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An Interdisciplinary Look at Substance Use

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Join Ashley Lytwyn, MS, RDN, Margot Chambers, L.Ac., and Kim May, LPC-S, LMFT as they discuss best treatment practices for clients who are dealing with substance use

Moderated by Dr. Ben Caldwell, this group of experts offer a unique and holistic approach to substance use treatment. They discuss everything from the most effective assessment tools for substance use, to best motivational practices to keep clients sober during the pandemic. 

If you’re interested in learning more about working with substance use, they also offer advice on how to get involved, and how to continue learning about this subject. 

  1. Introductions
  2. What is the difference between substance use and substance abuse?
  3. How valuable is interdisciplinary collaboration with a client who is suffering with substance abuse? Is this something that you require?
  4. What assessment tools do you find most effective when working with substance use disorder?
  5. For those of us who are new to working with substance use, can you explain what harm reduction is?
  6. With a growing amount of people relapsing during the pandemic, how do you help clients stay motivated to stay sober?
  7. What would the next steps be for a clinician who maybe is working with clients who have struggles with substance use, but they’re not as familiar with your particular line of work?

1. Introductions

Ben Caldwell: Good afternoon. And thank you everyone for attending today’s Ask the Experts webinar, An Interdisciplinary Look at Substance Use. I’m your facilitator, Ben Caldwell. I’m the education director here at SimplePractice Learning. We are honored to have you with us today, and we’ve got a great panel that’s going to give us a heck of a lot of information in the next hour about how to look at substance use from an interdisciplinary lens.

So let me go quickly into kind of what our agenda is for the day. That’s me, but you didn’t come here to hear me, you came to hear our great speakers. We’ll spend the first couple of minutes doing introductions, and then we will talk about the questions that folks submitted. A number of our viewers submitted questions online in advance of this webinar. We’ve got a great variety of questions. I think we’ll learn a lot from the next hour.

And we’ll include some time at the end for final thoughts. So as we go into the end of a very difficult year, I know that each of our panelists has some great knowledge and wisdom to share about kind of the times we’re going through and what’s ahead of us as well. So we’ll include time for that at the end. So with that, let’s introduce our panelists starting with Ashley Lytwyn. Ashley is a registered dietician nutritionist, and a certified intuitive eating counselor. Ashley also serves as the executive director of Breathe Life Healing Center in Los Angeles. Ashley has extensive experience working with clients with eating disorder and substance use disorder. Ashley, you want to talk a little bit about your work?

Ashley Lytwyn: Sure. Thank you so much for having me Ben, and thank you to the other panelists today. Hello everybody. My name is Ashley Lytwyn. I am a registered dietician nutritionist, and I’m the executive director at Breathe Life Healing Center in Los Angeles where we treat clients for substance use disorder, eating disorders and mental health. I also own and operate a private practice called Nutrition Unveiled where I’m specifically looking at the relationship to food and your body. So I’m so happy to be here today, and thank you so much again for having me.

Ben Caldwell: Thank you very much Ashley. We’re happy to have you here. Next we have Margot Chambers. Margot has worked as an acupuncturist in the pain management department at Simms/Mann Health and Wellness Center. She found that working alongside medical doctors, osteopaths, chiropractors, and psychologists in an integrative setting was both highly educational and of tremendous value to client care. In 2010, she began work in substance use and mental health at treatment centers in Los Angeles and Malibu. Margot, we’re very happy to have you with us. Can you tell us a little bit about you and your work?

Margot Chambers: Yeah, I’m a traditional Chinese medical practitioner and I have a private practice in Santa Monica. But for the last 12 years I’ve been working in drug treatment and mental health at various treatment centers in Malibu and Los Angeles and I continue my work at Avalon Treatment Center in Malibu today. So I use acupuncture alongside other practitioners and specialists to help people with mental health and substance abuse.

Ben Caldwell: Wonderful. Thank you. We’re very happy to have you Margot. And then lastly, Kimberly May. Kimberly May is the founder of Substance Use Therapy in Austin, Texas. Kimberly specializes in serving individuals, couples and families whose lives have been affected by substance use. She works from a harm reduction model, we’ll talk a little bit more about that, to support people wherever they are on the continuum of use. Kimberly, you want to talk more about yourself and your work?

Kimberly May: Certainly. I worked for many years in harm reduction and then I kind of diverged on a different path for a little while and I realized how much I really missed working with this population. And I think that other panelists can probably attest, you either have a passion for this work and this population or you don’t. It’s a privilege to serve this population, and for me, I can only do this work from a harm reduction model. It’s really all I know, and it’s the best fit and I’m so excited to be able to talk about it and share it with everyone today.

Ben Caldwell: Wonderful. Thank you all so much, really happy to have you. I’m looking forward to the diversity of perspectives here and how much we all can gain from it. With that, I want to get right into the questions that have been submitted, and we will start with question one here. And it’s a pretty fundamental question, but I think a lot of folks who are not ensconced in the substance use treatment world aren’t familiar with this. So can you start by talking about what is the difference between substance use and substance abuse? And Kim I’ll start with you.

2. What is the difference between substance use and substance abuse?

Kimberly May: Yeah, absolutely. Thank you, Art. It’s such a good question. And it’s confusing because diagnostically, the terminology has changed. In the DSM-IV-TR substance abuse was an appropriate diagnostic label. Since the DSM-V came out, the appropriate label is substance use disorder. I personally think it’s more accurate and I think it’s a lot less stigmatizing. The word abuse kind of implies, I don’t know, wrongdoing. It implies a certain level of judgment.

And in harm reduction, we don’t see all illicit substance use as being abuse necessarily, rather we see use as being along a continuum from experimentation and social use on one end to really kind of pervasive chaotic addiction on the other. I do find myself using substance abuse sometimes just out of habit, but I think when we say use, it really allows people to define their use a little bit more and not kind of fall into that stigmatizing language.

Ashley Lytwyn: Kim, I want to add to exactly what you’re saying, and I 100% agree with what you’re saying. And I think my training is from that trauma informed lens, and I love that you really shared that it’s decreasing the shame and the stigma with the term abuse because from that trauma informed lens, substance use is looking at what are the manifestations of that deeply rooted trauma?

Kimberly May: Right.

Ashley Lytwyn: How is that wound interacting with your everyday life? And as a dietician I’m looking at, is it your relationship to food? Is it your relationship to substances? How are you using substances?

So I think it’s definitely a more appropriate term and it’s now widely accepted as our diagnostic term too.

Ben Caldwell: Margot, how would you address this question? What’s the difference between substance abuse and substance use?

Margot Chambers: Well, because I work in traditional Chinese medicine, primarily my assessment tools are really based on traditional Chinese medicine diagnosis and assessment. I leave that definition step up to really the experts. So Ashley and Kim really have a better idea of how to label and define that thing so I kind of leave it up to them. Because for me, I really go off of traditional Chinese medicine diagnosis. So I don’t read the DSM-V and all that stuff so I kind of leave it up to the experts to define that thing.

Ben Caldwell: Sure.

Margot Chambers: But it really touched me what Kim was saying about the difference between the words abuse and use and that really resonates with me. And so I would say 100% of my clients have some form of trauma, like Ashley was saying, and I really agree that using the word use rather than abuse is a softer, kinder way of approaching the medicine. So I 100% agree with that.

Ben Caldwell: Yeah, there does seem to be this thing, right? And I’m a licensed MFT, right? So substance use treatment is not my wheelhouse, but I think in any kind of mental health care, you inevitably encounter some levels of substance use and abuse. And there does seem to be this thing where that label of abuse, people experience shame around and it discourages them sometimes from seeking help when if we can talk about a use disorder, problematic use, that kind of terminology, doesn’t seem to lead to the same reaction.

Margot Chambers: And I definitely believe in a… For my practice, it’s a no shame practice. So yeah.

Ben Caldwell: Ashley, what would you say in response to Art’s question here? What’s the difference between substance abuse and substance use?

Ashley Lytwyn: Sure. So I’d shared a little bit when you got cut off, but I’ll repeat it again for anyone else that may have gotten cut off too. First and foremost, the terminology changed with the new DSM. So substance abuse is the older terminology and the newer terminology is substance use disorder. I come from a trauma lens so I’m really, really interested in that language and that verbiage and how it hits someone.

So when we’re talking about trauma, we’re saying the wound is the origin for these manifestations that could be occurring in your life, whether it’s the eating disorder or the substance use disorder or insomnia or flashbacks. So really decreasing that shame and decreasing that stigma and saying, “How are we using substances as a form of surviving because of the trauma wound?” Is much more palatable for the clients that I work with. So basically everything that Kim and Margot have said, I 100% agree with.

Ben Caldwell: Well, good. It’s good to see the alignment. Let’s go to our next question, which comes from Kaitlin. How valuable is interdisciplinary collaboration with a client who is suffering with substance abuse? Is this something that you require? And I’m curious about that language of require because it seems like with the other mental health professionals that I talk to, there’s consensus that yes, it’s helpful to talk with other folks in other disciplines relevant to the client’s needs. And yet I think maybe, and I’ll be curious to hear what you think, is this something that you require and how valuable… I’d like to hear from everybody on this, but Ashley I’ll start with you.

3. How valuable is interdisciplinary collaboration with a client who is suffering with substance abuse? Is this something that you require?

Ashley Lytwyn: Sure. My formal training is as a registered dietician nutritionist, so it’s absolutely imperative that I collaborate with the team. Most of the time I’m brought in as an additional form of support for a therapist and a psychiatrist and a medical doctor. Just being a dietician by nature, that’s where I fit into the mix. Now on the flip side, if somebody, if a client does seek private practice services, I will be very clear in the beginning that I must have a therapist, an MD and a psychiatrist on board in private practice.

Just because of the nature of being a dietician, it’s really important for me to know therapeutically where they are and medically where they are. So you can think of a dietician as kind of the liaison, a manager of the entire treatment team. This is also applicable in higher levels of care, whether it’s intensive outpatient or partial hospitalization or residential.

In those levels of care, I would absolutely agree that it is required not only for the best practices, but also because coverage and insurance payments are requiring the interdisciplinary team. So I think it’s different for different levels of care. And specifically at private practice, I work, I must work, it is required for me to work on that interdisciplinary team.

Ben Caldwell: Yeah, that makes sense. Margot, and then Kim.

Margot Chambers: It’s the same for me. It’s very, very rare that somebody will walk into my private practice or call me to be the sole person working with them in regards to substance use. Usually I get the call from other people to collaborate in my private practice with other psychiatrists, doctors, psychologists, other people to collaborate with them, to help them work with a patient who’s dealing with substance use. But half of my work has always been since I started working in inpatient treatment, IOP, step down level of care. So I’ve always worked in collaboration with other people and it’s been tremendously rewarding and I actually can’t imagine it doing it any other way.

Ben Caldwell: That makes a lot of sense. And Kim, I’ll be curious to hear from you, if you don’t mind. How do you facilitate that kind of collaboration? Because I know that that’s one of the questions that private practitioners in particular sometimes will struggle with, is knowing who to reach out to and how to reach out to make sure that you’re getting the right professionals on board at the right times.

Kimberly May: Sure. So I work with people kind of all along that continuum. So sometimes I am their first point of contact and there is no one else on board. Sometimes I’m the last point of contact after other things, and I’m brought in where there’s already other professionals. It’s certainly ideal to work with a collaborative team, I certainly don’t require it. I like to create as low of a barrier to entry as possible especially because sometimes it takes everything someone has with substance use issues to seek out help and so I don’t want to make it hard.

Beyond that, not everybody has the opportunity or the means to have a robust treatment team intact. I do frequently refer out to other professionals, be it medical or dietary, or what have you and I will always request that somebody open release of information so that I may communicate, but again, I don’t require it. If for some reason they’re not comfortable or they’re not ready, then I kind of leave that alone. Again, I want to support the person where they’re at. And so for me, that takes precedent sometimes to the opportunity to be able to collaborate.

Ben Caldwell: Understandable. I like that notion of meeting people where they are and creating as few barriers as possible to care. Our next question comes from Sonja. What assessment tools do you find most effective when working with substance use disorder? And Kim, why don’t I start with you on this one?

4. What assessment tools do you find most effective when working with substance use disorder?

Kimberly May: Sonja, I like that question because it gives me a chance to talk about my favorite, and it’s something called drug set and setting, it was developed by Norman Zinberg. Drugs certainly just refers to potency, route of administration, what types of adulterants are frequently added? Sets is you, your personality traits, your motivation or expectation for using, any kind of health or mental health issues, and setting is the context for which the use occurs. Are you alone or with other people? Where do you use? Are you in a rush or are you at ease when you use? And we’ve always kind of had this notion that it’s the drug itself that has the greatest impact on creating addiction.

And I think that’s a fallacy. I think that how addiction comes to be for a particular individual is vastly complex and drug set and setting kind of examines these three interrelated factors to see how it kind of combines to create a unique experience for a particular person. It’s not a judgmental assessment and it kind of puts you in that stance of objective curiosity. And most clients haven’t looked at their use from that perspective before so sometimes they find it quite interesting. It’s certainly not of terribly formal assessment or one of the most robust assessments, but it’s my personal favorite.

Ben Caldwell: That’s great. You said it’s called drug set and setting?

Kimberly May: Mm-hmm (affirmative). Developed by Norman Zinberg.

Ben Caldwell: Great. Thank you. Ashley, what about you? What assessment tools do you use?

Ashley Lytwyn: So I use a wide variety of nutritional screens and nutritional assessments. I really, really am interested in looking at client’s relationship to food and their body and how it relates to their substance use. So I’m going to be doing a lot of different screening and a lot of different assessments on the front end to evaluate someone that might have an underlying eating disorder or disordered relationship to food. I’m also looking at the health questionnaire that’s typically mandated by the state that the client is in and the specific questions and evaluative tools that are really important to really evaluate their physical health.

I do that because as a dietician, I’m a lot of times the liaison between the medical doctor and the clinical therapeutic team. And so I can help the client and the team understand lab values, or if a person is physically compromised and that would hinder their ability to really synthesize the therapeutic work that they’re doing with their therapists and in that either individual or group setting. So I would say I view a lot of different assessments and I specifically will use nutrition screens and nutritional assessments.

Ben Caldwell: That makes a lot of sense. I know we’re going to talk a little bit more later on about some of that relationship between disordered eating and substance use. Now Margot, what about you? Well, how do you use assessment tools and processes in your practice?

Margot Chambers: Well, mine’s a little different because mine’s really based on traditional Chinese medical practices. But the idea of traditional Chinese medicine is based on imbalances of the organ systems. So when I’m looking at a client, I’m actually using traditional Chinese medical assessment such as tongue, pulse, palpation. There’s a lot of body work that goes into assessing the client as well as questions. But it’s actually mostly pulse taking in traditional Chinese medicine that allows me to see what imbalances are going on inside the internal system that then shows me what I’m going to use in my toolbox to help the client. So it’s very, very specific to our medicine.

Ben Caldwell: That makes a lot of sense. Thank you. Our next question comes from Pamela. And Kim, we’ll start with you on this because this is certainly your wheelhouse. 

5. For those of us who are new to working with substance use, can you explain what harm reduction is?

Kimberly May: Yes, and thank you for asking, so I can, I love talking about harm reduction. Harm reduction really originated in the ’80s in Europe as a response to the HIV crisis that was happening. Harm reduction is really a set of practical kind of strategies aimed at reducing the negative consequences associated with use. So rather than initially targeting the use itself, we’re looking at the consequences associated with that use.

Harm reduction really comprises a lot of different things. So this could be medication assisted treatment, it could be things like syringe access or the distribution of naloxone. But all of us kind of live with examples of harm reduction in our everyday life. I always point to designated driving as a great example. The designated driving campaign doesn’t assume that people won’t drink nor does it tell them to drink less. The implication is you do you, and then have someone drive you home after.

Again, the target is on not the act of drinking, the act of driving after drinking. So that’s really kind of the essence. Really important though, harm reduction is also a movement for social justice and it’s built on a belief in and a respect for the rights of people who use drugs. And as we all kind of spoke to before, there is still so much stigma and shame around substance use and people who struggle don’t always have a voice in their goals and in their treatment. And so harm reduction really seeks to advocate for people and show respect towards people. Even if we don’t necessarily agree with all the choices that they make, we want them to have a voice and we respect the path that they’re on.

Ben Caldwell: That makes a lot of good sense. That’s a great explanation of harm reduction. So thank you. I have a kind of follow up on that and you all I’m sure are familiar with NAADAC, the professional organization for substance use professionals. They’ve put out a legislative alert a couple of weeks ago talking about a federal bill and in their legislative alert, they expressed opposition to the decriminalization and recreational use of marijuana.

And they came back a day or two later saying, basically, “Wait a minute, let’s clarify here because we’re actually on board with decriminalization. That part’s okay. Our objection is recreational use and approving marijuana for recreational use.” So I’d be curious to hear from actually all of our panelists, what is your, I guess professional opinion or professional belief about recreational use of marijuana and this direction that we seem to be going in policy of not only decriminalizing, but also approving in many states for recreational use. And Kim, I’ll start with you just because you’ve been talking about harm reduction, but then Margot, I’ll go to you next and then Ashley.

Kimberly May: Yes. NAADAC did come out with that, but they are also approving of harm reduction. I know this because I presented to them just a week or two ago. But I did find that post a little bit questionable. The ways that we have approached addressing drug use and addiction has been quite punitive and a little hypocritical especially if you compare use to how we have legalized things like alcohol when they’re also just a psychoactive substance.

In harm reduction, there are big pushes for not only decriminalization, but legalizing as well simply because the other methods that we have tried have proven to be ineffective. And when we address what people are actually needing, what they are struggling with and we stop seeking to penalize them, then we really start to make progress in addressing not just the substance use, but the issues that are driving and sustaining ongoing use. If anyone’s curious, there’s a phenomenally fascinating research that’s been done in Portugal who decriminalized every drug and they have seen really impressive results in decreases in addiction, decreases in illegal activities, and it’s in many ways really done amazing things to improve their community.

Ben Caldwell: That’s great. Thank you. Margot, what do you think here?

Margot Chambers: I think it’s a really interesting question that I think I would have to think about some more. The populations that I’ve worked with 100% have been not harm reduction and the people that I’ve seen in my clinic have been 100% abstinence from all drugs and alcohol. And of course, I’ve seen a lot of success in a lot of cases that have not been successful. I think it’s very much on an individual basis of what people need. Chinese medicine is so based on the individual.

I don’t think there’s any blanket statements that work for anybody in my field. And I’m really open to the idea of all of it and I would love to see it in practice work, and I would be more than happy to… I would definitely work with people who are working with harm reduction tools. So as more and more studies come out that harm is the way to go and more of those people come into my practice, I would have a better idea. But right now for the last 12 years, it’s been 100% abstinence in my practice. So yeah.

Ben Caldwell: That makes sense. Ashley, I’m curious about your experience here because if you’re working with folks at various stages of use and recovery, I would imagine, that probably also impacts what you’re doing with them in terms of nutrition and treatment. What are your thoughts on decriminalization and legalization of marijuana?

Ashley Lytwyn: So I come from a background of abstinence-based treatment as well. However, I would say that my observation is the treatment overview is shifting as we are increasing the modes of harm reduction through creating resources for our clients and educating our clients on resources to access clean needles or to get naloxone spray or other modes of decreasing substance use and the criminalization of substance use. So I don’t think that… I would definitely have to think more about the decriminalization and the legalization of marijuana before I would make a statement about how I feel about it.

But I do think that the way that I’m seeing the treatment world shift is with the intention of improving our rates of sobriety and recovery in any which way that looks like. So I’ll give you another little example. When I began my journey as a dietician in the treatment industry, we were not using medically assisted treatment, so any type of medications that could help with overdose or help with cravings.

And a few years back, we shifted that and we look at MAT, we call it MAT, as something that can be extremely beneficial for long-term recovery. So I’ve seen a lot of shifts in that way, I’ve seen a lot of access to preventative tools that I do believe will ultimately help our community and our country at large.

Margot Chambers: I think I might’ve gotten it confused. I think for me, there’s a difference between the decriminalization of drugs and harm reduction. So I just want to say that as the criminologist in me really does believe in the decriminalization of drugs. But in regards to harm reduction and using harm reduction in my practice for substance use, that for me is a totally different subject. But I actually do believe in the decriminalization of drugs on a whole like what Oregon’s doing and things like that. I do believe in that.

Ben Caldwell: You’re drawing a distinction between what happens on a policy level versus what’s happening actually in the treatment room.

Margot Chambers: Exactly. Because I think I got the question wrong.

Ben Caldwell: There’s no wrong answers here, there’s only experiences. I’d like to go then to Ashley to hear about the intersection that you see between eating disorders and addiction.

Ashley Lytwyn: Sure. This is my absolute favorite thing to talk about and where my passion really lies, is that intersection between the eating disorder or those dysfunctional eating behaviors and the substance use disorder. Now as a dietician, you can think of me as someone who is like a little investigator. So if I’m working with someone and they’re recovering from substance use disorder or recovering from the eating disorder, I’m very, very specific about my assessment questions around the other diagnoses of either eating disorder versus substance use or substance use with eating disorder, because I see these diagnoses act in a whac-a-mole behavior.

So you know that game at Chuck E. Cheese or Carnival’s when you hit them all and the other one pops up? That is something that I see so often. And I can give you an example of that. I got a call last week from someone for a private practice work that is… she’s been sober from heroin for, I think it was something like 45 days and she can pinpoint the shame and the sadness that she feels about her body and her body image and her relationship to food is always a contributing factor to her substance use relapses.

And so I think that’s such a beautiful point of observation and insight into an individual’s journey because it’s saying… Just like Kim said, it’s not just about the drug, it’s about the whole picture, it’s about the whole package. And it’s looking at your relationship to self. And so I really, really like to help somebody understand their relationship to food, their relationship to their body and how that may play out in their use with substances.

I also kind of would like to map out their cycle or their patterns with body image and substance use disorder. So say for instance, someone is really, really low body image, really, really seeking validation, they might be so desperate for validation and connection that they engage in sexual behavior or other types of dating that might be around substance use disorder or using substances that could activate their substance use disorder.

And they might be using, and then they might come down off the drug and they are saying, “Oh my God, I can’t believe I did it again, I did it again.” And then that shame starts and then that body image piece starts and then that seeking validation starts. So I really like to map that cycle with my clients as well.

Ben Caldwell: That makes a lot of sense. I can’t remember where I heard this along the way. It might’ve been back in graduate school, but at some point I heard about the so-called holy trinity of self-harming behaviors, right? Of self-injury, substance use and eating disorder and how each of these can interrelate to one another and be various forms of coping. And that understanding that etiology is so important to treatment. And I think that’s a nice segue into our next question that comes from Geraldine. On the treatment side, how does acupuncture help those struggling with addiction? Margot?

Margot Chambers: Well, it’s an interesting question, a really, really big one. But I’ll start out by saying this. When I was first asked to work in the treatment world, I didn’t seek it out, they sought me out because what was happening is a lot of people were coming into treatment because of pain. So they were using opiates to deal with the pain situation. And when they got off the opiates, the treatment center did not have a lot of natural modalities to deal with the pain that was underlying the opiate use.

So they brought me in and we started to use acupuncture for pain management. And what happens is slowly but surely what they realized is that acupuncture can be used not just for pain, it was very, very successful in reducing pain and that’s what most people know it as, it stops physical pain. But what they didn’t realize is that because of the way the medicine works itself, it’s a very systematic medicine based on the organ systems, that we can actually not just treat pain, physical pain, but we also treat mental and emotional pain as well.

Because for us, it’s all one, the internal system works as one unit. So through our diagnostic methods, we look at the internal organ systems and see where there’s imbalances. And when we can find that imbalance, the imbalance then allows us to treat the body, mind and spirit triad. Because every single organ system inside the body has a systematic way to look at the body, mind, spirit through that organ system. And once we know that organ system is out of balance, we can use acupuncture to bring the organ system back into balance. And then the spiritual, mental and physical body goes back into balance as well.

So addiction for us is just a representative of an imbalance inside an organ system. So there’s a couple of ways that you can use it for addiction. One would be the nervous system. It’s really, really good to calm down the nervous system after you puncture, has been studied over and over through the brain. That shows that when you stick the acupuncture needles in, it actually calms down the system. It also releases dopamine and other chemicals inside the brain that are lacking for a lot of people who are using substances to increase these levels inside the brain so that they feel better. Acupuncture is really good at that.

And then a lot of people have heard of the NADA protocol. That’s the main system that has been used in addiction throughout the years. And the NADA protocol is five points inside the ear that actually reduce cravings inside the body. So when people are wanting to… it can be used in all levels of care, the NADA protocol obviously. And when people are dealing with all sorts of addiction, not just addiction to drugs and alcohol, but also food and other co-addictions, you can use the NADA protocol to bring down all of those cravings for people.

It was studied at heroin clinics in the ’70s and they found that the NADA protocol actually reduced cravings for heroin addicts and so we use that protocol as well. But acupuncture can be used for depression, anxiety, pain. Anything the physical and mental body goes through, acupuncture can help in balancing those things out.

Ben Caldwell: That’s great. And what I’m hearing from you is that acupuncture is not just symptom relief, but that really the action goes beyond that into addressing some of the underlying etiology that is driving the problematic substance use.

Margot Chambers: That’s the beauty of the collaboration with traditional Chinese medicine and addiction. You hit it right on the head. So we’re able through our systematic diagnostic tools that we get from traditional Chinese medicine, we’re actually able to feel these deep, deep imbalances that are going on in the body, not based the addiction. Some of it can come from the addiction, but these are deep internal organ imbalances that could have started when the person was born, right? And so to be able to diagnose those imbalances and treat them allows there to be a higher success rate for treatment of addiction.

Ben Caldwell: That’s wonderful. Thank you. I want to move us to our next question. This might be the last one we have time for before we get into final thoughts. But I want to make sure we do have some meaningful time to discuss this because it’s relevant to what’s happening in the world around us right now. This is from Gina. With a growing amount of people relapsing during the pandemic, how do you help clients stay motivated to stay sober?

6. With a growing amount of people relapsing during the pandemic, how do you help clients stay motivated to stay sober?

Ben Caldwell: I’m going to ask everyone about this, and I’m curious about this on a couple of different levels. First of all, just the question of how do you motivate clients and what is for many folks, a very, very difficult time to cope with in general. I’m also curious, while this certainly matches the experience of a lot of healthcare providers, do we have hard data about the scope of the problem that we are dealing with during the pandemic? Do we have a meaningful sense of how much more substance use, how much more relapse that we are seeing in the midst of this emergency? Kim, why don’t I start with you?

Kimberly May: So you’ve kind of got two questions in there. Regarding use during the pandemic, I don’t think we can have conclusive data because we’re still in it, but so far it appears that people are using at higher rates and they are overdosing at higher rates. And I think we are some years out from really having a full picture of what that looks like. In terms of helping people to stay motivated, so I work with clients who some are sober and are wanting to maintain that, others are seeking to maintain some moderation or they’re in different places.

But regardless of where somebody is, I’m a really big fan of motivational interviewing. And the writers of Motivational Interviewing, Miller and Rollnick, they talk about how the motivation is really fluid and it’s incredibly sensitive to the interactions between two people. And so I’m always very cognizant of that in working with people. I’m always cautious not to put a goal on someone. It matters not that I think someone should be sober. If that is not their goal, then I’m going to meet them, going back, I’m going to meet them where they are.

I do a lot of work in exploring ambivalence. People tend to be incredibly ambivalent about their use. And I think all too often, we label that ambivalence as denial or as lack of motivation. And more often than not, ambivalence is the sign of a healthy and functioning brain that’s capable of seeing gray areas around issues that are incredibly complex when we serve our clients well by helping them really deepen their understanding of their relationship to substances. And during the pandemic, it’s really critical that we help our clients kind of pivot with their changing needs.

A lot of people may have had really stable support systems for going to AA meetings or had access to drop in centers or people that they could see and connect with and touch that the pandemic has just eradicated a lot of those opportunities. And so a lot of, I think the motivation comes from just helping people meet their basic needs. What do you need right now to feel connected, to feel supported, to feel healthy and like your stress is managed?

And sometimes when we come at it through that general angle of what do you need, we are also kind of starting to figure out what they need also to remain sober. But sometimes coming at it just from the place of sobriety feels a little too much or a little too pushy. So taking that wider lens can be helpful.

Ben Caldwell: Yeah, that’s great. Thank you. Ashley?

Ashley Lytwyn: Sure. I don’t have any hard data that would help us understand the increase of relapse, overdose or substance use rates right now. However, I do have anecdotal data and I do observe a large increase of people that are struggling with substance use disorder right now, and I’m seeing that from the treatment side of things and the private practice side of things. So people are still going to treatment. People are still… even though we’re in the midst of a pandemic, we are still fighting to decrease the stigma of addiction and increase the access to longer care.

And if treatment is a part of that plan, they are still taking flights, they are still attending treatment in person with the safety protocols. And I think that this is something really interesting because I am a huge proponent of every single safety measure that Dr. Fauci or the CDC, or the scientists that are leading our country. I take every single recommendation and I want to keep all of our clients safe. And I still know the incredible influence, positive influence on someone’s sobriety when they are in person in treatment and really, really healing together.

So with that being said, from a private practice standpoint, this is kind of an interesting thing because some people… we do talk about Zoom fatigue, and we do talk about being on the screen all the time. So the question might be how to increase and meet your needs in other ways, in other safe ways? Another thing that I might think about is, is the client that I’m working with, is part of their substance use cycle with using or abusing substances online and can virtual support groups be activating for someone’s substance use disorder?

So really having those conversations with our clients and understanding what it is that they need as an individual. Because there are safe, socially distanced, in-person meetings that could be more appropriate for someone than others. So I don’t do the best at this, but I like to really decrease my own bias, the lens that I see the world through. And if I do see people traveling, or if I see people at a park in groups, I really want to remind myself, I don’t know what the reason behind them getting into a group or getting onto a plane.

It might be going to save their life just like anybody with a physical disease that isn’t as stigmatized as addiction might need in these times, or anyone without a disease, it doesn’t matter, just a human or animals because animals need love. So really how to stay motivated is really looking at that picture, looking at what is going to work for the individual and how to create a foundation and really a relationship in the home, whether that is cooking more or we see the sourdough bread phases and the gardening phases and all these things, how can we get some of that hands-on? And I come into the picture with the hands-on nutrition skills to create and continue that motivation for sobriety and for recovery.

Ben Caldwell: Yeah, it makes a lot of sense. And you’re speaking to something that’s near and dear to my heart as an MFT about the importance of relationships and helping people stay connected, stay motivated, stay committed to whatever recovery process they’re engaged in. Margot, I’ll give you the last word here. How do you help clients stay motivated to stay sober?

Margot Chambers: Well, I have to say that loneliness has been pervasive throughout all of my clients in my private practice. I’ve been lucky enough, I call it lucky enough, to be able to have protocols where I actually have stayed open. So I get in-person treatment with my clients, and that has been more important than ever. So I have been in contact with my clients, every single one of my clients, more than ever on the phone, through tele-health, in-person because loneliness is really driving my clients to want to not stay sober.

And so I’m trying to have as much contact with them as possible and create a safe space where it’s okay to not be okay because a lot of people are not okay right now and it’s okay to come in and talk about it and figure out some coping mechanisms that we need now more than ever, that we’ve never needed in the past and trying to figure out a good system for them that is different from what they’ve done in the past that is going to keep them sober. And for a lot of them, it’s contact.

So I’ve just been having more contact than ever with all of my clients. And I’m finding actually in treatment, the work I do in treatment, people are staying at least 90 days, which really interesting that we have a ton of long-term treatment happening. Through the years I’ve seen a lot of different types of treatment, but right now during COVID, people are staying in treatment for long periods of time. So I think that attests to people wanting to be connected with other people and not be alone during this time.

Ben Caldwell: Absolutely. I think it has been really well put. I’m going to skip us past the remaining questions here because I want to get to final thoughts. And I think in the limited time that we have here, I wonder if I could get each of you to talk about next steps for a clinician who maybe is working with clients who have struggles with substance use, but they’re not as familiar with your particular line of work.

7. What would the next steps be for a clinician who maybe is working with clients who have struggles with substance use, but they’re not as familiar with your particular line of work?

Ben Caldwell: If that clinician was wanting to better integrate harm reduction or eating disorder treatment or acupuncture and Chinese medicine into the recovery process for their clients who want that, what should that clinician do next? Where do they look? Where do they go? What do they need to learn? And Ashley I’ll start with you and then Margot and Kim we’ll close out with you.

Ashley Lytwyn: Sure. There is a lot of resources to help build your understanding as a clinician in terms of the addiction and eating disorder. I would say that there are less resources in terms of nutrition for addiction. However, it is a growing body of research and of support and supervision for new clinicians. I know that this might sound silly, but the best places that I see a lot of like-minded clinicians buying together to talk about best practices and resources are Facebook groups that are specifically tailored to what it is that you want to do with your career or what type of population you might want to work with.

So I know I personally am involved with eating disorder Facebook groups and the substance use and eating disorder mental health intersection Facebook group where it’s a small group of people, but there’s a beautiful, beautiful amount of information. So if anybody is watching and wants any more resources about where to find those types of groups or trainings or coaches that might help along those parts of your career, I would be happy to help anyone find those resources.

Ben Caldwell: And we’ll make sure to include contact information for you in the follow-up email that goes out to our viewers after we’re completed today so that people can reach out to you. Thank you so much, Ashley. Margot?

Margot Chambers: It’s so funny because I’ve been in traditional Chinese medicine for so long that I tend to believe that everybody knows about it and knows how to get in touch with an acupuncturist. But still to this day, it’s kind of a mystery medicine for a lot of people and a lot of treatment centers and psychologists and psychiatrists and such have not integrated traditional Chinese medicine into their practices and it’s a little bit more of a mystery.

And there’s no real general database to find answers which definitely should have them because using traditional Chinese medicine systematically for addiction is so incredibly successful for the patient. And I guess I would say the same thing. If you have any questions or need any resources, I have a ton all over the world because of how long I’ve been working in treatment. So you can definitely get a hold of me and I’d be happy to refer you to anybody in your area in the United States or outside of the United States and help you integrate this medicine into your practice. Because it is a beautiful synergy with working with addiction. I hope that’s helpful.

Ben Caldwell: Yeah. That’s very kind of you, I hope you’re not going to mind having a busy inbox for a while.

Margot Chambers: Yeah. I don’t mind at all. My hope and dream is that everybody has one Eastern doctor and one Western doctor. So that would be my dream for everybody.

Ben Caldwell: That’s great. Thank you so much Margot. And Kim, I’ll give you the last word here. How can people better learn about and integrate harm reduction?

Kimberly May: Certainly. In terms of integration, the number one thing in harm reduction is just to start redefining success and seeing progress and small steps and safer practices as success. And if you are able to do that, God, that’s half of it right there. But in terms of kind of actual more information, the National Harm Reduction Coalition has amazing website, tons of information, ways to learn about the different facets of harm reduction, how to advocate, how to get involved, how to just find other resources.

For people who want a little bit more clinical information, there’s a great book, it’s called Over the Influence. It’s by Patt Denning and Jeannie Little. It’s written kind of for clients or for clinicians and it’s a great overview on the harm reduction kind of view on substance use. And then it also gives really a specific harm reduction strategies for different types of substances, be it stimulants or opioids.

And as the others have offered, I’m always happy to be contacted with questions or lists of resources because resources do vary drastically depending on your region. But there are lots of resources and lots of information, and we certainly need more people interested and passionate about harm reduction. So thank you the participants for the questions and thank you for the opportunity to be a panelist today.

Margot Chambers: Yeah, thank you.

Ben Caldwell: Well, we are very, very happy to have you all with us. This is very kind of you to give your time, your wisdom, your expertise. So we really appreciate it more than we can say. Thank you so, so much. This work is critical, especially at this time. To everyone in attendance, again, you’ll get a follow-up email shortly that’s got some additional resources and has a link to the recording of this webinar. And if you are engaged in substance use treatment, your work is really critical at this time.

And I know it’s been, for a lot of health and wellness providers in a whole lot of different areas, a very challenging year. And so from all of us at SimplePractice, we just really want to reinforce how important your work is, how valuable it is, how grateful we are for it. Thank you so, so much for spending part of your day with us. Once again, I’m Ben Caldwell. On behalf of all of us at SimplePractice and SimplePractice Learning, take care.

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