What's the Difference between Sobriety and Recovery

0:00:14 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 disorders, prevention, research, treatment and recovery support. I'm your host, William Moyers, and today we come to you from on the road at the Betty Ford Center here in Rancho Mirage, California. The home office if you will of my guest and colleague, Joseph Skrajewski. Joseph, welcome.

0:00:44 Joseph Skrajewski
Thank you so much, William. Pleasure to be here.

0:00:46 William Moyers
The Executive Director of our Medical and Professional Education Programs. Tell me your personal experience why are you so passionate about this subject?

0:00:54 Joseph Skrajewski
I view medical and professional education as the future and impacting and influencing health care professionals. Whether they be students or active practitioners, I know they're gonna help countless individuals—

0:01:06 William Moyers
Yes.

0:01:06 Joseph Skrajewski
—Over the next 20,30,40,50 years. So I think our outreach, our impact is huge and that's why I've decided to dedicate my life to it.

0:01:13 William Moyers
And of course medical and professional clients or patients of Hazelden Betty Ford are as interested in outcomes as anybody else who comes to treatment at Hazelden Betty Ford. 'Cause they wanna know whether or not they can find recovery and what recovery looks like. You know today we wanted to talk to you about the difference between sobriety, which ultimately is a goal, right? Of people who use substances. And the difference between sobriety and recovery. Can you talk about that?

0:01:43 Joseph Skrajewski
Absolutely. So I work with lots of professionals and one of the first questions I receive every time I'm with them is what is your success rate.

0:01:51 William Moyers
Yes.

0:01:52 Joseph Skrajewski
You know, what are your outcomes. And I really want them to dial that down a bit. I want them to really think about that question and what they're asking. Because if you walked out of here today and call ten different treatment facilities in the state of California—

0:02:04 William Moyers
Mmm-hmm.

0:02:05 Joseph Skrajewski
And ask them what is your success rate, eight of those ten are gonna quote a number to you immediately. I urge my professionals to challenge those numbers. And I'll give ya an example. You take all of the patients at any of our sites and once they discharge from treatment and go back home or wherever they're going to, they get phone calls from our alumni counselors, from our case managers, asking them how they're doing. And typically when we ask them how they're doing, we say you know are you abstinent? Are you going to meetings? Have you got a sponsor? Do you have a home group? How's work going? How's your life going with your family? And they tell us about their lives. The moment that they tell us that they're abstinent, that they're not drinking or using, and we go and check a box to say that they are in fact abstinent, any reliable research institution will come on in and say, 'Oh no, Hazelden Betty Ford, you can't believe them at their word! What you need to do is hop on a plane—

0:03:02 William Moyers
Ohh. [groans]

0:03:03 Joseph Skrajewski
—And fly to Chicago, or Orlando, or Boston, or New York, or Minnesota show up unannounced, take a urine sample from them, test the urine, if it does in fact come back without any substances, then you can go ahead and check that box.' And I just don't think that's realistic. I know it's not practical. I know it would be very expensive. So let me even take it a step further. People always say to me well like how do you define success?

0:03:27 William Moyers
Right.

0:03:28 Joseph Skrajewski
In a treatment environment. So take the same situation, take a patient that does three, four weeks in inpatient residential treatment, does a little bit of day treatment, some outpatient, goes back home, gets a job, gets a sponsor, has a home group, starts responding well, family's rallying around them. Let's say nine months after discharge they take a drink. They feel some remorse regarding that drink, they call their sponsor, they tell on themself [sic], they don't bury that as a secret. They don't spiral out of control. They don't go on a major run. They don't get a DUI. They get right back into a Twelve Step environment. I view that as a success.

0:04:08 William Moyers
Right. [slightly inaudible]

0:04:08 Joseph Skrajewski
That person doesn't need to go back into an inpatient residential treatment. They learn something through the treatment experience and they're living life.

0:04:15 William Moyers
They're committed to recovery! Even though—yeah, yeah.

0:04:16 Joseph Skrajewski
Committed to recovery. And I feel like that's the practical sensible approach we need to take. We can't just bang our hands on a table here and say 'You drank!' Or 'You used!' And shame on you and wag our finger we can't do—

0:04:28 William Moyers
Start over!

0:04:29 Joseph Skrajewski
Start over! I mean people learn things in treatment all the time.

0:04:32 William Moyers
Yes.

0:04:33 Joseph Skrajewski
They learn about the Twelve Steps, they learn about spirituality, they learn that they're not alone—

0:04:37 William Moyers
Mmm-hmm.

0:04:38 Joseph Skrajewski
They're surrounded by other people sharing instances about themselves, sharing life experiences, and realizing that they connect to these other individuals who are successful as well, who are like them, and who want a better outcome for themselves and their future. So I—I think it's very important when we define things like the word recovery, we look back to some of our lived experiences—

0:04:59 William Moyers
Right.

0:04:59 Joseph Skrajewski
We look to some of our colleagues. You have—2006, we had the creation of the Betty Ford Institute, and we had a Symposium whereby we brought industry leaders and professionals. Bob Dupont, Mark Gold, Tom McClellan, Keith Humphries, I mean a lot of people that were really profound and well-known in our field.

0:05:15 William Moyers
Yes.

0:05:16 Joseph Skrajewski
And they had one goal and that was to come up with a working definition of the word recovery. And what they came back with is abstinence is a component of recovery. It's a piece of it. But that's not what we're looking for here. We're looking for an increase in the quality of life for individuals. And we measure that and all that but what I wanna see is people get clean and sober, and stay clean and sober, and have better lives for themselves, are better parents to their children—

0:05:44 William Moyers
Mmm-hmm. Yeah.

0:05:45 Joseph Skrajewski
Are better partners to others, are better citizens in society. I think that's what we need to be looking at and measuring. ASAM did the same thing, The American Society of Addiction Medicine. They came up with a working definition of the word addiction. And a working definition of the word [stumbles] alcoholism. And we—they were long definitions. [William Moyers chuckles] I mean they were long and impractical and very wordy and took up multiple slides. I mean I know we—sometimes we think ourselves into paralysis here. But at the end of the day, they basically came up with a similar conclusion that abstinence is a piece of this, but it's a small portion.

0:06:19 William Moyers
Right.

0:06:19 Joseph Skrajewski
We wanna see people's lives get better. If people stop drinking and stop using, but their lives are getting worse, and they're unhappy, and they're still you know trudging this road downward, then we really need to evaluate that and look at those individuals. Maybe they need to see a—a professional. A psychologist, a psychiatrist. Maybe there are some other mental health issues here. But I think again at the end of the day, recovery is not simply just abstinence. It's a way of living, it's a way of thinking, it's a lifestyle.

0:06:49 William Moyers
There are many pathways to recovery, right?

0:06:51 Joseph Skrajewski
Absolutely.

0:06:52 William Moyers
What are some of them?

0:06:53 Joseph Skrajewski
Yeah I mean it's impractical to think that everyone's gonna be able to go to a Hazelden Betty Ford facility. I mean it's great that 93 percent of our patients use insurance nowadays, it's great that we scholarship the other 7 percent, but at the end of the day, people need to get help when they need to get help. And I know for myself here, if I would have got help the first time I needed it, I probably would have spared myself a lot of sadness and sorrow and a lot of tragedy for my family. But at the end of the day, it happened when it happened. So I think when we're—when we're working with individuals, we need to be practical yet again. We need to let them know that there are Twelve Step meetings all over the world. You know here in our valley within ten miles of here, we have 500 meetings every week.

0:07:34 William Moyers
Mmm-hmm.

0:07:34 Joseph Skrajewski
I mean so it—there's meetings that start at 5 in the morning and go to 10 at night. There are other alcoholics, addicts, people with substance use disorders, just waiting with their hand out like this [gestures] offering help to people that need it the most. So people can enter through Twelve Step programs, they can enter through churches or religious services. They can enter through treatment environments, outpatient is where a lot of people start this nowadays.

0:07:57 William Moyers
Wow.

0:07:59 Joseph Skrajewski
I always like to equate treatment options like surgery. And so people look at me like what do you mean it's like surgery?! And I say you know when we're making recommendations as surgeons, we think of least evasive process, right? I'm not gonna go and do a—a big, huge surgery on an individual if they have a small malady.

0:08:16 William Moyers
Mmm-hmm.

0:08:16 Joseph Skrajewski
So, if I'm making a recommendation, I'm gonna refer somebody to go to Twelve Step meetings. Not gonna say go to inpatient residential. They can go to a Twelve Step meeting. And if they stop drinking and stop using and embrace the life of recovery, wonderful. I've made a nice recommendation. But if they continue to drink and continue to use, they can look at outpatient programs in the evening for those that work during the daytime. During the daytime for those that work in the evening. Three to four hours per day. Three to four days per week. Six to eight weeks. And we've helped them through an outpatient program. But if they continue to drink, continue to use, you can then look at day treatment.

0:08:52 William Moyers
Mmm-hmm. [nods]

0:08:52 Joseph Skrajewski
[continued] You can then look at inpatient residential. So you've got options. And you've got the sort of progression of the disease. Because people can waver back and forth through those different stages here. But what I wanna do is let people know that there is a solution. There is help. And it's waiting for them whenever they're ready for it. And if the time is now, then they should embrace that.

0:09:11 William Moyers
What should people expect in terms of outcomes? I mean obviously when somebody reaches out for help or when somebody is told they need to get help, it's because they're drinking and drugging too much. Their lives are a mess; they've had legal consequences, work consequences, professional consequences, whatever. But it's not realistic to expect that everybody's gonna be able to stay abstinent, right? I mean it is a chronic disease. So that when somebody enters the journey of recovery, that often times starts with a recognition that they have a problem and that they need some sort of treatment. What should they and their families realistically expect in terms of continuity of the experience? I mean, what do you think?

0:09:55 Joseph Skrajewski
Yeah so it's a chronic disease. But it is a treatable disease. So I think the first step is reaching out for help. Maybe that is to their family member or maybe that is to a treatment facility. But I don't think people enter into a treatment—I mean maybe some do. But I think a lot of people enter into a treatment environment because they're in pain. They're in pain and they have a litany of consequences to their drinking and using. If their life was going well, they would not be entering into a treatment environment.

0:10:19 William Moyers
Right. Right.

0:10:20 Joseph Skrajewski
They would not be seeking help—

0:10:22 William Moyers
Yeah.

0:10:22 Joseph Skrajewski
In Twelve Steps or elsewhere. People always ask me, patients do this all the time, they say like what are your relapse rates?

0:10:28 William Moyers
Yeah.

0:10:29 Joseph Skrajewski
You know, again I hate quoting relapse rates because they'll hang onto the negative. So when I'm speaking in front of large-scale environments like at Betty Ford or at Hazelden facility or at a—at a university system or a hospital environment, I always say I believe that every single one of our patients can in fact get clean and sober, and can in fact stay clean and sober. But the reality is that some may not.

0:10:51 William Moyers
Mmm-hmm.

0:10:52 Joseph Skrajewski
The key is not to punish those individuals if they do have a lapse or a relapse. I mean what type of chronic disease [William Moyers chuckles] takes place whereby we sit there and we shame individuals and wag our fingers at them—

0:11:04 William Moyers
Right. [nodding]

0:11:05 Joseph Skrajewski
—Because they've had a lapse or a relapse. I—it doesn't make sense so I think we need to be understanding. We need to be loving.

0:11:11 William Moyers
Mmm-hmm.

0:11:11 Joseph Skrajewski
We need to be caring. Because people that are addicted don't come to us with low self-esteem, they come to us with no self-esteem. How do we help build them back up so they become comfortable in their own skin again, so they become a little bit more confident, so they realize that they can in fact climb out of the hole that they've dug for themself [sic] and realize that there is hope in the future. There is this light at the end of the tunnel and we're there to help support them whenever they're ready.

0:11:39 William Moyers
Mmm-hmm.

0:11:39 Joseph Skrajewski
And if it's not today maybe it's next week, maybe it's next month, maybe it's next year. But what people like us do is we plant seeds.

0:11:47 William Moyers
Right. Right.

0:11:48 Joseph Skrajewski
We plant seeds and we share ideas and we show some happiness and some joy to people. We show them that there is hope in recovery.

0:11:54 William Moyers
Mmm-hmm.

0:11:54 Joseph Skrajewski
And whenever they're ready to grasp onto that we'll be there for them. And then again we don't shame them and we don't hold them back and we don't—

0:12:02 William Moyers
Mmm-hmm.

0:12:02 Joseph Skrajewski
You know we don't judge them if they have some struggles or challenges along the way.

0:12:07 William Moyers
Abstinence, sobriety, recovery, a day at a time. It is a journey.

0:12:11 Joseph Skrajewski
Absolutely. I mean when I got clean and sober, I was not buying into the idea that I would be clean and sober the rest of my life. And I say this to young people all the time. Because they end up in some sort of treatment environment and their minds are blown. They think, you know take a 19-year-old. 'I'm never gonna have a legal drink, what do you mean?! I'm in treatment right now for my heroin use disorder, what do you mean I can't have a drink at 21?' I'm not trying to—to shock their system. I'm not trying to tell them that you know there's no happiness left in their life. I'm here to say we're here to save your life today. We're here to work on you right now. And we're here to take this thing as you mentioned one day at a time. And my hope then is as the days add up and become weeks, the weeks add up become months, the months add up become years, they see that there is something special in this thing that we call recovery. And that sort of understanding, that realization, that recovery is where they wanna live, and what they wanna be a part of, I mean that's amazing. You stay clean and sober for a while, you look around yourself and you're like 'Wow, I'm surrounded by people in recovery!'

0:13:11 Joseph Skrajewski
[continued] And I think that's pretty magical because when I was drinking and you know patients again they ask me all the time they say like you know how do you view recovery and I say uh tell me a little bit more. And they say well what's this thing about meetings, going to meetings? You know, why should I go to meetings? And I associate meetings with bars. And they look at me like I'm crazy. And I say okay, if you're drinking and you go to a bar, and you're not having fun, what do you do? And they say well, I go to another bar. And I say, so you go to the other bar, and you're not having fun or a good time again, what do you do? They say well I—I go to another bar. And I say what eventually happens? And they say I get the job done. I get the feeling I'm looking for. And I say okay, well, when you go to a Twelve Step meeting, if you can't relate and you can't connect with others, and you can't understand what they're looking for, you're not having a good time, you're not enjoying yourself, what do you do? And they say, I go to another meeting? And I say exactly! And I say if you go to that other meeting and again you can't connect and you can't relate and it's not what you're looking for, you go to another meeting but sooner or later, you get the job done again. And you find those meetings you're comfortable with and you find that home group and you find that magic in recovery.

0:14:19 William Moyers
Yes.

0:14:19 Joseph Skrajewski
And that hope shines through and—and I think people can understand that. They say wow, wait, if I go to a meeting and I can't fit in in that first one I don't have to stop going? Correct! [William Moyers chuckles off-camera] You don't have to stop going. You know you find the one that you can fit in or you find a home group. And they do. And I think so again we—we take the burden off of individuals. You know we don't try to build this thing up like sponsors. They—they say oh it's gonna be so hard to get a sponsor. I say go to a Twelve Step meeting when you leave treatment. Somewhere over the course of that meeting raise your hand and say, 'My name is so-and-so I'm an alcoholic, I'm recently out of treatment and I'm looking for a good network of individuals to help me.' Watch at the end of that meeting how you're surrounded by people—

0:15:00 William Moyers
Mmm-hmm.

0:15:00 Joseph Skrajewski
—With good intentions that wanna help you. Especially during a time of need. That's the magic of recovery.

0:15:07 William Moyers
Thanks for reminding us Joseph Skrajewski that recovery is not a destination it is indeed a journey. I'm your host, William Moyers, and on behalf of our Executive Producer Lisa Stangl and the great production team at Blue Moon Productions, this has been another edition of Let's Talk. We hope you'll join us again for more conversation on the issues that matter to us at the Hazelden Betty Ford Foundation and the issues that we know matter to you as well. Thank you.