| CARMEN 00:04 | [music] Welcome to Recovery Out Loud, a Niznik Behavioral Health Podcast, where we discuss addiction, mental health, and recovery. We’ll explore the true nature of addiction with behavioral health experts and hear firsthand personal testimony about what the path to recovery really looks like. From Niznik Behavioral Health, I’m your host Noelle Carmen. [music] This episode of Recovery Out Loud contains audio from a recent presentation given by Safe Landing Recovery for the Miami-Dade County’s School System. I joined Safe Landing Recovery Outreach coordinator, Laura Kennedy and clinical director, David Duffy to discuss signs and risk factors of teen substance abuse, as well as all the ways Safe Landing Recovery can help. Please enjoy the conversation, and don’t forget to subscribe for future episodes. |
| CARMEN 01:03 | Okay. So let’s get started. Uh, good morning, everyone. Welcome to the conversation. We are going to be talking about creating a safe learning environment, a safe space for our students, um, as it relates to substance use and trauma. We, we realize all of you are tasked with guiding students who have already presented issues in these areas. Uh, I wanna make sure you know that you are welcome to ask questions at any time, interrupt the conversation at any time, uh, because most-mostly we are here for you and wanna know particularly what you are specifically dealing with, not just, um– we don’t wanna just sit here and present our spiel without actually addressing issues that you are seeing, um, in your daily interactions with your students. Um, so please, please feel free to ask questions at any time. Uh, with us today is the clinical director for Safe Landing, um, Safe Landing Recovery for teens Mia– in Miami David Duffy. Hi, David. Thank you for– |
| DUFFY 02:07 | Hey, Noelle. How are you today? |
| CARMEN 02:09 | Good. How are you doing? |
| DUFFY 02:11 | Good. Nice to see you. |
| CARMEN 02:12 | So I’ll just jump right in to the questions, um, and we’ll get started. I, I think that it’ll be a good idea to discuss. We kind of all have this idea– some of us, this idea in society of the norm of experimenting with drugs. So whenever we have students, um, that are– that are coming in experimenting, it’s very hard to distinguish, um, where this norm breaks with this is– this is creating an issue. Uh, but before we get into the issue part, just how would you approach, um, the way that we think about the norm, um, of experimenting with drugs? We all have it. Uh, you hear all the time from families, “Oh, well, I did that when I was a kid.” So can you kinda talk us through that idea? |
| DUFFY 03:08 | Sure, Noelle. Um, I think one way that we wanna look at it is, i-i-s just looking at adolescence in general as a, a period of time in a young person’s life where they’re kind of establishing their identity. And as part of that process, um, establishing autonomy and testing the water, um, testing their independence. And oftentimes, that, that kind of manifests itself with testing the limits of parental authority, testing the limits of school authority, um, and kind of engaging in behavior that, that we consider kind of more so rebellious in nature. Um, it, it, it is a, a, a normal part of many adolescents, um, development to experiment with drugs and alcohol. Um, lots of– lots of reasons why from, um, you know, the, the social media aspect of it, the mass media, uh, film, television, and music, it– you know, you know, it’s something that they’re exposed to a lot. And when they’re exposed to it in these mediums that they’re so attracted to, it becomes something that attracts them as well, and, um, yeah. |
| DUFFY 04:37 | A-a-and just kinda, kinda to show you how normal it is, um, I did have some– just some kinda numbers here just to, to reflect how normal it is in, in adolescence. And, and some of those are about two-third and– two-thirds of students by their senior year have tried alcohol. About half of all high school students, 9th through 12th grade, uh, report having used marijuana. So, you know, uh, when we’re talking about reporting, we know that the numbers might be a, a little bit above that as well. And about half of students, um, have tried or are currently smoking cigarettes. And, and about 20% of 12th graders reported using, uh, prescription meds in the past year without a prescription. And, and so, you know, i-i-it’s, it’s just something that’s becoming more normal, so much so that this– the center for disease controls does recommend screening, uh, which typically happens in the primary care setting to start at the age of 9 years old, if you can believe it or not. |
| CARMEN 05:52 | Wow. Okay. So with that in mind, um, as we’re approaching these teens, what is our messaging? Obviously, um, “No, don’t do it,” um, is a challenging message, uh, in light of these numbers. What do you– what are your thoughts on that? |
| DUFFY 06:11 | Well, you, you know, there’s no safe amount of drugs for an adolescent to take, uh, based on research. So, you know, i-i-i-it’s a time where, um, we need to have messaging that focus on prevention. Um, and, and some of the ways you do that, i-i-is by identifying other behavioral issues that emerge early on, um, that are oftentimes precursors for maladaptive substance use. And that could be aggression in the– in the educational setting, that could be withdrawal, that could be, um, you know, la-lack of, uh, school performance. So, you, you know, I think the messaging, messaging of prevention and intervention is, um, important, Noelle. But if it’s okay, I’d like to talk a little bit about kind of why it’s so important to, to catch this early on. |
| CARMEN 07:12 | Oh, please. |
| DUFFY 07:14 | Okay. Thank you. So, you know, first and foremost, just, uh, catching a substance use issue early on, and/or a behavioral issue, mood disorder, um, catching it earlier results in better outcomes, um, moving forward. And the numbers s-speak for themselves. When someone under 18 is experimenting and, and progressing to kind of maladaptive substance use, their chance of developing a substance use disorder in adulthood is significantly greater. You know, the, the research shows when people first experiment in their early to mid-20s, uh, they, they, they have like a 4% chance of develop– being a substance use disorder. Whereas if it’s before 18 years old, it could– i-i-it’s around 25% that develop the substance use diso-disorder in adulthood. So we wanna certainly, uh, set our adolescents up for success. We wanna start them off with the– uh, uh, uh, with good momentum going into early adulthood. And just to speak to that a little bit, the adolescent brain is still developing, right? Um, i-i-it’s still kind of a, a work in process. |
| DUFFY 08:35 | And, and one of the kinda recipes for disaster when it comes to substance use in adolescence is that the first areas of the brain to develop in, in adolescence are the reward centers, the centers for reward and pain. They’re the first ones to develop. And, uh, you know, that– it-it– there’s good aspects, you know, when, when, when students and adolescents are, are doing healthy behaviors, pleasurable behaviors, dopamine, dopamine released in their brain, and, uh, it activates those reward center activities. The, the problem with substance use is that when an adolescent uses any substance of, of abuse, the dopamine isn’t just released, it is flooded– |
| CARMEN 09:31 | Mm-hmm. |
| DUFFY 09:31 | –after the use of any substance use. And it can, and often times will motivate a youth to replicate those feelings by using the substance again. And so you got the reward centers developing first, and then you’ve got the prefrontal cortex developing last, still developing all the way into their 20s. And that’s the– that’s the area for judgment, for, uh, emotional regulation. It, it, it– it’s, it’s the area where there helps them make healthy decisions. So you’ve got the reward center developing first and the, the judgment center developing last. So you could see how it– how it can become a problem because the, the adolescent brain is very malleable. And when I say malleable, it’s the term we hear in neuroplasticity. So when they have these reward center experiences with drugs and they replicate them, they’re developing these new neural pathways that are– can potentially entrench the, the adolescent to use– the youth into, you know, uh, substance use disorders. You know, and they, they make those connections. “Drugs make me feel happy. Drugs make me be able to socialize with friends more.” And when they develop those belief sets and those neural pathways ways, um, you know, that it, it– it’s certainly a time to intervene with an adolescent and get them the help that they really need. |
| CARMEN 11:05 | So, in speaking about intervening, what about, um, identifying when we’ve now crossed into an alarming situation? We’ve seen– we’ve seen behaviors on and off in terms of, “Okay, maybe this is a red flag. Maybe this isn’t a red flag.” But where is that line, um, when a student comes into the office where we’re like, “Okay, we are in DEFCON red here”? Um, and how do we– how do we screen for that and look for that? Especially, it’s not like we’re spending hours and hours, you know, in the office with these kids. Sometimes we don’t have a whole lot of time to assess. They’re just presenting here and there. |
| DUFFY 11:50 | No, absolutely, Noelle. And I– and I, I think it’s important to have that kind of prevention mentality, but being prepared to intervene when we do notice these red flags. And if it’s okay, I’d like to just kinda go over some of those, uh, red flags that we can identify in the school setting, that we can educate parents to identify in the home setting, that we can educate our fellow community, uh, providers and resources to identify in the social environment. So, um, the way I kind of wanna talk about it is identifying physical signs, emotional signs, signs that emerge in the family system, signs that we’ll identify in the school system, and then just general social and behavioral, uh, signs and red flags. So, you know, if a– if, if a student comes into your office and they just are really fatigued, they’re just presenting as way more tired than normal. You know, they have, uh, bags under their, their eyes. Or for that, uh, uh, the staying with the eyes, their eyes could be bloodshot, uh, could be a sign of marijuana use, uh, could be a sign of being hungover from the night before, um, you know, not sleeping well. |
| DUFFY 13:15 | Well, when we see students emerging with more frequent general health complaints, um, you know, like a lasting cough, like, um, a-a-any general, but more frequent health complaint, those can be some physical signs. Some of the kind of emotional signs that we’ll see with adolescence, um, and th-this is a key red flag to look for, and it, it, it, it– I, I should have, uh, qualified this with saying a lot of mood disorders and substance use disorders and trauma can look like each other. So it– it’s cert-certainly important to, to do comprehensive assessment where we see these things, but there are red flags and, and a lot of them overlap. So with the emotional ones, just a lot of dramatic changes and personality. Um, that’s a huge, huge, huge factor to identify. It’s almost like, “Who is this, this youth, this adolescent that’s in my office? It’s not the same student that I’m familiar dealing with.” You know, and, and with sudden personality changes, um, can come more sudden and rapid and stable mood changes, you know, highly anxious, depressed, angry, isolated. |
| DUFFY 14:39 | Um, students struggling with substance use disorders can present as very irritable. Um, they certainly oftentimes have low self-esteem, um, certainly in, in not using the best judgment. And, and, and just kinda one, one telltale sign, um, for adolescents and, and adults for that matter is losing interest in things that they normally love. That’s a big one, right? So not, not involving in those extracurricular activities, not, you know, following their favorite sports team or, or doing the hobby that, that, that we’re so used to seeing them do. Um, in the family system, i-i-it, it, it can be arguments starting, the general disrespect, uh, general rule-breaking. Uh, and, and a very, very important one to educate our families about is that withdrawing from the family. Sometimes we, we say it’s just an adolescent being an adolescent and, and being a teenager, and it could be. But substance use is a disorder that’s done in the shadows. It’s a– it’s kind of a secret experience for adolescents and, and adults for that matter, whether students are doing it completely by themselves or with a small group of, uh, friends or acquaintances, i-i-it’s certainly a secretive process. There’s a lot of time and energy put into how to conceal that. So, uh, that withdrawing piece is very important. |
| DUFFY 16:25 | Um, at school decreased interest, negative attitudes, certainly a lack of performance in the classroom, absences, um, continued, uh, absences and discipline problems and just some social problems, uh, uh, that can happen in school or outside, fights, aggressive behaviors, bullying. Unfortunately, adolescents with their limited judgment capacity, uh, and under the influence of, of, of substances could be more prone to inter-intermittent partner violence, um, or abuse and, and high-risk behaviors, whether it’s operating a motor vehicle under the influence, whether it’s engaging in promiscuous sex, using IV needles to administer drug, and just generally putting themselves in dangerous areas and situations to facilitate it. Um, just a, a, a few more, just a– seeing, uh, adolescent kind of congregate to a new group of friends and changing their behavior in terms– in terms of their music interest maybe, their style of dress, a-a-and these aren’t all blanket red flags. They’re just things to be aware about. So those physical, emotional, family, school, and social issues, Noelle, I think are certainly important to, to identify. |
| CARMEN 17:56 | Next question. As these students enter our offices– |
| DUFFY 18:01 | Mm-hmm. |
| CARMEN 18:01 | –what– let’s talk about how we are communicating with these students. How do we approach, uh, troubled youth in a way that creates a conversation, uh, where we don’t create defensiveness? Um, what are your thoughts on that? |
| DUFFY 18:19 | Yeah. And that’s a difficult one, right? Um, if– you know, again, the, the– this type of issue is one that is done in the– in the shadows and secretive. So it is a issue that we’re gonna get a lot of, uh, resistance and pushback and lying and manipulation, and from the family system, even those same things, including denial and not my child, you know, that sort of thing. So we, we wanna– we wanna kinda separate our two approaches with prevention and intervention. Um, when it comes to prevention, we, we really wanna educate the adolescence in a clear way, not, not an intimidating, not a punitive, not a scary way, but really educating them about the effects of different substances of abuse and how they can affect their life and their general wellbeing and their, their trajectory for their, their, their hopefully bright futures. |
| DUFFY 19:28 | Um, so in addition to that psychoeducation with, with, with the prevention, it-it’s kind of setting clear expectations and rules about drug use in terms of a school setting, a family, uh, uh, any other kind of system that, that a, a, a child might fi-find themselves in. Kids respond better when they have that structure, when they have that clear expectations, when they have the opportunity to ask questions, when they’re brought in and, and, and feel part of the process, as opposed to feel that the process is happening to them, right? And, and that prevention mindset, Noelle, is just a continuous process, uh, that, that we wanna touch on on a regular and intermittent basis to, to just keep, keep reminding it. And th-then we have the, the issues when the students in our office we know are struggling with substance use, um, or, or we have a strong feeling, or some of those risk factors we just talked about. You know, we’re, we’re running out of fingers about how many they’re, they’re meeting at the moment. And so we have some serious concerns. |
| DUFFY 20:44 | And, and in these, these type of situations, Noelle, again, I, I think it’s important to, to respect the student’s autonomy to, to not– to not approach it as a big– you know, “We have to have this monumental talk about some things that, that I’ve noticed in, in the school system or the home.” You know, it, it– it’s something I wa– I was reading that really hit home to me. And, and it– and it was a quote from someone, and, and it just made so much sense to me. And with my experience working with adolescents at the treatment center is, talk to the youth, talk to the adolescence like the adult that you want them to become and, and empower them in that way. And, and it– and it– and it will empower them, hopefully, uh, give them some autonomy in the process and, um, you know, uh, uh, help them be kind of, uh, uh, take that emotional, uh, guilt aspect down a notch and hopefully encourage them to, to talk. |
| DUFFY 21:58 | Um, I think being clear and honest, you know, and teaching the parents, especially to be clear and honest about expectations when we suspect someone is actively using, you know, uh– some, some students might say, “You know, beer’s not a big deal,” or, or, or, “Marijuana’s not a big deal.” I-i-it’s important to tell them like, “You know, maybe one beer might not ha– do so much harm, but did you know that 10, 10 beers can be fatal?” Um, I, I– letting the them know about these things and letting them know that opiates, uh, cause so much death in our community. And to be honest, it is more dangerous than cannabis. And some of the students know that. So when you’re being honest with them, they, they see that immediately. Um, you know, letting them know that, that the dangers of vaping aren’t, aren’t clearly fleshed out yet, and that there’s a lot more to be found out in that arena. So, so being open and honest with them can help and, and really exploring why they started using, um. |
| DUFFY 23:06 | When, when we explore in a kind of nonjudgmental way, it reduces that pressure. It kind of lets the, the, the adolescent know that, “Hey, there’s a precursor to this. It just wasn’t because I’m a bad kid.” You know, the, the unfortunate part that– is that a lot of the kids have that feeling. And a lot of it– times, it’s, it’s from their family. It’s from– i-i-it’s from– not from the audience we’re talking to now ’cause I, I know all the counselors here understand this, but maybe some other elements in the school system, you know, don’t have that understanding, and they feel like a bad kid sometimes. So, you know, exploring why they started using from a nonjudgmental perspective, Noelle, I think really helps reduce that stigma, reduce that guilt, that shame, and kind of allows the student to be open– more open with us, um, and, and op– and be open to, to, to getting some work done clinically in terms of, of, uh, sobriety maintenance. Um– |
| CARMEN 24:18 | So I– so you, you said something that, um, I think is super significant. Um, you’ve, you’ve definitely touched on denial, and we all know that people who struggle with substance use exist in denial. And so I just wanted to make this point clear and get clarity. What you’re saying is even if you are a counselor, you’re very aware that there’s a problem. Our job isn’t day one to get them to admit that there’s a problem. Um, you’re saying have an open, more curious conversation with them so that you are allowing them to realize that along with you. |
| DUFFY 25:04 | Yeah, absolutely. And it, you know– |
| CARMEN 25:08 | You disappeared from the screen, I think, uh, at least on my side. |
| DUFFY 25:12 | Uh, I can see myself. |
| CARMEN 25:14 | Oh, okay, good. |
| DUFFY 25:15 | Um, so yeah, I think with, with anything, uh, i-in this field, Noelle, and in the helping professions and, and even for educators in the classroom, it’s all about developing relationships and, and, and starting off the therapeutic alliance in that way. The therapeutic alliance is more important to clinical positive, clinical outcomes– |
| CARMEN 25:42 | Hmm. |
| DUFFY 25:43 | –than the evidence-based practice or the experience of the clinician. So in other words, if you’re able to connect with a client, uh, you, you have– you, you– you’ve started off on, on the right foot. You’re ahead of the game. You know, even if you’re still learning about evidence-based practices, still getting that experience, that connection, that relationship development is fundamental to helping our clients, uh, achieve their goals. And, you know, sometimes the goals early on, especially, you know, as, as, as people that are trying to help adolescents, uh, embrace sobriety and as family members, certainly, we just want them to stop. We want you safe. So sometimes we’re geared to only stop. Complete abstinence. Sometimes that’s not completely realistic, Noelle. So sometimes, uh, no matter how hard it might be for us, in a– in a– in a certain way, we wanna embrace harm reduction. We wanna talk to them about being safe in the event they are gonna use, talking about designated drivers, talking about having supports, uh, being a phone call away. That sort of thing. |
| DUFFY 27:04 | And, and, and again– and, and it’s being real, real clear to, uh, an adolescent. You know, we, we can educate the family members that, “Hey, on a Friday night when they say they’re going out, don’t just tell your, your kid, ‘Be smart tonight.'” You know, an adolescent can take be smart is like, “Okay, well, mom or dad just means I can’t get too drunk because they don’t want me driving home like that.” You know, we, we wanna be clear and let them know that, “You’re allowed to go out tonight as long as you commit to not using drugs or alcohol.” And, and just giving them the respect of clarity, it, it helps them work within that framework a little bit more, I think. Um, and employing amnesty policies at school and at the home can be beneficial. It can, uh, uh, facilitate an environment and a therapeutic, uh, milieu that allows, uh, an adolescent to be honest, because they know, “Hey, we agreed to an amnesty policy. They’re rewarding safety. And if I tell them that I relapsed yesterday, they’re not gonna make me feel again, like a bad kid. They’re gonna help me address what I’m going through and, and, and to get through it.” |
| CARMEN 28:30 | Let’s talk about family involvement. Is there ever a time when you keep the family outside of the circumstance? |
| DUFFY 28:40 | Uh, well, you know, Noelle, that should be the exception. Um, families are key to, uh, positive clinical outcomes with our adolescents, um, achieving their goals and maintaining sobriety. Now, that’s not to say that there’s not time when a parent’s involvement, both parents’ involvement, a sibling’s involvement isn’t, uh, isn’t contraindicated from a clinical perspective. And so if there is, God forbid, parents supplying drugs and alcohol, um, parents that are actively, you know, obviously abusing, uh, clients cannot be, uh, brought into that therapeutic alliance at that point. You know, uh, uh, we need to use our clinical judgment to ensure that support system engagement is not contraindicated to the client’s progress. |
| DUFFY 29:47 | So if someone in that family system is just gonna really, uh, trigger them and, and result in, in the adolescent shutting down, um, or is intimately tied to the act of drug use in, in a negative way, um, that’s when we should– w-w-we, we shouldn’t involve them– involve them. And that doesn’t mean we can’t involve them later. ‘Cause, you, you, you know, just like as everyone in this, this webinar embraces that unconditional positive regard for our clients and that unconditional hope and belief that they can change, we have to have that hope and belief that the parents can change as well. So i-i-it’s when it’s contraindicated or also before they’re ready and they’re prepared to be a part of that therapeutic process in a– in a kinda loving and supportive way. |
| CARMEN 30:48 | So what about when you have a family that is resistant? So you are trying to pull that family into a circumstance where there is denial in the family, but the family really does need to be involved. Um, what are the processes we should consider in that case? |
| DUFFY 31:09 | Sure. And, you know, uh, this is a big one. I don’t know if there’s any questions or if we, we– |
| CARMEN 31:14 | Oh yeah, we– yes. Do we have any questions at this time before we head into this part of the conversation? |
| DUFFY 31:21 | ‘Cause I know family resistance could be something everyone deals with on a regular basis. And we do have a, a, a few things we might be able to help you with. |
| CARMEN 31:32 | I think one of the comments, um, in one of our last presentations was, uh– a counselor said, “It isn’t the– it isn’t the students that we have the most trouble with. Oftentimes, it is their, their extended, um, caregivers who end up creating a lot of the chaos and a lot of the conflict.” Um, so is anyone, um, in this audience experiencing anything like that? Okay. Well, let’s just continue on then. |
| DUFFY 32:11 | So– yeah, no. Ju-just to talk about that, that family piece, which again, is crucial to those successful outcomes, Noelle, um, as a clinician, working with a family, I think one of the things we wanna do is treat that first phone call to the family with, um, as much importance, which– with as much preparation, with as much kind of self-awareness and deep breathing before the process happens, as we do with the first family session. That first call can be even more challenging than the first family session. Because at the first family session, you’ve already got them in the chair ready to do therapy with you. That first call, a lot of times families think that, “All right. You have the child now. You fix them.” Not knowing how important just ’cause they’re not aware. They, they don’t have the, the resources, the knowledge about the, the vital importance of family and substance use treatment. |
| DUFFY 33:23 | So really embracing that first call and taking it with, um, thoughtfulness and making it with thoughtfulness and, and preparation and, uh, treating it with, uh, as much importance as we do with that first family therapy session, I think can really help. You know, when it comes to resistance, uh– and I think motivational interviewing for the, the clinicians here that are trained and, and experts in that as well is a key evidence-based approach to not only deal with clients, with adolescents who are struggling with substance use, but to deal with the families as well. ‘Cause one of the– one of the features of motivational interviewing, Noelle, it, it talks about resistance, and it talks about rolling with resistance. |
| CARMEN 34:15 | Mm-hmm. |
| DUFFY 34:15 | Not confronting resistance. Confrontation always breeds more confrontation. So one of the humbling parts for me in learning about resistance in a therapeutic setting is that, you know what, most of the time resistance is more so a feature of the therapeutic alliance than it is of the person, than it is of the family. So the resistance is really a feature of our therapeutic alliance, that dance that we have with the clients or the client system. Um, and, and, and I encourage everyone to kind of reflect on, on resistance. What does it say about the family? You know, I, I think to be a strength-based clinician and with adolescents and with families is key. And sometimes it’s recognizing that resistance can be the family empowering itself. Uh, you, you know, the family might think that they have– even though they’re struggling, they’re still maintaining some kind of balance ’cause they’re managing. And they feel if they get too deep into a therapeutic process ’cause– |
| CARMEN 35:29 | Hmm. |
| DUFFY 35:29 | –they’re unfamiliar with it, they might lose that balance. You know, maybe it’s them empowering themselves to unite against us as clinicians. Um, and a lot of times it’s really more so about keeping things private. You know, there might be a, a, a mom or a dad that actively uses himself and can’t bear the thought of admitting that in family therapy with their adolescent. Maybe there’s issues with domestic violence in the house. Maybe there’s issues with infidelity. There’s a whole spectrum and range of family issues that can present that a family system wants to keep private either from a cultural, uh, perspective or, or just a guilt and shame perspective. So understanding that, um, can really help us address resistance. And, and I think when you’re addressing it with the family, Noelle, you really want to use logic and reason with them and explain to them why not engaging and keeping that family status as kind of status quo is not gonna be helpful for the youth’s recovery, i-is not gonna help them in achieving their goals. But that engagement and, and, and kind of, uh, developing, uh, a more collaborative family process will help. |
| DUFFY 37:04 | So, you know, we always gotta be culturally competent and respect, uh, you know, the unique world views of families and individuals and, you know, also reflecting on our own assumptions, right? I’ve had them. We’ve all been there. You know, this client’s parent doesn’t get it. You know, th-this client– this client’s parent enables their, their loved one. Um, you know, they always trigger the child. Um, they increase distress level of the, the child. They argue with us. And a lot of these kind of things and personal biases we can experience as clinicians can adversely affect our ability to do that key piece of relationship building with the family members. And, and, and when we’re– when we’re using, um, motivational interviewing and, and embracing all these things we just talked about and they’re still resistant, engagement and reengagement and reengagement and reengagement and continuing to bring them on board. Um, and yeah, just, just that motivational interviewing piece, I think for both adolescent and the family. |
| DUFFY 38:28 | Um, you know, I don’t know, uh, how many are, are you– are familiar with it. I’m sure most of you are using those OARS, those open-ended questions, get the people talking, using affirmations when they’re involving in change talk, motivating them to continue engaging in change talk, active listening skills of reflective listening. Let the family know that you’re joining them. You know, you, you need to join the family and earn their trust in the family therapeutic system as a leader of that system, as a guide. Um, you know, you’re– we use our OARS in motivational interviewing. So it’s kind of like we’re guiding that boat for the family, um, to a certain degree. So, so those are– using that act of listening will really help us develop those relationships and get families on board. |
| CARMEN 39:29 | So the relationship piece, um, sounds like the most important part. Um, and it, it sounds like what you’re saying is that the resistance is almost a measure of the relationship. And it also sounds like, um, what I’m hearing you say is in terms of walking into those conversations with judgment. It sounds like the family same as the student, um, is afraid of being labeled as bad in one way or another. And removing that piece of judgment allows that relationship to flow into more of a healing circumstance. I-is that– does that sound right to you? |
| DUFFY 40:14 | Oh, a 100%, Noelle. And, and, you know, just again, you know, we have to be sensitive to all sorts of family conflict and, and family issues that not only can make the family resistant to engaging in treatment, but can also underpin the substance use disorder of the adolescent. So we have to be super sensitive to those things. And yes, just like a, a kid might think, “I’m a bad kid.” They’re not bad kids. We– a-as clinicians we’re– we– we’re able to separate bad choices, bad behaviors, uh, diseases like the disease of addiction ’cause we embrace the disease model. Um, we’re able to separate those things from the inherent goodness of the adolescent, the child. Likewise, the resistance, the pushback, the, the, the negative interactions with family, I’m hoping we’re also able to separate those things from the inherent goodness of the family, because families in general do want their kids to be successful and thrive. Sometimes you resist so many barriers, emotionally and system from a system perspective that we can really help them work through. Um, you know, just like the kid can think they’re a bad kid that the family, the mom and dad can feel like, “I failed. You know, it’s my fault my son is in this– in this situation. My sister’s kid’s not in this situation. The neighbor’s kid’s not in the situation.” |
| CARMEN 42:02 | Yeah. |
| DUFFY 42:02 | You know, these, these kind of maladaptive thought processes that the family has as well, can underpin their resistance and can really, um– can really be a barrier that if we’re sensitive to it– |
| CARMEN 42:18 | Mm-hmm. |
| DUFFY 42:18 | –and let them know that this is a disease. This is not, you know, your fault. This is something that you can help, uh, steer, steer the boat and, and, and help your, your adolescent overcome. And don’t get me wrong. Some, some parents do play me major roles and, and are major triggers and reasons for substance use. But I– when I s– when I say– when I say we’re telling them it’s not their fault, that’s on the, the more bigger picture at things ’cause, ’cause oftentimes some things they don’t– they do don’t help, but there’s other underlying reasons as well, so. And, and we gotta be sensitive to the way that substance use impacts the entire family system– |
| CARMEN 43:02 | Yeah. |
| DUFFY 43:03 | –the siblings, the, the grandparents, the, the parents themselves, and kind of teaching that difference between healthy so– support and enabling. You know, um, sometimes our, our, our adolescents and teaching the parents is– can be important. They, they might need money for something. They might need money for something at school, a field trip, just to give an example. Now, as the parent, if I suspect substance use, am I enabling by just putting on my denial glasses and not seeing the problem and giving them the money without following up? I could be. So maybe, uh, when we see some of those red flags, we tell our, our, our– we teach the, the parents to tell the adolescent, “Hey, tell me who I need to pay this to, and I’ll take care of it for you.” So it’s kinda– uh, it’s kind of still helping them with what they need in a healthy way that’s not enabling. And they, they– and I’m sure everyone’s familiar with that show, Intervention, um, that’s on A&E. In one of the first seasons, they had a– they had an interventionist that said something I’ll never forget. And I’ve said it to families and therapies over, over the last, uh, 12 years I’ve been in the field. And, and that’s that, “Without a doubt, we love– we love our loved ones, the, the folks that are struggling with substance use. Love them up and down. It’s the only way to truly help them, but don’t love them to death.” |
| DUFFY 44:42 | And when I say that, I’m talking about the enabling behaviors that can facilitate active use, the $50 in, in, in cash that we give for whatever reason that could end up being the, the substance that, um, kills them, that results in, in, in serious consequences, so. And, and families, they– we, we haven’t talked about co-occurring issues, Noelle, you know, with, with adolescents and substance use disorder. There– there’s kind of about a 60% co-occurrence rate. Um, and family is extremely key in managing mental health disorders with adolescents as well, especially when medication management issues are, are part of that process. So you just see how, how the family system is so vital and empowering the families and rolling with that resistance to get them to be more involved with the systems that our youth are in is just, uh, fundamental and, and something, I think, we’re all working towards to, to best address this, this problem in our community. |
| CARMEN 45:56 | I’m aware of the time. Um, if I’m not mistaken, we have close to 10 minutes, and I didn’t wanna end the conversation without talking about trauma, um, and how that plays a role in the learning environment, how that’s related to substance use. Um, I realized we don’t have that much time, but definitely wanted to address that piece of it as well. |
| DUFFY 46:22 | Yeah, sure. Um, so– and, and we just mentioned co-occurring, right? So– |
| CARMEN 46:28 | Yeah. |
| DUFFY 46:29 | –traum-trauma can, can, can manifest into, uh, PTSD or acute stress disorder, but trauma is much more than that, Noelle. And, and trauma, what we really wanna do as educators, as clinicians, as, um, community providers for adolescents and, and the general public is we wanna view trauma as not the exception, but we wanna to, you know, view trauma as the expectation. And when we do that, we can really focus on a trauma-informed approach to in intervening with students on a regular basin– basis. I’m sorry. Uh, trauma is part of the human experience. You know, and trauma is really a response. Uh, trauma isn’t really the issue that happens. Trauma isn’t that someone got shot. Trauma is the response that someone has from seeing someone get shot, whether that’s a physical, psychological, or emotional response. And when, when, when, when adolescents– and, and, and in this setting, we, we often think about it as, as first childhood experiences. When they have those issues early on, you know, th-the students adolescents will certainly be more sensitive to stress responses in general. |
| CARMEN 48:03 | Mm-hmm. |
| DUFFY 48:03 | And that’s gonna lead to a more profound stress avoidance response. And that’s where substance use can, can really come in and become a maladaptive coping skill for that trauma. ‘Cause unfortunately, the substance use can work. It can numb those feelings. And it– being that this– the adolescent still don’t have that judgment piece of, of their brain developed that they– they’re not gonna think through the consequences, ’cause yeah, it can work, but it comes with a lot of horrible consequences, a lot of brain development issues, a lot of, uh, emotional, just biopsychosocial issues that can present in their life and, and become really, really problematic for the student. So trauma, trauma can really underpin substance use in general for adolescents and adults. And, and it’s certainly something that needs to be assessed for on a– on, on a kinda regular basis, universal basis when, when dealing with substance use, uh, in adolescence. |
| CARMEN 49:16 | In the same way that we have these conversations, not just amongst ourselves as professionals, but also with our youth, how do you suggest that we discuss the topic of trauma? Uh, because the whole idea, right, is to create self-awareness for our students so that they’re becoming aware of possible substance use issues. They’re becoming aware of their own emotional responses, um, as stressful things occur. So how are we talking about these things with our youth? |
| DUFFY 49:53 | Yeah. And, uh, and I’ll go back to what we were saying earlier, Noelle. And that’s the key fundamental aspect of relationship building with our students and, and their families, uh, from the jump. That relationship building is gonna allow us to be able to intervene and, and, and is a game changer for intervention and is efficac– e-efficacy, um, for dealing with students and, and, and families. And, you know, a trauma-informed, uh, approach according to the American Psychological Association can be built into any framework, including a school system. And, and part of a trauma-informed a-approach, Noelle, is really having a 100% care and empathy and acceptance for a student’s successes or failures, knowing that all kids are worthy and having that unconditional positive regard that we talked about earlier. |
| DUFFY 50:58 | And, you know, there– there’s a concept that a mentor of mine taught me about that I really embrace. Um, and, and that’s, that’s the notion of carefrontation versus confrontation. And, uh, and, and it’s just such a beautiful concept that i-i-it’s something that I work on on teaching our staff on a regular basis. You know, sometimes we just wanna point our finger and tell them, “You know, you shouldn’t do that.” And that’s kind of more the confrontation approach and that typically breeds defensiveness and more confrontation. A carefrontation approach is having a softer tone of voice. It’s expressing empathy that we understand this behavioral expectation is, is something you’re struggling with meeting right now. And how can we help you achieve that? It’s kind of having that soft eye contact, you know, um, you know, partnering with the student, you know, maybe a fist bump or a handshake, you know, that kind of healthy contact, letting them know you’re on their team, team student to, to really help them get through these things because trauma can manifest itself in all sorts of ways, including outbursts, hypervigilance, anger, aggression. |
| DUFFY 52:21 | And to de-escalate, we really wanna embra– uh, embrace those, um, de-escalation techniques that we were just mentioning, identifying maybe a safe space and comfortam– comfortable environment that we can bring them to. Um, really important to, to bring someone who’s experiencing a, a traumatic situation or reexperiencing, I should say, and having a maladaptive kind of emotional response is kind of bring– removing them from any potential audience. We don’t want a client having a– an outburst, an emotional outburst in front of other students. It can kind of– the other students can kinda egg them on in a way even if they’re not trying. So kind of removing that audience, bringing them to a space– safe space and just really treating them with that care and compassion and not escalating with them, but de-escalating with them when they escalate to hopefully ground them back into that learning experience that they’re there for at school or ground them back into that therapeutic experience that, uh, wonderful school counselors are having in their offices. Or, you know, when we’re talking about de-escalation, it’s really about grounding them back into the moment, into the present, and, uh, working with them to overcome those things. Oh, Noelle, I can’t hear you. I can see– |
| CARMEN 54:00 | I’m so sorry. Um, um– |
| DUFFY 54:02 | No. It’s okay. |
| CARMEN 54:03 | –let’s get these last few minutes and talk about Safe Landing Recovery for Teens. What does residential treatment look like for our youth who actually are struggling with substance use? Just talk us through what is available for our counselors. |
| DUFFY 54:22 | For– so we’re talking about Safe Landing? I’m sorry. |
| CARMEN 54:25 | Yes, yes. Sorry that I was on mute. Um– |
| CARMEN 54:28 | –I just wanted to take these la– we only have a few minutes left, and I just wanted to make sure, you know, that we’re here to offer these resources. What are these resources that– |
| DUFFY 54:36 | Yeah, no. We, we offer, um, we offer individual therapy. We have amazing therapists that work with the students and individual therapy. And again, that family engagement is an expectation. It’s something that if it doesn’t happen early on, we, again, reengage, reengage, reengage, as long as it’s not, uh, contraindicated, um, issue. We have all sorts of groups. We have skill development groups for the adolescence, um, life skills groups. We have, uh– just yesterday, we had our, uh, fitness trainers come and, and, and work with them, uh, on the fitness piece, really showing them that, that mind body connection and how that can be a healthy dopamine producing experience for them, ’cause we wanna identify these things that they can, uh, not only help cope with their cravings, but also replace in terms of, uh, activating those reward and pleasure systems in their brain. And, you know, food and, and fitness are, are, are things that can certainly do that. |
| DUFFY 55:48 | Um, we have mindfulness groups. We have creative expression groups, you know, as there’s different students learning different ways, and we wanna– we wanna acknowledge and embrace that. Um, so we do offer those different modalities. Uh, we do a lot of, um, groups on healthy relationships. Uh, we do psychoeducation groups, uh, you know, teaching the kids, uh, about some of the, the very, uh, real risks of, of continuing to use substances. Uh, and we’ll– I’ll use visual aids, you know, where we, we can literally show them the, the developmental aspect of the different regions of the brain and which ones kind of come in last and how substance use can kind of interrupt that development process. Um, and again, like, uh, like Laura mentioned, we have a wonderful educator that, uh, make sure that the schooling piece is in place and, uh, prioritized along with the treatment. |
| DUFFY 56:53 | We have a 24-hour nursing staff, um, that’s able to, um, treat and, and address any mood issues of medication management under the direction or of our, uh, psychiatrist and, and the doctor’s orders that he prescribes. And we do, um, fun things for the, the different seasons. Um, you know, Thanksgiving’s coming up. Christmas is coming up. So we’re, we’re definitely gonna embrace a lot of activities. The kids all had, uh, contests decorating their doors for Halloween, which was a blast. And, um, yeah, the– you know, i-i-it’s very– it’s very intense on the therapy, um, on the community building, on the relationship building. The family therapy piece, i-i-it’s a foundation at Safe Landing, and again, the education piece. So it’s just kind of a whole holistic approach, Noelle. Um, and, and, and w-we’re having some good success with, with clients that are, are going through the entire, uh, kind of, uh, progression of treatment and successfully completing. So it-it’s been really good to see. |
| CARMEN 58:09 | What is the average cost of residential treatment? |
| DUFFY 58:13 | The average cost? |
| CARMEN 58:15 | Yes. This is another– |
| DUFFY 58:16 | Um– |
| CARMEN 58:16 | –question that just came in. |
| DUFFY 58:18 | –it, it can de-depend. Um, you know, we primarily use insurance. So I, I, I wouldn’t wanna really just pull a number out of the sky ’cause, ’cause in a way it’s what I’d be doing, um, because there’s different– and I’ll let Laura talk about this maybe better than I could. Um, you know, ’cause there’s different services. So when our medication management’s indicated, we need some kind of testing. |
| CARMEN 58:47 | Right. |
| DUFFY 58:47 | Um, the– you, you know, the different services are gonna result in a different cost, uh, differential. So maybe, I don’t know if, Laura, you can hit that one a little bit more effectively than I could. |
| KENNEDY 58:59 | Sure. Well, it’s hard– as, as, as you said, it’s hard to give a, uh, a price. Um, I mean, we, we don’t– we prefer using insurance, but I would say a cash price and that– you know what? I, I really shouldn’t. Um, why don’t you– |
| CARMEN 59:17 | Yeah. |
| KENNEDY 59:17 | –have somebody call me and if they call me and I could try and work with them as far as a sliding scale or something– I can’t commit to a particular price. Um– |
| CARMEN 59:27 | Because it also depends on, are we talking about detox? Are we talking about a full stay in residential and such an individualized plan coming in? Is that– is that right? Um, and– |
| KENNEDY 59:38 | And– |
| CARMEN 59:38 | –someone, someone also asked, uh, the duration. Is it– is it, uh, 30 days, 45 days? Or is it a very individual as well? |
| KENNEDY 59:48 | Well– |
| DUFFY 59:48 | It– |
| KENNEDY 59:48 | –we– |
| DUFFY 59:49 | Go ahead. |
| KENNEDY 59:49 | Go ahead. We’d like to do 45 days. |
| DUFFY 59:51 | Mm-hmm. |
| KENNEDY 59:51 | That’s the complete program, but we have been known to do less if that has to be– you, you know, usually the, the least will do is 30 days because– |
| DUFFY 01:00:01 | Mm-hmm. |
| KENNEDY 01:00:02 | –kids start to get, uh– uh, uh, I, I mean David could probably answer this better. It takes them a few days, maybe a week even to, to, to accept where they are and, and, and, and get with the program. So usually, i-i-it– we ask for 45 days. Someone asked about the insurances. We take Humana, Magellan, Molina, BayCare, Beacon, and, um, Blue Cross Blue Shield to Florida. So we take Florida Blue. Um, we try in any way that we can to help the community. I just want you to know that. So call me, and I’ll be happy to address it, uh, with the powers that be. |
| DUFFY 01:00:45 | Yeah. And I was gonna say that as well, Laura. You know, I– uh, we don’t wanna pull the number out of the sky for– from a cash price perspective, but from my experience and what I’ve heard is, is– like you said, we work with the community. So calling Laura and, and discussing those issues. Uh, our, our orientation is a solution-focused one, and it– it’s a– |
| CARMEN 01:01:07 | Mm-hmm. |
| DUFFY 01:01:08 | –it’s a helping one. And so that’s the, the way we’d move in that regard. |
| CARMEN 01:01:13 | Yeah. And I think, um, unless anyone has any other questions, uh, I think that is a wrap from our side. Appreciate you, David and Laura, for jumping into the conversation, and appreciate everyone for, for listening in. |
| DUFFY 01:01:29 | Thank you, Noelle. I appreciate the opportunity and just the honor to, to speak to a, a group of, um, healers in our educational system. It’s an honor. Thank you. |
| KENNEDY 01:01:40 | Thank you. |
| S4 01:01:42 | Wonderful. Thank you all for being here today, uh, Laura and David. Um, i-it’s good to have these connections in our community because we never know when we are gonna be confronted with the situation in, in– with the student that we’re working with or with a family, will come in, uh, requesting such services. And to have a partner, uh, with someone we know or someone we trust, um, that’s so responsive and so trauma-informed and, uh, really looking out for the interest of, of our families and our youth, we, we really appreciate this collaboration. |
| DUFFY 01:02:13 | We appreciate you, Gladys. Thank you. |
| S4 01:02:15 | Yes. |
| CARMEN 01:02:19 | [music] This has been Recovery Out Loud. Don’t forget to subscribe and stay up to date with notifications for new episodes. But most importantly, if you’re struggling, don’t hesitate to reach out. Help and a new beginning are only a phone call away. [music] |
