substance use disorders to maybemore of a recovery community or
reconnecting with family orother folks.

(50:56):
So

Carly Hill (50:56):
That one made so much sense.
Like, and it's something I cansee where you would like to look
at that data and be like,"whatis happening?" You don't, you
know, if everyone in your lifeknows about your substance use
disorder and you don't have theluxury of these new
relationships, like these peoplekind of, sort of have this idea
about you, you think, and it's,it can be such a dark cloud to
go into a place like NA or AAand have someone that you're not
really close to might be likethe look, because it's like, you

(51:19):
don't have any eggs in thatbasket.
If they really give you thisterrible stigmatizing response,
it's like,

Who cares ?

Carly Hill (51:25):
Who are you?
I'll go to a different meeting.
Like, you know, so it does makesense, but yeah, it's not
something I, I think I would'vethought to look for.

Well, Dr.
Brousseau, I got to say, this isthe last time I will quiz you on
the results of yourdissertation.
So, pass! Yeah, well done.
And I mean, I'm always, like, Ithink that these results are
really tricky results.
Like especially, I mean, forfolks who are familiar with
statistics who might belistening, like interpreting
again, that three-wayinteraction is, is really

(51:54):
challenging.
And I'm just like reallyimpressed with how you're able
to talk about it and likereal-world language and layer in
some like examples to try tohook in what might be going on
there.

Carly Hill (52:06):
She makes it look easy.

She does! No, that's the thing dude, like
Natalie has always made thingslook easy,

Carly Hill (52:11):
Right.
Yeah.
Yeah.
I know.

I know.
Y eah.

Carly Hill (52:14):
I know.
Sometimes things can getfrazzled, but for the most part
you're like, yeah, whatever, nota big deal.
Like, oh yeah.
Like, oh sure.
There was never like that highenergy doctoral student.
Like"what if I don't do it?"Like all these different, like
Natalie all,"it's going to workout.
Everything's fine".
It feels so manageable to seeNatalie do it because she's so

(52:35):
good at it though.

Very good at denying my feelings

Well, this is a little counterintuitive but I
would aks, now that you're atthe end of the program and you
know, you have your PhD, you didit.
You're a doctor, you know, oneof like 2% of the population who
has a PhD.
I was wondering if there anylike advice or anything you
would tell your former self.
I mean, Carly and I though havean impression that you've always

(53:01):
been fine.
Maybe never needed advice, butis there anything you would say
it a little Natalie or otherlittle Natalies starting their
program?

Yeah, I mean, one of the first things,
this is just for me in generalwas that I was on the right
path.
I think that I just, I, I don'tthink a lot of people go into
their PhD program not being acertain, but I was kind of like
on the fence of like, oh, Idon't know, is this the thing I
want to do for the next bigcommitment of my life?

I mean, a lot of people don't make it, but
that's part of the process.
And I think you also, like,don't really know what you're
getting into when you start aPhD program.
So I went in wanting to be likea teaching professor.
I was like, I want to teach, Iwant summers off.
I want to like

Carly Hill (53:49):
Jokes on you.

I know we've come far away.
And Now I'm like scienceforever! Science all of the
minutes.
Yeah.
Science all summer.
All right.
Well, I like that.
So what's next.

What's next.
So I'm going to go work with oneof our other episode guests,
Lisa and Seth, which I-- that'sone I listened to, it was great!

Sure you did.

Lisa Eaton and Seth Kalichman.

Lisa Eaton and Seth Kalichman, big deal HIV
researchers,

Big deal.
Yeah.
Uh, university of Connecticut.
So I'm doing postdoc there,which is going to be awesome.
I've already worked with them alittle bit during my last few
years here on a grant they'redoing, they're doing a training
grant with NIH.
So at T32, it's called, which isvery kind of proper sounding.
But basically it's all abouttraining, new HIV and stigma

(54:42):
researchers.
So worked with them.
We got to love them.
Just like you guys probably didin your interviews and Val you
worked with them before.

Yeah they've been stuck with me for awhile.

And so, yeah, one thing I didn't know is
that Seth is not about havingpostdoc students.
He isn't,

oh, I didn't know that.
So you have snuck by this then

He said he's only ever had one

Eileen Pitpitan and he loved her.
I mean, what she, so she was inmy cohort.
We'll have to get her on fornext season.
Yeah.
She was incredible.
Wow.
I didn't realize that you are,you are the second postdoc
following Dr.
Pitpitan.
Okay.

Carly Hill (55:23):
no pressure

You guys are equally awesome.

And that, uh, that's the reason he's never
had a postdoc because they neverthought one would...
Yeah.

Ohhh, Eileen was too good! No, but I mean,
he's been talking about thispost-doc for a year, so it's a
lot of enthusiasm.
That's awesome.
Yeah.
They are great.
Well, Dr.
Brousseau, you are just so superstinking smart.
I can't, you know, it's hard forme to imagine you not feeling

(55:56):
like, you knew thar you were onthe right path because I don't
know, at least from where Carlyand I are sitting, it's you're,
you're like a fish in water withthis stuff.
You're so natural at it.
You're really, really good atit.
You're so talented.
You're super duper hardworking.

Yes, keep going

I cannot wait to see all the amazing things
that you're going to do in yourcareer.
And we have been way too spoiledhaving you in our lab, like too
spoiled.

Carly Hill (56:29):
Like, I don't know what I'm going to do.
If I get beat up, does that meanI have to call you Valerie?

You are.
I t's not going to go very well.
Yeah.

Carly Hill (56:40):
It's not!

I just want to warn you right now with
everybody listening that I amvery much already looking
forward to embarrassing you atfuture conferences.
I'm going to do it total DanceMoms style.
I'm going to, I think you needto like get ready for all of the
signs.
The t-shirts the bannerscheering, the whole thing.

(57:00):
I'm going to bring Carly.
We're just going to sit in theback and go like full out,

Carly Hill (57:09):
We're going to get jackets made.

Fair amount of glitter.

Oh yeah.
We'll do all of the glitter.
No problems.

Carly Hill (57:16):
Seems like a good ask.

Yeah, because I think we're forever going to
be your biggest fans.
Yes.
Dr.
Brousseau.
So thank you so much for joiningus, talking about your
dissertation and good luck withall the things.

All right.
Well thank you for having me.
And this is going to be my fifthepisode!

Thanks to the Stigma and Health Inequities Lab
at the University of Delawarefor their help at the podcast,
including Sarah Lopez, MollyMarine, James Wallace, and
Ashley Roberts.

Carly Hill (57:44):
Thanks to city girl for the music as always be sure
to check us out on Instagram at@sexdrugsscience, and stay up to
date on new episodes by clickingsubscribe.

Thanks to all of you for listening.

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