Treatment for alcohol and other drug addiction comes in many different varieties. So what are your best options when you or your loved one need help? Addiction recovery expert Christopher Yadron, PhD, joins host William C. Moyers to discuss today’s most-effective addiction treatment programs, including: specific treatment modalities for opioid, alcohol and meth addiction, important mental health considerations, group therapy and other therapeutic approaches, relapse prevention and long-term recovery support. 0:00:15 William Moyers Hello! And welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues that matter to us and the issues that we know matter to you as well. Substance use disorder, prevention, research, treatment and recovery support. I'm your host, William Moyers, and today we're on the road here at the Betty Ford Center in Rancho Mirage, California, where we're joined by Chris Yadron. Chris is the Vice President of the West Region. You are the Administrator of the Betty Ford Center. Welcome Chris. 0:00:47 Dr. Christopher Yadron Thank you very much. I'm glad to be here. 0:00:49 William Moyers Glad you're with us today. To talk about an issue that I know that you and I and many others on our organization get all the time. The issue of finding the right treatment program. How do people go about finding the right treatment program for a substance use disorder? 0:01:05 Dr. Christopher Yadron Right well I think how they actually go about it is they often do a web search. And then when they do so, there are over 14,000 different treatment centers in the United States and so it can be very difficult to choose. So I think there's some important things to take a look at or factors to consider when one is seeking treatment for themselves or for a loved one. Is it a licensed facility? Do they practice by ethical standards? And do they offer a complete continuum of care? That meets people at their most critical moments physically, psychologically, in the throes of addiction. But then supports them and offers support in a long-lasting way. 0:01:45 William Moyers So we know that a drug is a drug is a drug, but we know that drugs interact differently. But a treatment program is not a treatment program is not a treatment program, right? You need to find a program that matches the needs of your loved one or yourself. 0:01:57 Dr. Christopher Yadron Absolutely. Every person has unique and individualized needs, you're right. A drug is a drug. And yet we all experience the chaos and the effects of addiction in a slightly different way. Perhaps depending on our age or our community. The number of resources we have available to us in terms of support within that community. So I think it's very important to research treatment centers thoroughly and effectively probably most important is to take that first step and reach out for help. That's one of the hardest things people face is actually making that first call. A few years back, the Surgeon General released a report and the report said that maybe 1 or 2 out of 10 people in this country who need treatment get treatment. So one of the toughest things is for people to access treatment in the first place. So I'm glad we're talking about this today. 0:02:53 William Moyers But people put in to a Google or another search engine 'rehab' or 'drug addiction treatment facility' and so on, and they may get a lot of information but you just can't go off of that information, you need to make that phone call, right? 0:03:08 Dr. Christopher Yadron You need to make the phone call. I would call a trusted resource. Whether it's the Hazelden Betty Ford Foundation or anyone else who's accredited and licensed appropriately. I think more and more and again as a Foundation, we offer training for medical students or professionals. Medical professionals and residents on how to assess and intervene upon individuals struggling with addiction. So, one's primary care physician is often times a resource. There are a number of different reputable resources or ways to access treatment. Certainly I believe in the work that we do here at Hazelden Betty Ford because it offers that complete continuum of support for individuals seeking recovery. 0:03:54 William Moyers But of course we also know that so many people now are accessing or accessing treatment through their insurance, so it's not just a question of finding the place you wanna go to, you have to find a facility that's not only medically or clinically appropriate for you or your loved one, you have to find one that is recognized by your insurance company. Can you describe that process? 0:04:12 Dr. Christopher Yadron Yeah, absolutely. You—a person wants is gonna wanna seek treatment where the costs of treatment are transparent. I also think that's an ethical issue that's important. At the Hazelden Betty Ford Foundation, it's been our goal to serve more and more people as the problem of addiction continues to grow in this country. We wanna provide better access to individuals. And so, over the last five years or so, we've really transformed our model where we're serving individuals primarily over 90 percent of the time are accessing their insurance benefits. So contacting your insurance carrier's another way to sort out what—what's involved with that process. If you were to call the Hazelden Betty Ford Foundation, the first person that you would speak to here in our access department would help you work through some of those questions related both to finances but also whether or not you're appropriate for care here at the Hazelden Betty Ford Foundation. 0:05:11 William Moyers Right. Right and in fact, we know there are many pathways to recovery. More so perhaps than in—than in any other time in our history. Which means there are many pathways to a treatment center, there are many different types of treatment centers. What are some of the different ways that people can get treatment? 0:05:27 Dr. Christopher Yadron So when you talk about different pathways, I—I think of some individuals who simply engage the Twelve Step community which has been present for 80 plus years and helped countless individuals find recovery. But sometimes especially with the potency of drugs today, even beyond certainly beyond alcohol and alcohol's probably still one of the major substances of use that people come for treatment for. But given the potency of—of many substances today, people need extra help. They need extra support beyond that. And so that's a good reason to access a—a viable and a qualified treatment center. 0:06:05 William Moyers There are many people who are turned off by the Twelve Steps. I mean that's been hanging on the wall of all of our facilities for 70 years now and that's a pathway that's worked for many millions of people. But there are people who say that that's probably not for them because it's either a religious program or it's too spiritual for them. What would be your counsel to people who are sort of turned off by the Twelve Steps? 0:06:28 Dr. Christopher Yadron Well again, that's a great question. I think a number of people present at times with barriers to accessing Twelve Step communities— 0:06:35 William Moyers Yes. 0:06:37 Dr. Christopher Yadron Or Twelve Step support. If it were to be characterized as a religion I'd say that is a real problem. Because if it's regarded as a religion or treated as such, that's contrary to the values of the program. And probably very, very unhelpful to the process of recovery. I might describe it as a—a program for spiritual transformation— 0:06:59 William Moyers Mmm. 0:06:59 Dr. Christopher Yadron —That's probably a more helpful way and a more inclusive way to think about the Twelve Steps. And I also think it's one part or one aspect of the experience. Today we use Medication-assisted Treatment— 0:07:11 William Moyers Yes. 0:07:12 Dr. Christopher Yadron We use other evidence-based therapies such as motivational interviewing or dialectical behavioral therapy. A whole variety of modalities that are evidence-based, research-based, to help people recover in addition to the Twelve Steps. It's a disease—it's a chronic disease that impacts a person's mind, and their body, and their relationships and their spirituality as a person. So we need to use all the resources possible to help people heal. 0:07:41 William Moyers I often times remind people who contact me asking for guidance on how to access treatment with us or somewhere else, I often remind them that treatment is not the end, it's just the beginning. 0:07:52 Dr. Christopher Yadron Absolutely. Yeah. 0:07:53 William Moyers Of a process. And that there is no cure for addiction at least not in a way most people expect, but there is a solution. And so it is really about disease management, right? Chronic disease management. 0:08:01 Dr. Christopher Yadron It really is. For years in this country, we've treated a chronic problem as an acute issue. 0:08:07 William Moyers Yes. Yes. [nodding] 0:08:08 Dr. Christopher Yadron In my own experience, when I first got into this field of mental health in general but then addiction specifically, I used to work in a hospital emergency room. On the South Side of Chicago. 0:08:20 William Moyers Hmm. 0:08:20 Dr. Christopher Yadron And I was a Crisis Counselor there. And I would see people with psychiatric complaints but in particular substance use disorders enter the emergency room and then be pushed off to the side and just placed on a cot or a gurney in the hallway until they could sober up and then be pushed back out to the street. And the staff would refer to these individuals as frequent flyers because they'd come in and out, it was a revolving door. In which people really didn't get the help that they need. And so we absolutely need to treat this as a chronic problem and address not just the body, but the mind and the spirit. And allow someone or give someone the best opportunity for lasting recovery by providing resources to extend that over time. Recovery doesn't just happen in a single moment or in a single day, but over weeks and months and years of restoring the body, building relationships, moving out of isolation in the community— 0:09:20 William Moyers Mmm-hmm. [nodding] 0:09:20 Dr. Christopher Yadron In relationship with one another. Developing a spiritual program that's not religious in nature per se, by any means, but impacts the human spirit. In terms of how we create meaning and purpose as human beings in our lives. 0:09:36 William Moyers I often talk about the fact that it's easy to stop using, it's hard to stay stopped. And stay stopped is about being—getting those tools in treatment then learning how to use those tools in the real world. So really when somebody is accessing treatment, they should expect they're gonna get more than just a way to stop using but how to stay stopped. 0:09:55 Dr. Christopher Yadron I think that's a great point. And if I were calling for myself or for a loved one, I would ask what resources exist beyond the initial stages of treatment? 0:10:05 William Moyers Mmm-hmm. 0:10:05 Dr. Christopher Yadron Are their web-based programs of support? Are there recovery coaches that I can stay connected to over time? How do you help me get reconnected back into my community? Or develop other resources once I return? What are your attitudes or beliefs about the use of Medication-assisted Therapy or treatments? In order to provide a floor or a resource to individuals who are trying to put together the psycho-social aspects of long-term abstinence and sobriety. There are a lot of great questions that can be asked at the beginning of the process to make sure that you or your loved one get the care that they need. 0:10:45 William Moyers And what about community-based treatment? We know that you know often times many of our patients will travel to come to treatment here at the Betty Ford Center or in Minnesota or where else—Oregon—where else we have facilities. But not everybody can get on an airplane or travel to treatment. Talk about the role of community-based treatment in this country. 0:11:05 Dr. Christopher Yadron Sure. I think that's an important issue. And the reason why I believe it's important is because addiction impacts every part of our lives. It's not just our bodies. It's our relationships, it's our minds, right? As we've been saying. So if I'm gonna get well, or if I'm gonna stop using, as you just described, but to be able to stay stopped— 0:11:23 William Moyers Right. 0:11:23 Dr. Christopher Yadron Or sustain that recovery, I need to figure out how to reintegrate into my community working or get back to work, live with my family, develop those community resources. So whether that's a Twelve Step community or whether that's online and Internet-based support so that I can get the tools that I need and the knowledge that I need, it's really important to build resources. And I would just say it's especially important to build resources in terms of one's community. One of the things that we promote as well as we help people move toward the process of discharge from those early stages of treatment— 0:11:58 William Moyers Mmm-hmm. 0:11:59 Dr. Christopher Yadron Is help them connect with a primary medical care provider or a counselor in their community of origin. 0:12:06 William Moyers Therapist—[nodding] 0:12:08 Dr. Christopher Yadron A therapist. Twelve Step community or other support group resources. Similar but perhaps even different than Twelve Steps to help them build those relationships that are so vital to their long-term recovery. 0:12:22 William Moyers And of course a lot of people who are looking at treatment options wanna know does it work? So what's the role of outcomes in that consideration and the transparency of outcomes? 0:12:35 Dr. Christopher Yadron I also think it's important to be asking about outcomes. Many people have this perception that addiction and addiction treatment centers are simply revolving doors. Like the emergency room that I described earlier in our conversation. I'm really proud of the work that we do here. As we treat patients, we ask for their permission to follow them and contact them. To follow them in terms of outreach. So that we can learn more about our outcomes. We call patients at one and three and six and nine-month intervals and beyond. At nine months, we've found that about 70 percent of our patients are have been free, have been—have practiced continuous sobriety from using alcohol. What we find at the nine-month mark is that 80 percent of our patients report a very high quality of life and quality of health. And we use survey questions from the World Health Organization survey that's very—very well thought of. About 90 percent of our patients at that nine-month mark report to be free of all other drugs separate from alcohol. 0:13:44 William Moyers Mmm-hmm. 0:13:44 Dr. Christopher Yadron And I'm proud of those statistics because this is a tough disease. I mean it's a chronic illness, there's tremendous stigma attached to it. The people who face this disease are incredibly courageous. They're the most courageous people I know. And it's tough work to get well. And the vast majority of our patients who engage treatment do get well. 0:14:05 William Moyers And what's your message to those who might have relapsed? They've been through treatment and they've relapsed and now they're looking for a program now knowing that they've had a relapse. What's your encouragement for them? 0:14:17 Dr. Christopher Yadron Yeah it first off, I don't even necessarily and perhaps this is me—I don't know if I even like the word relapse. 0:14:23 William Moyers I hate the word relapse, actually. Thank you. 0:14:24 Dr. Christopher Yadron Yeah because it has—[chuckles]—it has a connotation of— 0:14:28 William Moyers Negative. 0:14:29 Dr. Christopher Yadron I've done something wrong. 0:14:30 William Moyers Right. 0:14:30 Dr. Christopher Yadron This isn't about being right or wrong or good or bad. And I think even the term relapse ends up being stigmatizing for our patients. 0:14:37 William Moyers Absolutely. 0:14:38 Dr. Christopher Yadron It's a recurrence of a chronic disease process. And so, recognize that it's a chronic illness that hope and health and healing are available and ask for help, reach out and ask your medical physician, your counselor, Hazelden Betty Ford, or another accredited and licensed treatment provider for the help that you need. 0:15:00 William Moyers Mmm-hmm. As that was rolling off of my tongue, I was realizing I was using the wrong word. I like to use the term recurrence of use. Because relapse does, I mean that's what it is but in terms of how people understand it, but it has a negative connotation. And there's a lot of shame and stigma around that term. 0:15:16 Dr. Christopher Yadron I—I was gonna say the very same thing in terms of shame. 0:15:18 William Moyers Yeah. 0:15:19 Dr. Christopher Yadron I think one of the biggest barriers for entering treatment and then successful outcomes from treatment is internalized shame. 0:15:27 William Moyers Mmm-hmm. 0:15:28 Dr. Christopher Yadron And internalized shame represents the attitudes of our society and our culture. That something—that a person struggling with a substance use disorder is somehow morally deficient. Or they just don't simply want to be well. Or they're not trying hard enough. And I think that's an incredibly unfair and maligning characterization of individuals suffering from this disease. And so, shame is a big—is a big factor that gets in the way. And so in the language that we use, in the treatment that we offer, we wanna try to do everything we can to minimize and eliminate shame. So that people can access treatment and then engage in treatment and the treatment process on a long-term basis. And also help their families and their children and their support network also to do business with that shame and that stigma. So that the whole family can heal and that—that person can have the best chance for recovery. 0:16:23 William Moyers Well and you just touched on something and we need to wrap it up here but I think it's a good way to close which is that when somebody's considering options for treatment, they should be considering it not only for themselves or for the sick person, but for the entire family. All treatment programs should have a family or children's program, correct? 0:16:39 Dr. Christopher Yadron I couldn't agree more. I think that's an important factor, right? If we do more than just give lip service to the idea that this a family disease, then we need to treat the problem as a family problem or as a family issue I should say and offer solutions as such. So I'm really proud of the work that we do with our Children's Program. It's really a child-centered family program— 0:17:01 William Moyers Right. Right. 0:17:02 Dr. Christopher Yadron —That helps individuals with children 7 to 11 or 7 to 12 work through the way addiction has affected them as a family. 0:17:10 William Moyers Mmm-hmm. 0:17:10 DR. Dr. Christopher Yadron But regardless of where you go for treatment, I would ask or I would investigate what other types of resources exist for the family for the children. How do you help us reconnect in our community once treatment, or the primary stage of treatment has completed, what does that process look like in terms of what we call recovery management? Another thing that I think is important is to consider are there alumni from the program that I can connect with? That's another important feature of the work that we do here. We have alumni chapters around the world. Addiction drives us into solitude, and loneliness and isolation, right? 0:17:50 William Moyers Yes. [nodding] 0:17:50 Dr. Christopher Yadron So part of the solution is really rebuilding community and healthy relationship. So whether that's with my family or my children or with other sober individuals in my community, those are the important ways that people heal. 0:18:03 William Moyers Chris Yadron, the Administrator here at the Betty Ford Center Rancho Mirage and our Vice President of the Western Region, thank you for joining us today and sharing your experience with our viewers and our listeners. We'll have you on again another time! 0:18:15 Dr. Christopher Yadron Thank you, William. 0:18:16 William Moyers And thank you all for joining us for another edition of Let's Talk. I'm your host, William Moyers, we'll be back again with another edition of Let's Talk. Talking about the subjects that matter to you and to us. Thank you.