April 29, 2024 • 60 mins
Embark on a transformative journey with Marcia Bremenour, a highly experienced therapist in addiction care, who shares her profound insights into America's drug addiction crisis and the courageous path to recovery. This episode offers an honest look at the societal tremors caused by substance abuse, evolving trends in addiction.
With Marcia, we untangle the intricate web of addiction treatment, from the temptation of short-lived coping strategies to the cultivation of lasting self-care practices that kindle genuine well-being. We peel back the layers of complexity surrounding various treatment options, dissecting everything from support meetings to inpatient programs, and zero in on the necessity of medical detox, particularly for alcohol addiction. Our exchange equips you with practical advice for seeking treatment, providing a guiding light for anyone embarking on the road to sobriety, with or without insurance.
We confront the harrowing introduction of potent substances like fentanyl into the recovery equation and the reality of relapse as an integral part of the healing process. Marcia advocates for a holistic recovery approach, encouraging self-compassion and employing tools like EMDR, yoga, meditation and mindfulness to aid in self-regulation. We close on an uplifting note, sharing triumphant recovery stories that affirm each step toward healing is a profound leap towards the restoration of hope and life. Join us for this candid and hopeful perspective on overcoming addiction.
- To learn more about recovery and Marcia Bremenour please visit https://www.mbremenour.com/
- Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357) Website: www.samhsa.gov SAMHSA is a government agency that provides a national helpline, treatment facility locator, and resources on substance abuse and mental health issues for people of all incomes.
- Partnership to End Addiction Helpline: 1-855-378-4373 Website: www.drugfree.org This non-profit provides a free, confidential helpline as well as online support groups, coaching, and resources for parents and families affected by substance abuse.
- Shatterproof Helpline: 1-800-597-2557
Website: www.shatterproof.org Shatterproof is a national nonprofit working to reverse the addiction crisis through advocacy, resources for families, and treatment options.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
David Liss (00:06):
Hello and welcome to the Wellness Musketeers podcast
, a podcast discussing health,wellness and, more broadly, the
art of living.
I'm Dave Liss, DC-basedjournalist, your host for this
podcast.
In a world where health andwellness advice comes from many
directions, we created WellnessMusketeers to help you live with
(00:27):
a greater understanding of theworld we experience together.
Every single day in America,over 230 people lose their lives
to drug addiction.
In Americans battling addictionand less than 10% receiving
(00:48):
treatment, we're confronting acrisis that intertwines societal
pressures, mental health andbiological factors.
The surge in drug overdoses,with more than 100,000 deaths in
2021, and fentanyl playing alethal role, underscores the
urgency of this issue.
And while the path to recoveryincludes the risk of relapse,
(01:10):
today's conversation aims toshed light on the resilience
that fuels hope for recovery forthose in need and those that
care for these people.
Today we have a remarkable guest.
Marcia Bremenour is a seasonedtherapist and educator who has
dedicated her career toaddressing the challenges of
(01:31):
addiction.
With over a decade ofexperience managing addiction
care within the healthcaresystem and guiding students in
the academic world, Marshabrings invaluable insights to
our discussion.
Her clinical focus is now onsupporting recovery and
understanding what recoverymeans from a holistic
(01:51):
perspective.
Marcia's expertise will guideus through understanding
addiction's grip and thetransformative journey towards
recovery.
Welcome, Marcia, it's a realpleasure to talk to you.
Marcia Bremenour (02:03):
Oh, thank you, Dave.
It's a pleasure to talk withyou as well.
Thank you, glad to be here.
David Liss (02:09):
Could we start by your framing for us?
What is the drug addictionproblem in America today?
What trends are you observingand how has the landscape
changed over the years?
Marcia Bremenour (02:22):
Well, that's a big question and it's a great
one.
I think we all know that drugaddiction is, of course, as you
mentioned, growing at monumentalrates and certainly getting
into different populations.
It's not an inner city issue,it's not a country issue, it's
not an urban issue, it's not asuburban issue.
(02:44):
It's an across-the-boardsocietal issue.
So there are certainly nopopulation that is impacted more
or less, but it is certainly aninsidious problem that is
really hurting all of us.
For healthcare systems,scientists who are busy working
(03:04):
really hard to develop andunderstand research and
(03:29):
interventions and technology toconfront addiction are neck and
neck with those developers whoare working for, those
scientists who work fordevelopers of illicit drugs.
We all know about the same,about what creates and
perpetuates addiction, both on apositive and recovery-oriented
(03:51):
side and an addiction side.
So that gets a little scarybecause I mean to put it simply,
people who are selling drugs,people who are wanting to
promote addiction, know how todo it because they have access
to the research to do that, justas people in health care
systems who want to fightaddiction have access to the
(04:12):
same research.
David Liss (04:13):
Wow, does that make sense?
Yeah, yeah.
Marcia Bremenour (04:18):
It's kind of scary.
David Liss (04:20):
Two different sides looking at the same issue from
different perspectives.
Marcia Bremenour (04:24):
Absolutely, and there are good things to
every situation.
And with the legalization ofmarijuana, the positive side to
that is that research around theimpact of marijuana and the
uses for it, which are prettybroad, there's a lot more that
we know now and because we canlegally research.
The downside is that that isone of the drugs that's
(04:46):
normalized and is veryaccessible to kids very young,
which can, as you and Idiscussed a little bit a little
while ago.
You know, it can be verycrippling for kids who are
developmentally dealing, as weall, during adolescence.
For example, if you're goingthrough adolescence, adolescence
is difficult for everyone andif you take two kids, one kid is
(05:11):
dealing with adolescence andjust dealing with the things
that the hurdles that thatsomeone would go through during
adolescence social hurdles andthe self-esteem hurdles and the
character things that we gothrough and they're just dealing
with those things and they falland they get back up.
They fall and they get back upand then they get to the
adulthood and they have thestrength that comes from pushing
(05:33):
through those challenges andthe confidence that comes from
pushing through those challengesand knowing how to make a
mistake and survive the mistakeand fix the mistake and move
through it.
Then you have their counterpart,maybe a kid, who has the exact
same challenges.
But that kid has what feels tohim or her like the luxury of
(05:58):
not having to deal with theangst attached to those
challenges because someone'sintroduced them to, for example,
marijuana.
So instead of dealing with thechallenge, they get high.
Then they're less stressed,they're less anxious in the
moment they're not reallyexperiencing the same challenges
, they're just pushing throughit.
Well, when they get to adulthood, they're at a deficit because
(06:20):
they don't know what it feelslike to deal with those kinds of
challenges unattended.
What's the word without thecrutch, if you will of using a
substance that actually makesthem not care so much about
failing and trying again thanpushing through the challenges?
My personal opinion of whatI've witnessed with young adults
(06:44):
, and now middle-aged adults aswell, is, when you introduce a
substance that takes thechallenges away for you that you
would otherwise deal withyourself, you are actually
putting yourself at adisadvantage without intending
to.
You know it's no one'sintention to to at a deficit,
(07:05):
but that's what we're fightingfor?
David Liss (07:08):
Yeah, but I'd always heard of marijuana as a gateway
drug.
I don't know if that is.
Is that true or along the linesof what you're saying?
Marcia Bremenour (07:19):
You know, Dave , I think that could be true for
some people, but I don't thinkin general.
Usually my experience withpeople who enjoy a relationship
with marijuana is they'reusually okay with that.
They may find that they'reintroduced to other things and
move on.
That is not the typical in myexperience, in my observation.
(07:40):
That is not a typical gatewaydrug.
For many people it's an endgoal drug because people develop
a love for marijuana like arelationship that is very tight
and so it's kind of all theyneed for many people.
And of course now, with theintensities, marijuana is much
higher and the THC levels, I'msorry, is much higher than it
(08:03):
was when you know, in the 60s,70s, even the 80s.
So the impact of the THC on thebrain is higher than it's ever
been before.
So we don't really, we don'tknow what that's going to look
like in 20 years from now, butit is very difficult to get in
between a person who has arelationship with marijuana and
(08:24):
their marijuana, if that makessense.
David Liss (08:27):
Yeah, no, that's really interesting.
You hinted at this already, butwhat are the key factors that
contribute to addiction and howdo they impact a person's life?
Marcia Bremenour (08:39):
So if you're referencing the contributing
that make us most likely to besusceptible to addiction, yes.
Different people may usedifferent language, but there
are essentially three groupsbiological, psychological and
social.
So and there's differentlanguage that you can use.
(09:01):
They're not, these words arenot allcompassing, but the
biology is the genetics.
For example, if you're bornwith your parents have brown
eyes, you might have brown eyes.
Or your parents have blue eyes,you might have blue eyes, for
example, any of those things,along with medical illnesses.
(09:21):
You know that we're moresusceptible to developing
because we're geneticallypredisposed to have those
illnesses.
So the genetics, the wiringstatistics about that, are that
usually there's a strongpaternal link.
So three out of four boys bornto fathers who are diagnosed
(09:43):
with an addiction are likely tobe diagnosed with addiction
themselves.
Oh, for girls, it's one out oftwo.
So one out of two girls born tofathers with an addiction are
likely to develop an addiction.
Now, when I say addiction, it'snot necessarily a chemical or
substance addiction.
It could also be an addictionto gambling, to food, to
(10:06):
relationships, to shopping, tosex, to gambling.
So there's a plethora of thingsthat we are likely that can
contribute to addiction, thatcan be defined by addiction.
It's not just substance abuse.
David Liss (10:22):
Okay.
Marcia Bremenour (10:22):
Yeah, so the biology psychology is pretty
much what it says the geneticpredisposition to have a
psychological influence, like ifthere's a bipolar disorder
that's untreated.
Many times people with apsychiatric condition will
(10:43):
develop a drug addiction becausethey're self-medicating.
Kids with attention deficit,for example If you have kids in
a classroom who have some degreeof attention issues, some what
we refer to as a diagnosis of anattention issue, and then they
happen to be presented with somemarijuana, well, the THC has a
(11:08):
tendency to calm the person down, so they're less interactive,
so they feel better.
It actually normalizes them Inthe moment.
Good, longer term not so much.
But the point of that is thatthe underlying psychiatric
condition makes that person moresusceptible to developing an
(11:31):
addiction later on because theyend up self-medicating or more
at risk of self-medicating.
The third is social and thatwould be environmental.
For example, even if your, evenif your parent is and has an
addiction, but they're inrecovery when you're born, you
(11:52):
still have the same statisticallikelihood of developing an
addiction if they're in recovery.
The thing is that you're notgoing to be exposed to.
Is the environmental pieceright?
So if so, if they're not usingin the whole, not witnessing it.
Kids who witness using in thewhole as a way of dealing with
(12:12):
life or just as a part of life,are far more likely to develop
an inclination or a relationshipwith drugs or alcohol If it's
around them, if it's normalizedin their lives, so that's the
environmental piece, and iftheir friends, of course, are
doing the same things, and ifthey don't have the structure in
(12:36):
their home where they're taughtto deal with life on life's
terms, as it were.
David Liss (12:42):
From your experience .
What is the satisfaction orvoid that drug addiction or
negative behaviors fill in aperson?
How does the addiction impact aperson's emotional well-being?
Marcia Bremenour (12:59):
I love this question, Dave.
I really do, because I feellike I could talk about it for
six hours, but I won't.
We are all comfort-seekingcreatures.
Every living being is alwaysseeking comfort, moving toward
comfort, moving away fromdiscomfort Plants, animals,
(13:24):
people, we all.
This is what we do.
Right?
If I'm uncomfortable in mychair, I'm going to shift so I
can be comfortable.
Right, if I'm uncomfortable inmy relationship, I'm going to
shift so I can be comfortable,and everything in between, right
.
So most of the time, often whenwe're uncomfortable, if we find
(13:46):
a substance that helps usregulate that is, helps our
nervous system regulate and weuse that substance and it helps
us regulate we're going todevelop an attachment to that
substance.
Right?
So that kind of sums up thequestion, right?
(14:07):
Like?
Does that make sense to you?
David Liss (14:10):
Yeah.
Marcia Bremenour (14:11):
Yeah, there are many, many, many behaviors
that are regulated right.
So self-regulating is in sayI'm anxious, right, well, I want
to self-regulate, I'm going todo certain things to
self-regulating is in say I'manxious, right, well, I want to
self-regulate, I'm going to docertain things.
To self-regulate.
When we choose things that areunhealthy ways to self-regulate,
(14:37):
like drinking, alcohol,gambling, using drugs, for
example, those things will giveus a sense of regulation, but it
is limited, it's a very shortlifespan, if you will, and
there's typically negativeconsequences attached to it.
So when we engage in thatbehavior, we may feel good about
(15:01):
it for a minute, like leadingup to it, like it's I'm going to
drink, right, this is nice, I'mgoing to do it.
And then we drink.
And then we end up especiallyif we have negative consequences
historically associated withdrinking then we drink and then
we feel bad.
So then that perpetuates thedysregulation, but we don't have
(15:23):
any other tools.
If we don't have any othertools to regulate, we go back to
the drinking, because we'regoing for that moment where it
does help us regulate.
So that's the stuff that iskind of a negative, that
develops this snowball effect,this cyclical nature that drives
addiction.
David Liss (15:43):
We're always seeking some kind of a comfort state.
Marcia Bremenour (15:47):
So the other and that's absolutely true.
The other side of that coin isif we engage in activities and
this is just the part that Ilove because and I know that
I'll get more into it I believelater on in our conversation if
we do things like exercise,going for a walk, gardening,
(16:08):
listening to music, socializing,laughing, those are also
self-regulating behaviors and ifwe engage in those behaviors,
the long-term impact of thosebehaviors is sustainable.
There are no negativeconsequences attached to it.
(16:29):
But the thing about recovery isgetting into those things.
In the absence of the drug, thedrug is just a quicker fix.
So that's the fight withrecovery is getting into those
other things that are actuallygood for us and getting away
from the addictive behaviors,understanding that it's not.
The other thing about addictionis our shame attached to it,
(16:53):
right?
So the shame attached to it isperpetuated by the behavior
because it's a self-harmingbehavior and intuitively we know
that.
So when someone is doing one ofthose behaviors they're
actually self-harming and theact of self-harming is
(17:14):
perpetuating the act ofself-harming.
David Liss (17:18):
So it's a self-perpetuating cycle.
Marcia Bremenour (17:24):
Absolutely, absolutely, yeah, yeah.
David Liss (17:28):
So how does drug addiction treatment begin?
What are the different kinds ofdrug abuse treatment and, say,
starting from outpatient careand progressing to residential
treatment facilities?
What options exist out therefor people that would like help?
Marcia Bremenour (17:46):
So another great question.
First and foremost, if somebodyhas insurance, you look on the
back of your insurance card itsays behavioral health.
You call that number and theywill tell you where you can go
to have an assessment.
(18:07):
So many times finances are abarrier and I know everyone does
not have insurance, obviously,so that's a huge factor.
For sure, If you are someonewho has insurance, look at the
back of your car and make thatcall and they will direct you to
an assessment, and I'll talkmore about that in a second.
If you don't have insurance,someone does not have health
(18:35):
insurance.
There are programs, there aresystems.
Every city has some treatmentfacilities that are geared
toward people who do not havecommercial insurance options.
It's really a matter ofGoogling that, like where can I
go for?
David Liss (18:50):
an assessment.
Marcia Bremenour (18:51):
Unfortunately, those programs are sometimes
difficult to get into.
You know they're difficult toaccess, but they do exist.
So there are so many barriersto recovery, accessibility being
one of them.
But, like I said, every cityhas some funded program that is
(19:15):
designed to at least try to help, and there are lots of great
people out there who want tohelp to help.
So once you do find the rightplace to go, you need an
assessment right.
So you go in, you meet withsomebody.
(19:37):
Hopefully if you can takesomebody who cares about you and
if you're someone who is tryingto take someone for an
assessment go with them.
The reason for this is that theperson who is using drugs and
alcohol, or alcohol and otherdrugs the person who is using
does not have the same memory ofwhat their use looks like as
(20:00):
their loved ones do Right, astheir loved ones do right.
It's why people who are using,like people who abuse alcohol,
don't understand what the fussis all about, because they don't
remember what it's like whenthey're drunk.
They don't, and usually, sofrequently, the family member
will clean up the mess.
(20:20):
You know the drug user or thealcohol user, all those
functions that alcohol does.
When alcohol enters the body,it essentially that the blood,
the liver.
I'm going to get into.
Is it okay if I get into alittle bit of biology here?
David Liss (20:40):
Yeah, I think it's helpful for people.
Marcia Bremenour (20:42):
The body can absorb and can process about an
ounce to an ounce and a half ofalcohol per hour.
So as we drink and the alcoholenters into our system, anything
over and above that, the liverdoes not work faster because
we've added more.
It stays at a steady pace, right?
(21:04):
So anything that we've added toour body, over and above that,
is absorbed into the bloodstream, to the lining of our esophagus
, our stomach, our intestines.
It just gets absorbed directlyinto our bloodstream and travels
to the brain and when it getsthere it essentially turns off
(21:25):
the switches that tell us not towet ourselves, not to talk
funny, not like it, not to walk.
The switches that tell us howto walk, how to talk, how to
behave, how to respond, how toengage, obviously, how to get
things done, how to drive thoseswitches all turn off right.
(21:48):
So when that happens, we arenot aware of what we're even
doing because the switches areall turned off, but the people
who are around us are acutelyaware of what they see, feel and
are not doing right.
So for them it's a problem, butthe person who's under the
influence does not understand itas a problem at all Because,
(22:09):
remember, it is a thing they useto regulate their nervous
system, to find comfort.
David Liss (22:16):
I see Does that make sense.
Yes.
Marcia Bremenour (22:21):
As far as getting treatment goes, it's
critically important to takesomeone in who can offer a
description of what they'rewitnessing.
This takes a lot of bravery onthe part of the person with the
problem with drugs or alcoholobviously right A lot of courage
, Because this substance thatthey're using is kind of their
lifeline in their mind, you knowwhether they or not.
(22:45):
So they sit down, they do a fullblown assessment.
The person who's doing theassessment is going to ask all
kinds of questions, like Imentioned before biology,
psychology, environment, yoursocial life, what's going on
with your friends, with yourwork, with you know, with your
life, what is happening in allaspects of one's life.
(23:06):
A thorough assessment iscritically important to
determine the level of care.
So when care is determinedright, when you determine
whether or not someone meets thecriteria for addiction, the
lowest level of care is whereyou want to start.
That's typically the model thatwe follow, so the least
(23:29):
invasive level of care.
So these are education, right,individual therapy, baby AA
meetings, other sober supportmeetings.
There's narcotics anonymous.
There's, of course, alcoholanonymous, alcoholics anonymous.
So there's support systems outthere.
(23:50):
That may be a recommendation.
Typically, people try and thehigher level of care is more
common.
People try and the higher levelof care is more common.
That is an intensive outpatientprogram.
That's the next step up,commonly known as an IOP.
Typically intensive outpatientprogram is typically three hours
(24:11):
per session and that's three orfour days per week.
It's group therapy.
It includes education, itincludes group process checking
in, checking for behavioralchanges while introducing ideas
of addiction and recovery to theclient who's involved.
(24:31):
It's designed so they can keeptheir job if they have one, they
can stay in their livingenvironment least intrusive as
possible but hopefully workingin elements of recovery while
they're dealing with real lifeto give them the kind of support
they need.
(24:52):
If they fail at that level ofcare, then they'll be advanced
to a partial hospitalization.
Then they'll be advanced to apartial hospitalization.
Typically partialhospitalization is six hours a
day, usually from about 9 to 3pm, 9 am to 3 pm.
More intensive group therapy,more intensive individual
therapy, still going home atnight.
(25:13):
So you still want to maintainas much normal life, typical
life as possible with theintention of working recovery
into their lives.
If the person fails at thatlevel of care, then we move up
to an inpatient level of care,typically residential treatment.
(25:36):
Some days, some cases are onlymaybe a week or two weeks, but
typically 30 days is recommended.
And then of course, there'shigher levels of care, even
above and beyond that, wheresomebody will go away for six
months, maybe even more.
Step down to a halfway house,then step back down to PHP, iob,
(26:00):
individual therapy.
So you go up and then you godown.
One thing I left out at thetime of the assessment the
assessor will evaluate theperson for the need for a
medical detox.
So for alcohol it's usuallydepending on how much the person
is drinking they meet.
(26:21):
They need to be monitored forwithdrawal symptoms, which can
actually be pretty serioususually three to five, maybe
seven days in a really severecase.
But you really want to makesure that they're stabilized to
avoid seizures, dehydration,which can be really serious, and
so those are medically managed.
(26:42):
Other drugs are typically alittle bit shorter only because
there's nothing much that theycan do medically for the person
and they're not going toactually die from their
withdrawals.
They're just very likely torelapse from their withdrawals.
Yeah, very likely to relapsefrom the witch walls?
David Liss (27:00):
Yeah, what kind of a role do mental health
considerations play in addiction?
Marcia Bremenour (27:15):
And is that a separate or how does that
incorporate it into drugaddiction treatment?
Well, there's differentperspectives on this, different
philosophies, and it is case bycase.
Typically, mental healthdisorders and substance abuse
disorders go hand in hand.
In other words, it's hard tosay chicken or the egg kind of
(27:47):
thing.
It is absolutely believed thatone needs to be sober from their
substance use in order toactually get a valid diagnosis
mental health diagnosis, becauseso frequently substances mimic
and create, but can sort ofmimic, mental health disorders.
Alcohol is a depressant.
So if someone comes to me andthey don't tell me that they're
drinking alcohol every day butthey're very depressed, low
motivation, disinterest, butthey just leave out the parts.
(28:09):
They're getting drunk everynight, right, and they're using
a depressant every single day.
Well, there's no interventionthat we can suggest that's going
to counter the negative impactof the alcohol use.
The same is true for marijuanause.
If someone's 24, 25 years oldand they've been using marijuana
(28:32):
every day since they're 15 or16 years old and then they come
to me at 25, and don't tell methat they're using marijuana,
but they have this fear, anxiety, right, well, and then finally
they tell me they're usingmarijuana, I'm like, oh, that
makes sense, because I developedthe skill to deal with their
(28:53):
anxiety without the marijuanaand unfortunately it's a
short-term fix that creates abigger problem Using marijuana
to treat or using anything.
Frankly, if I gamble to relax,I'm going to become dependent on
gambling in order to relax andI'm going to undermine my
(29:15):
natural ability to relax withoutgambling.
David Liss (29:19):
Yeah, I mean it's ingrained.
I'm going to undermine mynatural ability to relax without
gambling.
Yeah, I mean it's ingrained inyour life and in how you
function.
Marcia Bremenour (29:27):
Absolutely.
It becomes a very real partintrinsically in your style of
living and once you develop thatrelationship, it's very
difficult to pull away from thatbecause it's part of what you
know and you believe, you knowand you know I've had people get
really angry with me when Isuggest that maybe their
(29:49):
marijuana use is a little bitproblematic, and I don't like
that.
I don't understand why theydon't.
I don't understand why theydon't like that that.
I understand why they don't.
I do understand why they don'tlike that.
But you know, and now we livein an age where the word
medicinal has been added to theword marijuana.
So when you present it that way, you know so well, it's
(30:10):
medicinal marijuana.
As if that changes.
And the same is true for Xanax,for example Highly addicting,
highly addictive medication thattakes years to get off of Again
.
David Liss (30:26):
I could talk for a very long time about all this
how can families and friendssupport someone who's struggling
with addiction and what roledoes community support play?
And sort of a tangent I've beenthinking about as we talk here
is, I think, that alcohol,marijuana, food, gambling, I
(30:47):
mean all these things that are aperson can have as a part of
their life, but not a, not anaddiction.
Like how do you regulateyourself when you're, if you're
going to smoke, marijuana ordrink and you're going to be
with people who have alcohol oraddiction problems of some kind?
Marcia Bremenour (31:13):
Yeah, you know , it does get very tricky,
because not everybody who usesmarijuana is addicted to
marijuana and not everybody whodrinks alcohol is addicted to
alcohol.
There's so many, like we talkedabout before.
I did give the three-prongedperspective bio, psycho, social
but each one of those prongsalso has so many unique nuances
(31:38):
that you know it's, and I knowthat when we talk about these
things, people often come awaythinking that I'm saying that
well, everyone who's doing thisis an alcoholic or a drug addict
, and that's just not the case.
There are, however, certaindrugs like heroin.
You use heroin one time right.
Drug dealers know this, by theway.
(31:59):
You use heroin one time, youare not necessarily going to
develop it.
You just use heroin one time,that's it right.
Go back for day two, you stillmight not develop a
physiological addiction to it.
So you go back for day threeand you absolutely are going to
(32:28):
develop at that point.
That is where the thing happensright, and drug dealers so
you're on the parking lot of thegas station and someone's like
you know and they and somehowthere's radar, people have radar
, they find each other and theygive you enough.
They give you a phone number,they give you enough for three
(32:51):
days, right, come back, see mein three days, right.
And then you go home and you doit for three days, you're
coming back and they know you'recoming back.
So the risk, when the otherreinforcers are not present, for
the person to say I don't needto do that, I feel good as I am,
(33:12):
I'm regulated, I'm comfortable,I'm comfortable enough or I'm
okay with being uncomfortable,right, if someone knows how to
be uncomfortable and then knowshow to move through that and fix
it, naturally there's certainlythe advantage.
David Liss (33:38):
But many, many people don't?
They have an awareness thatthis is just, you know it's
deadly or something, or how doyou ignore?
Marcia Bremenour (33:50):
I can speak that a little bit that what
happens with many, many, is theydo have periods of subribe,
especially with the powerfulopiates.
Right with fentanyriety,especially with the powerful
opiates, right With fentanyl,with heroin, especially with the
powerful opiates and thesesynthetic opiates that are
designed to get the bodydependent on it immediately.
(34:12):
Right, if someone gets awayfrom it for a while and then
they go back to it.
That is where the problemreally.
The likelihood of overdosing isso much greater because the
body is not acclimated to it,but the person thinks I can use
this much and they go back towhere they dropped off the last
(34:34):
time.
They are likely going tooverdose because of the intense
drug in their body.
David Liss (34:41):
So is it sort of the case that their effort at
sobriety makes the drug moredangerous for them when they go
back to it?
Marcia Bremenour (34:51):
Absolutely, absolutely.
That doesn't mean peopleshouldn't pursue sobriety,
obviously right.
But that really does create arisk when they and I'm not
saying people don't overdose,who are using every day, because
of course they do.
What I'm saying is that there'ssuch a challenge for people in
those stages where they'retrying to recover because
(35:13):
relapse it's so common, it's anatural part of recovery, right?
So addiction, the natural partof addiction.
So because it is so common andexpected and anticipated.
And the problem was that is thatpeople will say dolphin in
recovery communities you'll hearpeople say, well, treatment or
(35:36):
recovery is kind of a buzzkillbecause once you have it in your
brain, right, that that okay, Irecognize that drug use is not
good, it's destructive, it's.
I recognize what it's doing.
We have a little recovery goingon, going back and using the
idea of going back and using theidea of going back and using
(35:59):
the regulating effect that thethought of using had before.
You know that those momentsbefore you pick up and you're
like, oh, I'm so happy I'm goingto be doing this, that kind of
goes away.
That gets a little smaller.
So the positive impact of usingdissipates, but the craving to
use does not necessarilydissipate.
(36:21):
So the person often uses anyway, and then they feel even worse.
David Liss (36:25):
Cheryl, does that mean that when you talk about
returning to drugs, does thatmean that it's a failure, or
does it mean that you're sayingit's part of recovery?
Marcia Bremenour (36:38):
It's actually part of the process.
It's an accepted part of theprocess.
It's not an encouraged one, butit's an accepted one.
And it's kind of likemeditating right.
Meditation, as you probablyknow this, many people know this
meditation is not the practiceof staying focused, it's a
practice of coming back.
It's a practice of having afocus, noticing when you wander
(37:04):
off and coming back right Samewith recovery.
Without the shame attached.
So if you are meditating andyou wander off and you're like I
can't meditate, I keepwandering off, I can't do it,
well, no, that's a part of it.
So recovery is the sameprinciple would say I keep
wandering off, I can't do it,well, no, that's a part of it.
So recovery is the sameprinciple Just keep coming back,
(37:25):
keep coming back.
And in the rooms of AA andother 12-step recovery programs
you will hear that all the timeJust keep coming back, keep
coming back.
And many, many, many peoplekeep coming back.
So that is the good news Manypeople keep coming back.
David Liss (37:41):
So it is understood to be a struggle.
It's not going to be easy.
Marcia Bremenour (37:49):
And there's so much shame attached to the use.
That is back in the day, a longtime ago and I'm old enough now
to say back in the day it usedto be the intention of recovery
and treatment programs was toactually really kind of like
shame the person and shame theirbehavior and to beat down the
(38:11):
arrogance of addiction is thatarrogance is a byproduct of a
lack of self-esteem, ofinsecurity.
Nobody is arrogant without anunderlying insecurity.
And so with recovery in myexperience which is why I have
(38:33):
focused so much of my attentionon recovery and supportive,
holistic recovery is to actuallyfeed self-esteem with self-care
and self-compassion and comingto understand one's nervous
system and how their body, howour bodies respond, how we're
talking to ourselves and thevalue of breathing, like just
(38:54):
like what happens when weactually take three deep breaths
and we reinforce to our bodiesthat we're actually okay.
When we go through life scared,we're sending messages to our
(39:16):
body that there's a fire in thekitchen is really a healthy,
supportive way of sort ofoffsetting the drive toward
addiction.
But it takes a lot of work,obviously, and to interrupt that
cycle of wanting the quick sixright right and not caring about
(39:42):
ourselves and not feelingguilty about the pain that we've
caused people who love us.
You know, as a byproduct of ouraddiction, you know, hurting
ourselves, hurting other people.
There's so much self-loathingthat goes with addiction that
the idea of introducingself-care and self-love is
almost like, so foreign topeople.
So really teaching that in away that is supportive, but not
(40:05):
coddling, because these people,often people, will come to
recovery.
I say these people, people whoare struggling with addiction,
are often coddling their ownemotional discomfort and, as a
byproduct of that, underminingtheir self-confidence, which
(40:25):
undermines their self-love,which undermines their ability
to access recovery.
David Liss (40:30):
That's a lot.
How has the rise of fentanylimpacted efforts to reduce
overdose deaths?
Fentanyl impacted efforts toreduce overdose deaths and what
is the impact of fentanyl?
Marcia Bremenour (40:50):
Well, my experience with all the
synthetic drugs, and fentanyl inparticular.
It is so fast acting and it isso available and it's insidious
because it's being interwoveninto other drugs.
People are using, you know,recreational cocaine, which I'm
not promoting at all, but youknow, maybe I should say pot,
and maybe it's someone who goesto a club once a month and when
they do that, they experimentwith cocaine and they've been
(41:13):
doing that for a very long timeand nothing's going to happen.
I'm not promoting thatwhatsoever, I'm just saying
there are people who do thatkind of thing.
And that person gets a hold ofsome cocaine that has fentanyl
in it and, all of a sudden,their ease, are addicted to it,
right, they're addicted to thefentanyl, or it kills them, they
overdose on it, it makes themsick, right.
(41:33):
So it's just.
And it's such a powerful drugand, like I said, it's so easily
accessed now, it is so highlyand broadly manufactured and
distributed.
And, you know, fighting that,fighting society that is
globally, that is really leaningtoward feeling good, fast,
(41:55):
right, like what's easy, whatmakes me feel good, what makes
me look good, what makeswhatever, what makes life easy?
And it's a ruse, you know.
But I think that those thingsall make us far more susceptible
(42:18):
to doing things that aredangerous and ignoring things
that are actually good for us.
David Liss (42:24):
Yeah, I mean I can think about, like how I eat.
I go to a vending machine andget a thing of cookies, as
opposed to looking for a fruitor a vegetable somewhere.
It's the easiest thing to find.
Right right, so you shouldn'tnecessarily look at it that
people are intentionally tryingto kill themselves.
It's with fentanyl.
It just is a byproduct of howit's included in different drugs
(42:47):
.
Marcia Bremenour (42:47):
My experience with people who use advanced,
different advanced drugs.
You know different syntheticdrugs and there's a lot of them
out there, right, they're veryavailable and very few people
are intentionally trying todestroy their lives, right, At
least not in the beginning.
(43:08):
Most people are just comfortseeking, and then sometimes that
comfort, the way they'reseeking that comfort is to just
drug, basically drug themselves,remove themselves from the
situation.
David Liss (43:22):
So they're not.
Marcia Bremenour (43:24):
And so that that piece of it is a challenge,
because intercepting theirself-esteem is where recovery
comes in.
But they're doing, they'rebehaving and they're
participating in behaviors thatthe rest of the world, if you
will, are so judgmental about.
You know it's hard, it is achallenge to intercept it and
(43:47):
you know you asked earlier, dave, what can family members do,
and what I would say to that is,first and foremost, do your job
of just loving the person, justlove the person job of just
loving the person, just love theperson, independent of what
they're doing, and then holdthem to some standard of
self-care, you know, and try todo what you can to support that
(44:12):
and and that is about all youcan do, whatever that means to
you.
Helping them access therapy, ifpossible, certainly is a goal.
Al-anon, codependent Anonymousboth excellent resources for
family members.
There's a series of books by anauthor and they've been around
(44:33):
forever Melody Beatty andCodependent Bill Moore, beyond
Codependency are the two thatcome to mind.
That are the first two that shewrote.
They've been around forever,but I tell you what?
The philosophy, the message istimeless, you know, and lots and
lots of families who are tryingto support people in recovery
(44:55):
have benefited greatly fromthose kinds of resources.
David Liss (44:58):
What are the barriers that keep people that
are suffering from addictionfrom accessing treatment?
Marcia Bremenour (45:06):
I think financially first of all, right,
not having the finances.
Treatment can be very expensive, you know, and more expensive
treatment is not always bettertreatment.
So, keeping that in mind, Ithink finding motivated people
who are motivated in recovery ahuge part of it.
(45:27):
And I'm not pushing a 12-steprecovery program, but I am going
to tell you that the 12 stepsof recovery are really, if you
read them, just a healthy way ofliving, and many people get
caught up in the religious pieceof it and you can easily take
the word God out and justreplace it with nature, sunshine
(45:48):
, whatever.
But it's just a really healthyway of living in that just
acknowledging that you can'tcontrol everything there's
things you can control, there'sthings you can't and recognizing
the difference, for one thing,being present and being mindful,
(46:09):
that's one day at a time isessentially mindfulness, which,
of course, has been around sincedirt.
David Liss (46:15):
But we've decided, we've just invented it, I think.
Marcia Bremenour (46:17):
And AA is free , no-transcript.
(46:52):
The addiction, the unhealthyrelationship with the drugs or
alcohol, is really an integralpart, and so, to answer your
question, you know what are thebarriers.
The main barrier is a lack offragile protection, if you will.
You know that thing that keepsyou from going back out there.
In the recovering communitythere's a saying people, places
(47:14):
and things.
So in recovery, especiallyearly in recovery, you want to
stay away from people you used,with, places you used and things
that remind you of using.
So for some people they can'tgo to the same grocery store
they once shopped at becausethat's where they bought their
beer, for example.
(47:35):
Or if they are at the grocerystore and they only have one
that they can go to, they can'tgo down the aisle where the beer
is sold.
For example, cigarette smokersare strongly encouraged not to
go into a store like a gasstation where they sell
cigarettes behind the counter,because they're likely to buy a
pack and, if they're trying toquit, probably not going to be
(47:55):
able to.
The brain does a thing and itjust goes.
So sober people, sober placesand sober things are critically
important hedges of protectionthat separate the person from
their choice while they developthose behaviors and those
activities and those skills thatgive them the ability to
(48:19):
regulate their nervous system.
That reminds them safely thatthere's not a fire in the
kitchen.
Right, there's no fire in thekitchen.
You're okay, which is wherebreathing comes in, and
grounding and understanding yourpolyvagal nervous system and
understanding all the thingsthat go on inside our bodies
that make us tick, basically.
(48:39):
So that's more advancedrecovery stuff, but it's there.
David Liss (48:45):
It's good to know what role should harm reduction
strategies like naloxone, excessor safe injection sites play.
Marcia Bremenour (48:58):
Well, there are medications that people use
to curb cravings right, that can.
If you drink, for example, youget sick if you're on certain
medications.
There's nothing wrong with ifthose serve as barriers to like
a hedge of protection.
If they serve as barriers tousing in a way that is
(49:20):
destructive and they give theperson an opportunity to
practice those things that helpthem calm their nervous system,
naturally, to promote recovery,then they're useful.
If they turn into a dependence,which happens sometimes, then
that becomes problematic becausenothing's changed.
(49:41):
They're just using a differentway to get to do the same
participate in the addictivebehavior.
Does that make sense?
David Liss (49:51):
Yeah, yeah, it's sort of a limiting or enabling
kind of thing.
Marcia Bremenour (49:57):
Absolutely.
It's not promoting recovery,it's just shifting the damage.
It's the same behavior, you know, just with that different
substance less damagingsubstance potentially, but if
without recovery, the person isfar more likely to go back to
(50:19):
addictive behaviors.
And speaking of it's really youasked before about mental health
issues.
And so people experience traumaright in their early life or
something that they experienceis traumatic, and the way our
brain functions with traumastore that in this place in our
(50:41):
brain, right.
We take it away there, it'sright there and it's tucked in
there and nothing can get to it,and then we have this
well-resourced part of our brainthat helps us get through the
day.
And so the problem with this,with addiction, is, once you
take away the drug that theperson is using to cloud their
access to all the parts of theirbrain and their memories, some
(51:04):
of those memories start to comeup right.
So when that happens, if thatperson doesn't have ample
support around staying sober,they're far more likely to be
re-traumatized by memories, andthat shame they around, you know
.
And so that I just want tothrow that in because I think
(51:24):
it's a really important part totake into consideration when it
comes to recovery.
David Liss (51:31):
Yeah, and along the lines of what you just mentioned
, could you speak a little bitmore about stigma and shame and
addiction recovery and theirimpact on recovery?
Marcia Bremenour (51:45):
Well, I think that sure, I absolutely can.
So many people see drug use asa choice and absolutely there
are elements that are of theperson's choosing.
They're choosing to do thething for sure and certainly at
(52:06):
first glance that's absolutelywhat it looks like, triggered.
If you understand that, you'llrecognize that once that ball is
set in motion they're justgoing to use.
If there's not barriers,they're going to use.
(52:27):
And it's not because they'restupid, it's certainly not
because they're weak, it's notbecause they're incapable of
something, it's just becausethey're caught up in this
cyclical relationship with thischemical that is driving them to
do these things.
And the barriers, for whateverreason, are not in place yet
(52:49):
that help them to stop doingthat behavior.
So I think the shame part of itactually just contributes.
It's like, well, screw it.
Everyone thinks I'm this anyway, I'm just going to go do it.
Who cares Right?
So, yeah, there's nothinghelpful.
Addiction is definitely ashame-based disease, if you will
, and it is identified as adisease because, amongst other
(53:13):
things, it's symptom-driven,it's progressive, it's fatal and
it's chronic.
So those are by definition adisease.
Are those things?
So I don't get into those kindsof debates with people.
I don't care if someone callsit a disease or not.
Frankly, it doesn't matter tome if they do or if they don't.
You know, what matters to me isthe actual mechanics of the
(53:34):
behavior and it's person byperson.
Everybody's different, you know.
So I'd have to sit with theperson, see what's going on with
them, find the similaritiesamongst other people who
struggle with addiction, so wecan kind of help, like navigate
where they need to be, and thenreally dig into the subtle
nuances that make theirsituation unique to them in a
(53:56):
way, not this terminaluniqueness that keeps them
separate, but the kind ofuniqueness that recognizes them
as a person, separate from theiraddictive behaviors.
David Liss (54:07):
Going from there.
What are some success storiesthat give hope from your
experience to those fightingaddiction today, and are there
people that you've worked withthat bring you some optimism?
Marcia Bremenour (54:21):
Well, I have lots of success stories.
Lots of people that I've workedwith over the years, who I stay
in touch with, still send mepeople from the recovering
community who have just reallystuck with it, kept going to
meetings, kept doing things totake care of themselves, kept
surrounding themselves as muchas they can with people who
(54:43):
support their recovery, and Iwitnessed it.
I continue to witness it.
There are people who do reallyreally care about staying sober
and they want to stay sober, andwhat I see the most is there's
an underlying inability toregulate their nervous system,
(55:06):
and when we introduce tools andskills to regulate, it's a game
changer.
So, you know, I practice EMDRwith clients, which is I move
into sensitization andreprocessing.
I practice a neurofeedback, anonlinear style of neurofeedback
(55:27):
which helps with brain trainingand helps with relaxation.
I promote yoga and just generalexercise, just stretching, like
paying attention to your bodyand taking care of it
differently than you did before,and those things that is where
the holistic part of my approachcomes in Like those things all
(55:49):
contribute to well-being fromthe inside out, which is exactly
what we need to get to, becauseonce you do that, those aren't
cures for addiction.
Once you do that those aren'tcures for addiction but as they
stabilize, they allow the personto actively stabilize from the
inside out and take ownership ofthat Like it's actually theirs,
(56:12):
because it's their body they'redealing with, right?
Yeah, I think that comes fromthat, and the ability to
self-regulate eliminatesessentially, or certainly
distinguishes, cravings in manycases and for sure allows them
that person to access supportsystems that serve as that hedge
(56:35):
of protection I talked aboutbefore.
David Liss (56:38):
What message of hope and empowerment would you offer
to anyone that's fighting theirown battle against addiction?
Marcia Bremenour (56:45):
If I summed it up in a couple of words, I
would really say self-compassion, be nice to you, give yourself
oxygen like breathe.
The whole idea of three deepbreaths.
You know you think about thefire in the kitchen, right idea
of three deep breaths.
You know you think about thefire in the kitchen, right, you
take three deep breaths thefirst deep breath shows an
(57:09):
intention that you're say oh,I'm, I'm doing this, I I must be
okay, I'm not gonna stop andtake a deep breath.
There's fire in the kitchen,right.
So first deep breath is theintention is of self-care.
The second deep breath allowsthe body to be more present,
(57:30):
more aware, mindful, right, likewhen you take the second deep
breath, you're like oh, then youkind of feel your shoulders
drop down a little bit, you'refeeling your feet on the floor.
The third deep breath, becauseyou've done the first two, the
third deep breath does thisreally magical thing of opening
up your circulation.
Right, that's what happens whenwe breathe we dilate our
(57:51):
circulation, we get everythingmoving and it feels really,
really good.
So if somebody can givethemselves the gift of just
doing those three things, theycan feel better.
Right, they can feel better, atleast for the 30, 20, 30
seconds it takes to do that.
If they could just get aninkling of what it feels like to
(58:12):
feel better.
That's something to build on,you know, with the support of
therapy and loving people aroundthem and all of the things.
But so I say breathe and itfeels flippant.
You know, you read memes or yousee something on social media
that's like just breathe, likemy mom says, just breathe.
Right.
(58:33):
But when it comes down tositting with a person and doing
this exercise and watching themexperience things, and then what
that feels like when they gooutside in the sun and they
stretch a little bit, when theyrecognize the value in
stretching for their nervoussystem and they start to
(58:54):
understand themselves just alittle bit better, those acts of
self-compassion make such ahuge difference in the overall
impact of their well-being.
It's not the end-all be-all byany stretch, but it's an
integral part of a foundationtoward wellness, right?
If you focus on wellness,whatever pathology you
(59:18):
experience or whatever you wantto call it kind of goes to the
background, Right.
And then it's kind of behindyou, it's in your rear view
mirror rather than in front ofyou.
David Liss (59:29):
Oh, that's great.
Sometimes, simplest things arethe best things.
Yes, absolutely we don't haveto overcomplicate our lives
sometimes.
Marcia Bremenour (59:40):
Right, right, right, right, right, right,
right, right, right.
So, to answer your question, Isee lots of people with
miraculous moments, moments.
It's the men who get moremoments.
David Liss (59:51):
Thank you, Marcia Bremenour, for being here today
and for this conversation.
To learn more about recovery,please visit www.
b remenou.
com that's M-B-R-E-M-E-N-O-U-R.
com.
And thank you for joining usfor Wellness Musketeers.
(01:00:16):
Tune in for our upcomingepisodes to learn how to live
with a greater understanding ofthe world we experience together
.
Please subscribe, give us afive-star review and share this
recording with your family andfriends.
Let us know what you need tolearn to help you live your best
life.
Send your questions and ideasfor future episodes to Dave Liss
(01:00:38):
at davidmliss@gmail.
com.
Hello and welcome to the Wellness Musketeers podcast
, a podcast discussing health,wellness and, more broadly, the
art of living.
I'm Dave Liss, DC-basedjournalist, your host for this
podcast.
In a world where health andwellness advice comes from many
directions, we created WellnessMusketeers to help you live with
(00:27):
a greater understanding of theworld we experience together.
Every single day in America,over 230 people lose their lives
to drug addiction.
In Americans battling addictionand less than 10% receiving
(00:48):
treatment, we're confronting acrisis that intertwines societal
pressures, mental health andbiological factors.
The surge in drug overdoses,with more than 100,000 deaths in
2021, and fentanyl playing alethal role, underscores the
urgency of this issue.
And while the path to recoveryincludes the risk of relapse,
(01:10):
today's conversation aims toshed light on the resilience
that fuels hope for recovery forthose in need and those that
care for these people.
Today we have a remarkable guest.
Marcia Bremenour is a seasonedtherapist and educator who has
dedicated her career toaddressing the challenges of
(01:31):
addiction.
With over a decade ofexperience managing addiction
care within the healthcaresystem and guiding students in
the academic world, Marshabrings invaluable insights to
our discussion.
Her clinical focus is now onsupporting recovery and
understanding what recoverymeans from a holistic
(01:51):
perspective.
Marcia's expertise will guideus through understanding
addiction's grip and thetransformative journey towards
recovery.
Welcome, Marcia, it's a realpleasure to talk to you.
Marcia Bremenour (02:03):
Oh, thank you, Dave.
It's a pleasure to talk withyou as well.
Thank you, glad to be here.
David Liss (02:09):
Could we start by your framing for us?
What is the drug addictionproblem in America today?
What trends are you observingand how has the landscape
changed over the years?
Marcia Bremenour (02:22):
Well, that's a big question and it's a great
one.
I think we all know that drugaddiction is, of course, as you
mentioned, growing at monumentalrates and certainly getting
into different populations.
It's not an inner city issue,it's not a country issue, it's
not an urban issue, it's not asuburban issue.
(02:44):
It's an across-the-boardsocietal issue.
So there are certainly nopopulation that is impacted more
or less, but it is certainly aninsidious problem that is
really hurting all of us.
For healthcare systems,scientists who are busy working
(03:04):
really hard to develop andunderstand research and
(03:29):
interventions and technology toconfront addiction are neck and
neck with those developers whoare working for, those
scientists who work fordevelopers of illicit drugs.
We all know about the same,about what creates and
perpetuates addiction, both on apositive and recovery-oriented
(03:51):
side and an addiction side.
So that gets a little scarybecause I mean to put it simply,
people who are selling drugs,people who are wanting to
promote addiction, know how todo it because they have access
to the research to do that, justas people in health care
systems who want to fightaddiction have access to the
(04:12):
same research.
David Liss (04:13):
Wow, does that make sense?
Yeah, yeah.
Marcia Bremenour (04:18):
It's kind of scary.
David Liss (04:20):
Two different sides looking at the same issue from
different perspectives.
Marcia Bremenour (04:24):
Absolutely, and there are good things to
every situation.
And with the legalization ofmarijuana, the positive side to
that is that research around theimpact of marijuana and the
uses for it, which are prettybroad, there's a lot more that
we know now and because we canlegally research.
The downside is that that isone of the drugs that's
(04:46):
normalized and is veryaccessible to kids very young,
which can, as you and Idiscussed a little bit a little
while ago.
You know, it can be verycrippling for kids who are
developmentally dealing, as weall, during adolescence.
For example, if you're goingthrough adolescence, adolescence
is difficult for everyone andif you take two kids, one kid is
(05:11):
dealing with adolescence andjust dealing with the things
that the hurdles that thatsomeone would go through during
adolescence social hurdles andthe self-esteem hurdles and the
character things that we gothrough and they're just dealing
with those things and they falland they get back up.
They fall and they get back upand then they get to the
adulthood and they have thestrength that comes from pushing
(05:33):
through those challenges andthe confidence that comes from
pushing through those challengesand knowing how to make a
mistake and survive the mistakeand fix the mistake and move
through it.
Then you have their counterpart,maybe a kid, who has the exact
same challenges.
But that kid has what feels tohim or her like the luxury of
(05:58):
not having to deal with theangst attached to those
challenges because someone'sintroduced them to, for example,
marijuana.
So instead of dealing with thechallenge, they get high.
Then they're less stressed,they're less anxious in the
moment they're not reallyexperiencing the same challenges
, they're just pushing throughit.
Well, when they get to adulthood, they're at a deficit because
(06:20):
they don't know what it feelslike to deal with those kinds of
challenges unattended.
What's the word without thecrutch, if you will of using a
substance that actually makesthem not care so much about
failing and trying again thanpushing through the challenges?
My personal opinion of whatI've witnessed with young adults
(06:44):
, and now middle-aged adults aswell, is, when you introduce a
substance that takes thechallenges away for you that you
would otherwise deal withyourself, you are actually
putting yourself at adisadvantage without intending
to.
You know it's no one'sintention to to at a deficit,
(07:05):
but that's what we're fightingfor?
David Liss (07:08):
Yeah, but I'd always heard of marijuana as a gateway
drug.
I don't know if that is.
Is that true or along the linesof what you're saying?
Marcia Bremenour (07:19):
You know, Dave , I think that could be true for
some people, but I don't thinkin general.
Usually my experience withpeople who enjoy a relationship
with marijuana is they'reusually okay with that.
They may find that they'reintroduced to other things and
move on.
That is not the typical in myexperience, in my observation.
(07:40):
That is not a typical gatewaydrug.
For many people it's an endgoal drug because people develop
a love for marijuana like arelationship that is very tight
and so it's kind of all theyneed for many people.
And of course now, with theintensities, marijuana is much
higher and the THC levels, I'msorry, is much higher than it
(08:03):
was when you know, in the 60s,70s, even the 80s.
So the impact of the THC on thebrain is higher than it's ever
been before.
So we don't really, we don'tknow what that's going to look
like in 20 years from now, butit is very difficult to get in
between a person who has arelationship with marijuana and
(08:24):
their marijuana, if that makessense.
David Liss (08:27):
Yeah, no, that's really interesting.
You hinted at this already, butwhat are the key factors that
contribute to addiction and howdo they impact a person's life?
Marcia Bremenour (08:39):
So if you're referencing the contributing
that make us most likely to besusceptible to addiction, yes.
Different people may usedifferent language, but there
are essentially three groupsbiological, psychological and
social.
So and there's differentlanguage that you can use.
(09:01):
They're not, these words arenot allcompassing, but the
biology is the genetics.
For example, if you're bornwith your parents have brown
eyes, you might have brown eyes.
Or your parents have blue eyes,you might have blue eyes, for
example, any of those things,along with medical illnesses.
(09:21):
You know that we're moresusceptible to developing
because we're geneticallypredisposed to have those
illnesses.
So the genetics, the wiringstatistics about that, are that
usually there's a strongpaternal link.
So three out of four boys bornto fathers who are diagnosed
(09:43):
with an addiction are likely tobe diagnosed with addiction
themselves.
Oh, for girls, it's one out oftwo.
So one out of two girls born tofathers with an addiction are
likely to develop an addiction.
Now, when I say addiction, it'snot necessarily a chemical or
substance addiction.
It could also be an addictionto gambling, to food, to
(10:06):
relationships, to shopping, tosex, to gambling.
So there's a plethora of thingsthat we are likely that can
contribute to addiction, thatcan be defined by addiction.
It's not just substance abuse.
David Liss (10:22):
Okay.
Marcia Bremenour (10:22):
Yeah, so the biology psychology is pretty
much what it says the geneticpredisposition to have a
psychological influence, like ifthere's a bipolar disorder
that's untreated.
Many times people with apsychiatric condition will
(10:43):
develop a drug addiction becausethey're self-medicating.
Kids with attention deficit,for example If you have kids in
a classroom who have some degreeof attention issues, some what
we refer to as a diagnosis of anattention issue, and then they
happen to be presented with somemarijuana, well, the THC has a
(11:08):
tendency to calm the person down, so they're less interactive,
so they feel better.
It actually normalizes them Inthe moment.
Good, longer term not so much.
But the point of that is thatthe underlying psychiatric
condition makes that person moresusceptible to developing an
(11:31):
addiction later on because theyend up self-medicating or more
at risk of self-medicating.
The third is social and thatwould be environmental.
For example, even if your, evenif your parent is and has an
addiction, but they're inrecovery when you're born, you
(11:52):
still have the same statisticallikelihood of developing an
addiction if they're in recovery.
The thing is that you're notgoing to be exposed to.
Is the environmental pieceright?
So if so, if they're not usingin the whole, not witnessing it.
Kids who witness using in thewhole as a way of dealing with
(12:12):
life or just as a part of life,are far more likely to develop
an inclination or a relationshipwith drugs or alcohol If it's
around them, if it's normalizedin their lives, so that's the
environmental piece, and iftheir friends, of course, are
doing the same things, and ifthey don't have the structure in
(12:36):
their home where they're taughtto deal with life on life's
terms, as it were.
David Liss (12:42):
From your experience .
What is the satisfaction orvoid that drug addiction or
negative behaviors fill in aperson?
How does the addiction impact aperson's emotional well-being?
Marcia Bremenour (12:59):
I love this question, Dave.
I really do, because I feellike I could talk about it for
six hours, but I won't.
We are all comfort-seekingcreatures.
Every living being is alwaysseeking comfort, moving toward
comfort, moving away fromdiscomfort Plants, animals,
(13:24):
people, we all.
This is what we do.
Right?
If I'm uncomfortable in mychair, I'm going to shift so I
can be comfortable.
Right, if I'm uncomfortable inmy relationship, I'm going to
shift so I can be comfortable,and everything in between, right
.
So most of the time, often whenwe're uncomfortable, if we find
(13:46):
a substance that helps usregulate that is, helps our
nervous system regulate and weuse that substance and it helps
us regulate we're going todevelop an attachment to that
substance.
Right?
So that kind of sums up thequestion, right?
(14:07):
Like?
Does that make sense to you?
David Liss (14:10):
Yeah.
Marcia Bremenour (14:11):
Yeah, there are many, many, many behaviors
that are regulated right.
So self-regulating is in sayI'm anxious, right, well, I want
to self-regulate, I'm going todo certain things to
self-regulating is in say I'manxious, right, well, I want to
self-regulate, I'm going to docertain things.
To self-regulate.
When we choose things that areunhealthy ways to self-regulate,
(14:37):
like drinking, alcohol,gambling, using drugs, for
example, those things will giveus a sense of regulation, but it
is limited, it's a very shortlifespan, if you will, and
there's typically negativeconsequences attached to it.
So when we engage in thatbehavior, we may feel good about
(15:01):
it for a minute, like leadingup to it, like it's I'm going to
drink, right, this is nice, I'mgoing to do it.
And then we drink.
And then we end up especiallyif we have negative consequences
historically associated withdrinking then we drink and then
we feel bad.
So then that perpetuates thedysregulation, but we don't have
(15:23):
any other tools.
If we don't have any othertools to regulate, we go back to
the drinking, because we'regoing for that moment where it
does help us regulate.
So that's the stuff that iskind of a negative, that
develops this snowball effect,this cyclical nature that drives
addiction.
David Liss (15:43):
We're always seeking some kind of a comfort state.
Marcia Bremenour (15:47):
So the other and that's absolutely true.
The other side of that coin isif we engage in activities and
this is just the part that Ilove because and I know that
I'll get more into it I believelater on in our conversation if
we do things like exercise,going for a walk, gardening,
(16:08):
listening to music, socializing,laughing, those are also
self-regulating behaviors and ifwe engage in those behaviors,
the long-term impact of thosebehaviors is sustainable.
There are no negativeconsequences attached to it.
(16:29):
But the thing about recovery isgetting into those things.
In the absence of the drug, thedrug is just a quicker fix.
So that's the fight withrecovery is getting into those
other things that are actuallygood for us and getting away
from the addictive behaviors,understanding that it's not.
The other thing about addictionis our shame attached to it,
(16:53):
right?
So the shame attached to it isperpetuated by the behavior
because it's a self-harmingbehavior and intuitively we know
that.
So when someone is doing one ofthose behaviors they're
actually self-harming and theact of self-harming is
(17:14):
perpetuating the act ofself-harming.
David Liss (17:18):
So it's a self-perpetuating cycle.
Marcia Bremenour (17:24):
Absolutely, absolutely, yeah, yeah.
David Liss (17:28):
So how does drug addiction treatment begin?
What are the different kinds ofdrug abuse treatment and, say,
starting from outpatient careand progressing to residential
treatment facilities?
What options exist out therefor people that would like help?
Marcia Bremenour (17:46):
So another great question.
First and foremost, if somebodyhas insurance, you look on the
back of your insurance card itsays behavioral health.
You call that number and theywill tell you where you can go
to have an assessment.
(18:07):
So many times finances are abarrier and I know everyone does
not have insurance, obviously,so that's a huge factor.
For sure, If you are someonewho has insurance, look at the
back of your car and make thatcall and they will direct you to
an assessment, and I'll talkmore about that in a second.
If you don't have insurance,someone does not have health
(18:35):
insurance.
There are programs, there aresystems.
Every city has some treatmentfacilities that are geared
toward people who do not havecommercial insurance options.
It's really a matter ofGoogling that, like where can I
go for?
David Liss (18:50):
an assessment.
Marcia Bremenour (18:51):
Unfortunately, those programs are sometimes
difficult to get into.
You know they're difficult toaccess, but they do exist.
So there are so many barriersto recovery, accessibility being
one of them.
But, like I said, every cityhas some funded program that is
(19:15):
designed to at least try to help, and there are lots of great
people out there who want tohelp to help.
So once you do find the rightplace to go, you need an
assessment right.
So you go in, you meet withsomebody.
(19:37):
Hopefully if you can takesomebody who cares about you and
if you're someone who is tryingto take someone for an
assessment go with them.
The reason for this is that theperson who is using drugs and
alcohol, or alcohol and otherdrugs the person who is using
does not have the same memory ofwhat their use looks like as
(20:00):
their loved ones do Right, astheir loved ones do right.
It's why people who are using,like people who abuse alcohol,
don't understand what the fussis all about, because they don't
remember what it's like whenthey're drunk.
They don't, and usually, sofrequently, the family member
will clean up the mess.
(20:20):
You know the drug user or thealcohol user, all those
functions that alcohol does.
When alcohol enters the body,it essentially that the blood,
the liver.
I'm going to get into.
Is it okay if I get into alittle bit of biology here?
David Liss (20:40):
Yeah, I think it's helpful for people.
Marcia Bremenour (20:42):
The body can absorb and can process about an
ounce to an ounce and a half ofalcohol per hour.
So as we drink and the alcoholenters into our system, anything
over and above that, the liverdoes not work faster because
we've added more.
It stays at a steady pace, right?
(21:04):
So anything that we've added toour body, over and above that,
is absorbed into the bloodstream, to the lining of our esophagus
, our stomach, our intestines.
It just gets absorbed directlyinto our bloodstream and travels
to the brain and when it getsthere it essentially turns off
(21:25):
the switches that tell us not towet ourselves, not to talk
funny, not like it, not to walk.
The switches that tell us howto walk, how to talk, how to
behave, how to respond, how toengage, obviously, how to get
things done, how to drive thoseswitches all turn off right.
(21:48):
So when that happens, we arenot aware of what we're even
doing because the switches areall turned off, but the people
who are around us are acutelyaware of what they see, feel and
are not doing right.
So for them it's a problem, butthe person who's under the
influence does not understand itas a problem at all Because,
(22:09):
remember, it is a thing they useto regulate their nervous
system, to find comfort.
David Liss (22:16):
I see Does that make sense.
Yes.
Marcia Bremenour (22:21):
As far as getting treatment goes, it's
critically important to takesomeone in who can offer a
description of what they'rewitnessing.
This takes a lot of bravery onthe part of the person with the
problem with drugs or alcoholobviously right A lot of courage
, Because this substance thatthey're using is kind of their
lifeline in their mind, you knowwhether they or not.
(22:45):
So they sit down, they do a fullblown assessment.
The person who's doing theassessment is going to ask all
kinds of questions, like Imentioned before biology,
psychology, environment, yoursocial life, what's going on
with your friends, with yourwork, with you know, with your
life, what is happening in allaspects of one's life.
(23:06):
A thorough assessment iscritically important to
determine the level of care.
So when care is determinedright, when you determine
whether or not someone meets thecriteria for addiction, the
lowest level of care is whereyou want to start.
That's typically the model thatwe follow, so the least
(23:29):
invasive level of care.
So these are education, right,individual therapy, baby AA
meetings, other sober supportmeetings.
There's narcotics anonymous.
There's, of course, alcoholanonymous, alcoholics anonymous.
So there's support systems outthere.
(23:50):
That may be a recommendation.
Typically, people try and thehigher level of care is more
common.
People try and the higher levelof care is more common.
That is an intensive outpatientprogram.
That's the next step up,commonly known as an IOP.
Typically intensive outpatientprogram is typically three hours
(24:11):
per session and that's three orfour days per week.
It's group therapy.
It includes education, itincludes group process checking
in, checking for behavioralchanges while introducing ideas
of addiction and recovery to theclient who's involved.
(24:31):
It's designed so they can keeptheir job if they have one, they
can stay in their livingenvironment least intrusive as
possible but hopefully workingin elements of recovery while
they're dealing with real lifeto give them the kind of support
they need.
(24:52):
If they fail at that level ofcare, then they'll be advanced
to a partial hospitalization.
Then they'll be advanced to apartial hospitalization.
Typically partialhospitalization is six hours a
day, usually from about 9 to 3pm, 9 am to 3 pm.
More intensive group therapy,more intensive individual
therapy, still going home atnight.
(25:13):
So you still want to maintainas much normal life, typical
life as possible with theintention of working recovery
into their lives.
If the person fails at thatlevel of care, then we move up
to an inpatient level of care,typically residential treatment.
(25:36):
Some days, some cases are onlymaybe a week or two weeks, but
typically 30 days is recommended.
And then of course, there'shigher levels of care, even
above and beyond that, wheresomebody will go away for six
months, maybe even more.
Step down to a halfway house,then step back down to PHP, iob,
(26:00):
individual therapy.
So you go up and then you godown.
One thing I left out at thetime of the assessment the
assessor will evaluate theperson for the need for a
medical detox.
So for alcohol it's usuallydepending on how much the person
is drinking they meet.
(26:21):
They need to be monitored forwithdrawal symptoms, which can
actually be pretty serioususually three to five, maybe
seven days in a really severecase.
But you really want to makesure that they're stabilized to
avoid seizures, dehydration,which can be really serious, and
so those are medically managed.
(26:42):
Other drugs are typically alittle bit shorter only because
there's nothing much that theycan do medically for the person
and they're not going toactually die from their
withdrawals.
They're just very likely torelapse from their withdrawals.
Yeah, very likely to relapsefrom the witch walls?
David Liss (27:00):
Yeah, what kind of a role do mental health
considerations play in addiction?
Marcia Bremenour (27:15):
And is that a separate or how does that
incorporate it into drugaddiction treatment?
Well, there's differentperspectives on this, different
philosophies, and it is case bycase.
Typically, mental healthdisorders and substance abuse
disorders go hand in hand.
In other words, it's hard tosay chicken or the egg kind of
(27:47):
thing.
It is absolutely believed thatone needs to be sober from their
substance use in order toactually get a valid diagnosis
mental health diagnosis, becauseso frequently substances mimic
and create, but can sort ofmimic, mental health disorders.
Alcohol is a depressant.
So if someone comes to me andthey don't tell me that they're
drinking alcohol every day butthey're very depressed, low
motivation, disinterest, butthey just leave out the parts.
(28:09):
They're getting drunk everynight, right, and they're using
a depressant every single day.
Well, there's no interventionthat we can suggest that's going
to counter the negative impactof the alcohol use.
The same is true for marijuanause.
If someone's 24, 25 years oldand they've been using marijuana
(28:32):
every day since they're 15 or16 years old and then they come
to me at 25, and don't tell methat they're using marijuana,
but they have this fear, anxiety, right, well, and then finally
they tell me they're usingmarijuana, I'm like, oh, that
makes sense, because I developedthe skill to deal with their
(28:53):
anxiety without the marijuanaand unfortunately it's a
short-term fix that creates abigger problem Using marijuana
to treat or using anything.
Frankly, if I gamble to relax,I'm going to become dependent on
gambling in order to relax andI'm going to undermine my
(29:15):
natural ability to relax withoutgambling.
David Liss (29:19):
Yeah, I mean it's ingrained.
I'm going to undermine mynatural ability to relax without
gambling.
Yeah, I mean it's ingrained inyour life and in how you
function.
Marcia Bremenour (29:27):
Absolutely.
It becomes a very real partintrinsically in your style of
living and once you develop thatrelationship, it's very
difficult to pull away from thatbecause it's part of what you
know and you believe, you knowand you know I've had people get
really angry with me when Isuggest that maybe their
(29:49):
marijuana use is a little bitproblematic, and I don't like
that.
I don't understand why theydon't.
I don't understand why theydon't like that that.
I understand why they don't.
I do understand why they don'tlike that.
But you know, and now we livein an age where the word
medicinal has been added to theword marijuana.
So when you present it that way, you know so well, it's
(30:10):
medicinal marijuana.
As if that changes.
And the same is true for Xanax,for example Highly addicting,
highly addictive medication thattakes years to get off of Again
.
David Liss (30:26):
I could talk for a very long time about all this
how can families and friendssupport someone who's struggling
with addiction and what roledoes community support play?
And sort of a tangent I've beenthinking about as we talk here
is, I think, that alcohol,marijuana, food, gambling, I
(30:47):
mean all these things that are aperson can have as a part of
their life, but not a, not anaddiction.
Like how do you regulateyourself when you're, if you're
going to smoke, marijuana ordrink and you're going to be
with people who have alcohol oraddiction problems of some kind?
Marcia Bremenour (31:13):
Yeah, you know , it does get very tricky,
because not everybody who usesmarijuana is addicted to
marijuana and not everybody whodrinks alcohol is addicted to
alcohol.
There's so many, like we talkedabout before.
I did give the three-prongedperspective bio, psycho, social
but each one of those prongsalso has so many unique nuances
(31:38):
that you know it's, and I knowthat when we talk about these
things, people often come awaythinking that I'm saying that
well, everyone who's doing thisis an alcoholic or a drug addict
, and that's just not the case.
There are, however, certaindrugs like heroin.
You use heroin one time right.
Drug dealers know this, by theway.
(31:59):
You use heroin one time, youare not necessarily going to
develop it.
You just use heroin one time,that's it right.
Go back for day two, you stillmight not develop a
physiological addiction to it.
So you go back for day threeand you absolutely are going to
(32:28):
develop at that point.
That is where the thing happensright, and drug dealers so
you're on the parking lot of thegas station and someone's like
you know and they and somehowthere's radar, people have radar
, they find each other and theygive you enough.
They give you a phone number,they give you enough for three
(32:51):
days, right, come back, see mein three days, right.
And then you go home and you doit for three days, you're
coming back and they know you'recoming back.
So the risk, when the otherreinforcers are not present, for
the person to say I don't needto do that, I feel good as I am,
(33:12):
I'm regulated, I'm comfortable,I'm comfortable enough or I'm
okay with being uncomfortable,right, if someone knows how to
be uncomfortable and then knowshow to move through that and fix
it, naturally there's certainlythe advantage.
David Liss (33:38):
But many, many people don't?
They have an awareness thatthis is just, you know it's
deadly or something, or how doyou ignore?
Marcia Bremenour (33:50):
I can speak that a little bit that what
happens with many, many, is theydo have periods of subribe,
especially with the powerfulopiates.
Right with fentanyriety,especially with the powerful
opiates, right With fentanyl,with heroin, especially with the
powerful opiates and thesesynthetic opiates that are
designed to get the bodydependent on it immediately.
(34:12):
Right, if someone gets awayfrom it for a while and then
they go back to it.
That is where the problemreally.
The likelihood of overdosing isso much greater because the
body is not acclimated to it,but the person thinks I can use
this much and they go back towhere they dropped off the last
(34:34):
time.
They are likely going tooverdose because of the intense
drug in their body.
David Liss (34:41):
So is it sort of the case that their effort at
sobriety makes the drug moredangerous for them when they go
back to it?
Marcia Bremenour (34:51):
Absolutely, absolutely.
That doesn't mean peopleshouldn't pursue sobriety,
obviously right.
But that really does create arisk when they and I'm not
saying people don't overdose,who are using every day, because
of course they do.
What I'm saying is that there'ssuch a challenge for people in
those stages where they'retrying to recover because
(35:13):
relapse it's so common, it's anatural part of recovery, right?
So addiction, the natural partof addiction.
So because it is so common andexpected and anticipated.
And the problem was that is thatpeople will say dolphin in
recovery communities you'll hearpeople say, well, treatment or
(35:36):
recovery is kind of a buzzkillbecause once you have it in your
brain, right, that that okay, Irecognize that drug use is not
good, it's destructive, it's.
I recognize what it's doing.
We have a little recovery goingon, going back and using the
idea of going back and using theidea of going back and using
(35:59):
the regulating effect that thethought of using had before.
You know that those momentsbefore you pick up and you're
like, oh, I'm so happy I'm goingto be doing this, that kind of
goes away.
That gets a little smaller.
So the positive impact of usingdissipates, but the craving to
use does not necessarilydissipate.
(36:21):
So the person often uses anyway, and then they feel even worse.
David Liss (36:25):
Cheryl, does that mean that when you talk about
returning to drugs, does thatmean that it's a failure, or
does it mean that you're sayingit's part of recovery?
Marcia Bremenour (36:38):
It's actually part of the process.
It's an accepted part of theprocess.
It's not an encouraged one, butit's an accepted one.
And it's kind of likemeditating right.
Meditation, as you probablyknow this, many people know this
meditation is not the practiceof staying focused, it's a
practice of coming back.
It's a practice of having afocus, noticing when you wander
(37:04):
off and coming back right Samewith recovery.
Without the shame attached.
So if you are meditating andyou wander off and you're like I
can't meditate, I keepwandering off, I can't do it,
well, no, that's a part of it.
So recovery is the sameprinciple would say I keep
wandering off, I can't do it,well, no, that's a part of it.
So recovery is the sameprinciple Just keep coming back,
(37:25):
keep coming back.
And in the rooms of AA andother 12-step recovery programs
you will hear that all the timeJust keep coming back, keep
coming back.
And many, many, many peoplekeep coming back.
So that is the good news Manypeople keep coming back.
David Liss (37:41):
So it is understood to be a struggle.
It's not going to be easy.
Marcia Bremenour (37:49):
And there's so much shame attached to the use.
That is back in the day, a longtime ago and I'm old enough now
to say back in the day it usedto be the intention of recovery
and treatment programs was toactually really kind of like
shame the person and shame theirbehavior and to beat down the
(38:11):
arrogance of addiction is thatarrogance is a byproduct of a
lack of self-esteem, ofinsecurity.
Nobody is arrogant without anunderlying insecurity.
And so with recovery in myexperience which is why I have
(38:33):
focused so much of my attentionon recovery and supportive,
holistic recovery is to actuallyfeed self-esteem with self-care
and self-compassion and comingto understand one's nervous
system and how their body, howour bodies respond, how we're
talking to ourselves and thevalue of breathing, like just
(38:54):
like what happens when weactually take three deep breaths
and we reinforce to our bodiesthat we're actually okay.
When we go through life scared,we're sending messages to our
(39:16):
body that there's a fire in thekitchen is really a healthy,
supportive way of sort ofoffsetting the drive toward
addiction.
But it takes a lot of work,obviously, and to interrupt that
cycle of wanting the quick sixright right and not caring about
(39:42):
ourselves and not feelingguilty about the pain that we've
caused people who love us.
You know, as a byproduct of ouraddiction, you know, hurting
ourselves, hurting other people.
There's so much self-loathingthat goes with addiction that
the idea of introducingself-care and self-love is
almost like, so foreign topeople.
So really teaching that in away that is supportive, but not
(40:05):
coddling, because these people,often people, will come to
recovery.
I say these people, people whoare struggling with addiction,
are often coddling their ownemotional discomfort and, as a
byproduct of that, underminingtheir self-confidence, which
(40:25):
undermines their self-love,which undermines their ability
to access recovery.
David Liss (40:30):
That's a lot.
How has the rise of fentanylimpacted efforts to reduce
overdose deaths?
Fentanyl impacted efforts toreduce overdose deaths and what
is the impact of fentanyl?
Marcia Bremenour (40:50):
Well, my experience with all the
synthetic drugs, and fentanyl inparticular.
It is so fast acting and it isso available and it's insidious
because it's being interwoveninto other drugs.
People are using, you know,recreational cocaine, which I'm
not promoting at all, but youknow, maybe I should say pot,
and maybe it's someone who goesto a club once a month and when
they do that, they experimentwith cocaine and they've been
(41:13):
doing that for a very long timeand nothing's going to happen.
I'm not promoting thatwhatsoever, I'm just saying
there are people who do thatkind of thing.
And that person gets a hold ofsome cocaine that has fentanyl
in it and, all of a sudden,their ease, are addicted to it,
right, they're addicted to thefentanyl, or it kills them, they
overdose on it, it makes themsick, right.
(41:33):
So it's just.
And it's such a powerful drugand, like I said, it's so easily
accessed now, it is so highlyand broadly manufactured and
distributed.
And, you know, fighting that,fighting society that is
globally, that is really leaningtoward feeling good, fast,
(41:55):
right, like what's easy, whatmakes me feel good, what makes
me look good, what makeswhatever, what makes life easy?
And it's a ruse, you know.
But I think that those thingsall make us far more susceptible
(42:18):
to doing things that aredangerous and ignoring things
that are actually good for us.
David Liss (42:24):
Yeah, I mean I can think about, like how I eat.
I go to a vending machine andget a thing of cookies, as
opposed to looking for a fruitor a vegetable somewhere.
It's the easiest thing to find.
Right right, so you shouldn'tnecessarily look at it that
people are intentionally tryingto kill themselves.
It's with fentanyl.
It just is a byproduct of howit's included in different drugs
(42:47):
.
Marcia Bremenour (42:47):
My experience with people who use advanced,
different advanced drugs.
You know different syntheticdrugs and there's a lot of them
out there, right, they're veryavailable and very few people
are intentionally trying todestroy their lives, right, At
least not in the beginning.
(43:08):
Most people are just comfortseeking, and then sometimes that
comfort, the way they'reseeking that comfort is to just
drug, basically drug themselves,remove themselves from the
situation.
David Liss (43:22):
So they're not.
Marcia Bremenour (43:24):
And so that that piece of it is a challenge,
because intercepting theirself-esteem is where recovery
comes in.
But they're doing, they'rebehaving and they're
participating in behaviors thatthe rest of the world, if you
will, are so judgmental about.
You know it's hard, it is achallenge to intercept it and
(43:47):
you know you asked earlier, dave, what can family members do,
and what I would say to that is,first and foremost, do your job
of just loving the person, justlove the person job of just
loving the person, just love theperson, independent of what
they're doing, and then holdthem to some standard of
self-care, you know, and try todo what you can to support that
(44:12):
and and that is about all youcan do, whatever that means to
you.
Helping them access therapy, ifpossible, certainly is a goal.
Al-anon, codependent Anonymousboth excellent resources for
family members.
There's a series of books by anauthor and they've been around
(44:33):
forever Melody Beatty andCodependent Bill Moore, beyond
Codependency are the two thatcome to mind.
That are the first two that shewrote.
They've been around forever,but I tell you what?
The philosophy, the message istimeless, you know, and lots and
lots of families who are tryingto support people in recovery
(44:55):
have benefited greatly fromthose kinds of resources.
David Liss (44:58):
What are the barriers that keep people that
are suffering from addictionfrom accessing treatment?
Marcia Bremenour (45:06):
I think financially first of all, right,
not having the finances.
Treatment can be very expensive, you know, and more expensive
treatment is not always bettertreatment.
So, keeping that in mind, Ithink finding motivated people
who are motivated in recovery ahuge part of it.
(45:27):
And I'm not pushing a 12-steprecovery program, but I am going
to tell you that the 12 stepsof recovery are really, if you
read them, just a healthy way ofliving, and many people get
caught up in the religious pieceof it and you can easily take
the word God out and justreplace it with nature, sunshine
(45:48):
, whatever.
But it's just a really healthyway of living in that just
acknowledging that you can'tcontrol everything there's
things you can control, there'sthings you can't and recognizing
the difference, for one thing,being present and being mindful,
(46:09):
that's one day at a time isessentially mindfulness, which,
of course, has been around sincedirt.
David Liss (46:15):
But we've decided, we've just invented it, I think.
Marcia Bremenour (46:17):
And AA is free , no-transcript.
(46:52):
The addiction, the unhealthyrelationship with the drugs or
alcohol, is really an integralpart, and so, to answer your
question, you know what are thebarriers.
The main barrier is a lack offragile protection, if you will.
You know that thing that keepsyou from going back out there.
In the recovering communitythere's a saying people, places
(47:14):
and things.
So in recovery, especiallyearly in recovery, you want to
stay away from people you used,with, places you used and things
that remind you of using.
So for some people they can'tgo to the same grocery store
they once shopped at becausethat's where they bought their
beer, for example.
(47:35):
Or if they are at the grocerystore and they only have one
that they can go to, they can'tgo down the aisle where the beer
is sold.
For example, cigarette smokersare strongly encouraged not to
go into a store like a gasstation where they sell
cigarettes behind the counter,because they're likely to buy a
pack and, if they're trying toquit, probably not going to be
(47:55):
able to.
The brain does a thing and itjust goes.
So sober people, sober placesand sober things are critically
important hedges of protectionthat separate the person from
their choice while they developthose behaviors and those
activities and those skills thatgive them the ability to
(48:19):
regulate their nervous system.
That reminds them safely thatthere's not a fire in the
kitchen.
Right, there's no fire in thekitchen.
You're okay, which is wherebreathing comes in, and
grounding and understanding yourpolyvagal nervous system and
understanding all the thingsthat go on inside our bodies
that make us tick, basically.
(48:39):
So that's more advancedrecovery stuff, but it's there.
David Liss (48:45):
It's good to know what role should harm reduction
strategies like naloxone, excessor safe injection sites play.
Marcia Bremenour (48:58):
Well, there are medications that people use
to curb cravings right, that can.
If you drink, for example, youget sick if you're on certain
medications.
There's nothing wrong with ifthose serve as barriers to like
a hedge of protection.
If they serve as barriers tousing in a way that is
(49:20):
destructive and they give theperson an opportunity to
practice those things that helpthem calm their nervous system,
naturally, to promote recovery,then they're useful.
If they turn into a dependence,which happens sometimes, then
that becomes problematic becausenothing's changed.
(49:41):
They're just using a differentway to get to do the same
participate in the addictivebehavior.
Does that make sense?
David Liss (49:51):
Yeah, yeah, it's sort of a limiting or enabling
kind of thing.
Marcia Bremenour (49:57):
Absolutely.
It's not promoting recovery,it's just shifting the damage.
It's the same behavior, you know, just with that different
substance less damagingsubstance potentially, but if
without recovery, the person isfar more likely to go back to
(50:19):
addictive behaviors.
And speaking of it's really youasked before about mental health
issues.
And so people experience traumaright in their early life or
something that they experienceis traumatic, and the way our
brain functions with traumastore that in this place in our
(50:41):
brain, right.
We take it away there, it'sright there and it's tucked in
there and nothing can get to it,and then we have this
well-resourced part of our brainthat helps us get through the
day.
And so the problem with this,with addiction, is, once you
take away the drug that theperson is using to cloud their
access to all the parts of theirbrain and their memories, some
(51:04):
of those memories start to comeup right.
So when that happens, if thatperson doesn't have ample
support around staying sober,they're far more likely to be
re-traumatized by memories, andthat shame they around, you know
.
And so that I just want tothrow that in because I think
(51:24):
it's a really important part totake into consideration when it
comes to recovery.
David Liss (51:31):
Yeah, and along the lines of what you just mentioned
, could you speak a little bitmore about stigma and shame and
addiction recovery and theirimpact on recovery?
Marcia Bremenour (51:45):
Well, I think that sure, I absolutely can.
So many people see drug use asa choice and absolutely there
are elements that are of theperson's choosing.
They're choosing to do thething for sure and certainly at
(52:06):
first glance that's absolutelywhat it looks like, triggered.
If you understand that, you'llrecognize that once that ball is
set in motion they're justgoing to use.
If there's not barriers,they're going to use.
(52:27):
And it's not because they'restupid, it's certainly not
because they're weak, it's notbecause they're incapable of
something, it's just becausethey're caught up in this
cyclical relationship with thischemical that is driving them to
do these things.
And the barriers, for whateverreason, are not in place yet
(52:49):
that help them to stop doingthat behavior.
So I think the shame part of itactually just contributes.
It's like, well, screw it.
Everyone thinks I'm this anyway, I'm just going to go do it.
Who cares Right?
So, yeah, there's nothinghelpful.
Addiction is definitely ashame-based disease, if you will
, and it is identified as adisease because, amongst other
(53:13):
things, it's symptom-driven,it's progressive, it's fatal and
it's chronic.
So those are by definition adisease.
Are those things?
So I don't get into those kindsof debates with people.
I don't care if someone callsit a disease or not.
Frankly, it doesn't matter tome if they do or if they don't.
You know, what matters to me isthe actual mechanics of the
(53:34):
behavior and it's person byperson.
Everybody's different, you know.
So I'd have to sit with theperson, see what's going on with
them, find the similaritiesamongst other people who
struggle with addiction, so wecan kind of help, like navigate
where they need to be, and thenreally dig into the subtle
nuances that make theirsituation unique to them in a
(53:56):
way, not this terminaluniqueness that keeps them
separate, but the kind ofuniqueness that recognizes them
as a person, separate from theiraddictive behaviors.
David Liss (54:07):
Going from there.
What are some success storiesthat give hope from your
experience to those fightingaddiction today, and are there
people that you've worked withthat bring you some optimism?
Marcia Bremenour (54:21):
Well, I have lots of success stories.
Lots of people that I've workedwith over the years, who I stay
in touch with, still send mepeople from the recovering
community who have just reallystuck with it, kept going to
meetings, kept doing things totake care of themselves, kept
surrounding themselves as muchas they can with people who
(54:43):
support their recovery, and Iwitnessed it.
I continue to witness it.
There are people who do reallyreally care about staying sober
and they want to stay sober, andwhat I see the most is there's
an underlying inability toregulate their nervous system,
(55:06):
and when we introduce tools andskills to regulate, it's a game
changer.
So, you know, I practice EMDRwith clients, which is I move
into sensitization andreprocessing.
I practice a neurofeedback, anonlinear style of neurofeedback
(55:27):
which helps with brain trainingand helps with relaxation.
I promote yoga and just generalexercise, just stretching, like
paying attention to your bodyand taking care of it
differently than you did before,and those things that is where
the holistic part of my approachcomes in Like those things all
(55:49):
contribute to well-being fromthe inside out, which is exactly
what we need to get to, becauseonce you do that, those aren't
cures for addiction.
Once you do that those aren'tcures for addiction but as they
stabilize, they allow the personto actively stabilize from the
inside out and take ownership ofthat Like it's actually theirs,
(56:12):
because it's their body they'redealing with, right?
Yeah, I think that comes fromthat, and the ability to
self-regulate eliminatesessentially, or certainly
distinguishes, cravings in manycases and for sure allows them
that person to access supportsystems that serve as that hedge
(56:35):
of protection I talked aboutbefore.
David Liss (56:38):
What message of hope and empowerment would you offer
to anyone that's fighting theirown battle against addiction?
Marcia Bremenour (56:45):
If I summed it up in a couple of words, I
would really say self-compassion, be nice to you, give yourself
oxygen like breathe.
The whole idea of three deepbreaths.
You know you think about thefire in the kitchen, right idea
of three deep breaths.
You know you think about thefire in the kitchen, right, you
take three deep breaths thefirst deep breath shows an
(57:09):
intention that you're say oh,I'm, I'm doing this, I I must be
okay, I'm not gonna stop andtake a deep breath.
There's fire in the kitchen,right.
So first deep breath is theintention is of self-care.
The second deep breath allowsthe body to be more present,
(57:30):
more aware, mindful, right, likewhen you take the second deep
breath, you're like oh, then youkind of feel your shoulders
drop down a little bit, you'refeeling your feet on the floor.
The third deep breath, becauseyou've done the first two, the
third deep breath does thisreally magical thing of opening
up your circulation.
Right, that's what happens whenwe breathe we dilate our
(57:51):
circulation, we get everythingmoving and it feels really,
really good.
So if somebody can givethemselves the gift of just
doing those three things, theycan feel better.
Right, they can feel better, atleast for the 30, 20, 30
seconds it takes to do that.
If they could just get aninkling of what it feels like to
(58:12):
feel better.
That's something to build on,you know, with the support of
therapy and loving people aroundthem and all of the things.
But so I say breathe and itfeels flippant.
You know, you read memes or yousee something on social media
that's like just breathe, likemy mom says, just breathe.
Right.
(58:33):
But when it comes down tositting with a person and doing
this exercise and watching themexperience things, and then what
that feels like when they gooutside in the sun and they
stretch a little bit, when theyrecognize the value in
stretching for their nervoussystem and they start to
(58:54):
understand themselves just alittle bit better, those acts of
self-compassion make such ahuge difference in the overall
impact of their well-being.
It's not the end-all be-all byany stretch, but it's an
integral part of a foundationtoward wellness, right?
If you focus on wellness,whatever pathology you
(59:18):
experience or whatever you wantto call it kind of goes to the
background, Right.
And then it's kind of behindyou, it's in your rear view
mirror rather than in front ofyou.
David Liss (59:29):
Oh, that's great.
Sometimes, simplest things arethe best things.
Yes, absolutely we don't haveto overcomplicate our lives
sometimes.
Marcia Bremenour (59:40):
Right, right, right, right, right, right,
right, right, right.
So, to answer your question, Isee lots of people with
miraculous moments, moments.
It's the men who get moremoments.
David Liss (59:51):
Thank you, Marcia Bremenour, for being here today
and for this conversation.
To learn more about recovery,please visit www.
b remenou.
com that's M-B-R-E-M-E-N-O-U-R.
com.
And thank you for joining usfor Wellness Musketeers.
(01:00:16):
Tune in for our upcomingepisodes to learn how to live
with a greater understanding ofthe world we experience together
.
Please subscribe, give us afive-star review and share this
recording with your family andfriends.
Let us know what you need tolearn to help you live your best
life.
Send your questions and ideasfor future episodes to Dave Liss
(01:00:38):
at davidmliss@gmail.
com.
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