You're always fine

[Interview] Breaking through the discomfort of addiction with Holly Wade, MA LCPC

• Holly Wade, MA, LCPS • Season 1 • Episode 11

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Join us for an intimate dialogue with the knowledgeable Holly Wade, MA, LCPC, whose wealth of experience from the mental health field and her active role in Maryland's Physician Health Program and Health Professionals Program makes her an authority in this space. We navigate through the shadowy corridors of substance use disorder stigmatization among healthcare professionals, an area that doesn't get nearly enough focus. Discover why it is essential for these individuals to have a secure and empathetic environment to lean on for help and how the fear of judgment can often be a hindrance. 

As we dive deeper, we shed light on the paradox of how medical professionals, despite having access to medication, can get ensnared in the clutches of addiction. Together with Holly, we probe into the normalization of substances in society, a factor that can blind people from recognizing their own addictions. We also discuss how the pandemic has altered coping mechanisms, leading to increased substance use. Gaining an understanding of the common misconceptions surrounding substance use disorders, we emphasize the need for compassion and patience to help those battling addiction. This episode is an invitation for anyone interested in breaking the barriers and misunderstandings surrounding addiction and mental health in our society.

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Speaker 1:

Welcome back to You're Always Fine a space to show up for yourself and embrace the mess that lives underneath. Because, let's be real, it's exhausting always being fine. So grab your headphones and allow yourself to listen, laugh and even cry, because you are not alone. And we aren't always fine, and that's okay.

Speaker 2:

October is Addiction Recovery Awareness Month. I know I speak for our whole team saying this month and every month, we are committed to breaking the stigma around substance use disorder and all mental illness. The best way we can do that is to continue to have the difficult, uncomfortable conversations about the taboo topics of mental health, and that is just what we have planned for you today. I'm your host, christine, and today I am joined by guest host Holly Wade, ma LCPC. Holly has over 18 years of experience working in mental health and currently serves the mental health needs of healthcare professionals. Her expertise in the areas of healthcare and substance use disorder is why we asked her here today. With that welcome, holly. Thank you so much for being here with us today.

Speaker 3:

Thanks for having me today.

Speaker 2:

So, Holly, can you give us a brief introduction on yourself and tell us you know, your background and your work experience?

Speaker 3:

Sure, my name is Holly Wade and I'm a licensed therapist in Maryland and Pennsylvania and I've been in the CL 20 years. I finished graduate school 20 years ago. I'm also a licensed clinical art therapist and have a board certification in clinical art therapy and I've worked in a predominantly in inpatient settings for most of my career and in health systems for most of my career, and currently I work in Maryland's physician health program and their health professionals program.

Speaker 2:

So can you tell us a little bit about, like your specialty or kind of what your passion is within the field of counseling?

Speaker 3:

And yeah, so for the last 10 years my first love was community mental health. I absolutely loved working in community health settings. Inpatient psych was I would say that was my first love. And as my career progressed and I, you know, started working in larger health systems, my experience shifted from community mental health that addresses mental health and substance abuse to helping health care professionals get the care they need and making sure people were in the right level of care. The right level of time was what I did for 10 years and that was mental health and substance abuse and that was predominantly for health care professionals and it kind of seamlessly transitioned to my work for the Maryland physician health program and the health professionals program. The state of Maryland.

Speaker 2:

Can you tell us a little bit more about that role specifically, like your aim is, what your goal is, as well as how, like substance use disorder kind of like wraps into that role?

Speaker 3:

Sure. So the program I work for presently really works to help health care professionals get the care they need in a confidential way. Every state has them and all health systems generally have agreements with them. So mental health and substance abuse, particularly substance abuse, I want to highlight today.

Speaker 3:

If you were, as a health care professional, to go to your employer and say I think I have a problem, the American with Disabilities Act protects you and protects your job and it protects your ability to work with a disease, because it is a disease, and I think people are petrified to get help, sometimes because they are afraid of they're completely afraid of it destroying their career. But what most people don't know is when you have disease and you say I need help and I need assistance, there's tons of resources built into every health system, not only to protect their employees but to get them the help they need, and we work with health professional programs. All over the United States there's treatment facilities that specialize in health care professionals and the aim of our program is to keep people healthy and in general that could include something like monitoring afterwards, but which would look like drug testing afterwards, like the real thing. That's the most important is people are getting help when they need it.

Speaker 2:

Why do you think people don't know? I mean, I'm not even sure it was until, like, honestly, this weekend my sister was over with her husband and we were just talking about random drug texts at work and he was like you know, I bet you, your job has something too that would protect you. Like I was like really surprised that like his company would like send him away for 30 days, save his job, but also like pay for the facility. And I was just like maybe because like we had this episode coming up with you and so I was like top of my mind, but so why do you think so many people just don't know that like that's like a thing?

Speaker 3:

Well, I think you know, from one stance, employers don't do a great enough job when they're using people to their protections. You know every orientation everywhere does include some kind of quickie on the American with Disabilities Act. And do you need accommodation? The people don't really think of accommodations as needing help. Right, it's oh, I need a ramp to get in the building if I'm a wheelchair, in a wheelchair, if I'm using a motorized scooter, I have access to do my job within whatever supports I need. But I think when it's something you can't see and touch, you know you don't look different.

Speaker 3:

People who struggle with substance abuse and substance use disorders in general look just like the rest of us. And in it in healthcare I think there's we are taught early in our careers muscle through it right, power through it. You're exhausted, the ER is getting slammed, you have to go do evaluations in an ER. You're going to muscle through it and push through it Like. I think healthcare professionals in general have a sense that we have to keep going because it's it's this well-oiled machine right and if one of the parts breaks down, we're like that's going to break down other parts of the system.

Speaker 3:

So you know, healthcare is dynamic in a very different way because people's lives are at stake. So you know, I think that what I have seen and observed over the years is pure fear and it and sometimes people know they are misusing substances or they are burned out, they are leaning into alcohol more than they normally would or other substances. There's, you know, lots of research that shows if you're in healthcare you have access to other medications too, like most addictions with an anesthesiology, you know. Yes, some are alcoholism. However, there's access to other drugs. So we also have friends with prescription pads. Right, we all find doctors who are friends and the access is just there. And a lot of times we think we can handle it on our own and muscle it, muscle through it and power through it. And there are breaks. People break down, there's a breakdown point with everyone where they can't be born.

Speaker 2:

Do you think that healthcare and the unique like pain points that they go through, you know systems, the pressures like? Is there research that like shows that the substance abuse like is higher in this population?

Speaker 3:

Like you would think that right, but it's not you would. You would think that it definitely escalated during the pandemic.

Speaker 2:

Okay, that makes sense.

Speaker 3:

So, like a lot of individuals who had their disease managed, there was a greater instance of relapse amongst healthcare professionals during the pandemic and there was a medscape study that referenced that recently. However, they are the same slice as the general population, which is amazing and it really just goes to show we all have great coping mechanisms as human beings. Right, we're not generally born with them. We learn them from our surroundings or models for us, like people we love and care, but they're no more likely than the general public. However, they have admitted to use like. I think it's like 12 to 14% admitting to use, to using a substance or being impaired at work at some point during a career, and that's the general population too. So the general population is 12 to 14%. All individuals have substance use disorders and it's no different for healthcare professionals.

Speaker 2:

You're right. I just would have assumed you know just the high burnout rates, the high pressure situations, like you said. But I think it also goes to shows too, just like how prevalent it is. Like you know, and it just, it doesn't spare.

Speaker 3:

It doesn't and what I think that somehow is mind boggling and I still struggle at this. As someone who's worked with individuals, my entire career Like I have my family is touched. There's not one family on the planet that's not touched by someone that's substance use issues right. We would never be told we have a cancer diagnosis and say I'm not way, five years for treatment. Most of the population there could be a fraction of the population.

Speaker 3:

I hate to over generalize, but if you found out you had a disease, you wouldn't say let me put a pin in that because I think I can beat it without treatment. We would never do that right. And no doctor would say to their patient okay, you're drinking a gallon of Westia Day, you try and handle that on your own Because there's so many risks that could go with that. You know when someone detoxes from alcohol they could have delirium tremens, they can have psychosis, all these highly dangerous things like seizures. So it's never something people should try and muscle through on their own. And death happens when people try and detox themselves from alcohol. They die, they can die.

Speaker 2:

And I think one of the things you said that really resonates with me is just like back to like this invisible type of disease or struggle. Like we would never tell someone not to take their diabetes medication or not to ask for accommodation around diabetes, but yet like this is something that has like more of a shame element around it.

Speaker 3:

Yeah, very much so, and I feel like mental health did too, until the pandemic. You're a social worker also. We've worked in a field where we were like the disregarded stepchild of healthcare, where only really like the pandemic.

Speaker 3:

It is, it's true. You know, only with the pandemic where people like, oh, this is real, because people who maybe were able did have really good ego strength and can keep it together for a while, all of a sudden couldn't Because we were inundated with death. Like, humans are not built to withstand death the way people were dying in the beginning of the pandemics and different parts of our country were hit harder than others. But you know we're not built to withstand that as humans, we're just not. So it's really. You know, in a way you would never want to say a pandemic is a blessing, but we can look for this overlining and everything. It's highlighting things that are very real and you know.

Speaker 3:

So, like the program I work for, it's been around for 45 years, started in the 1970s with doctors saying we have colleagues that need help and now you know many states are like Maryland. It expands to all healthcare professions and they can. You know some of the boards have their own programs but, like nursing boards in Maryland have their own program. However, we've gotten nurse practitioners and PAs through our program when it's confidential and they don't want it to be public. So it's just really important that people get help.

Speaker 2:

I agree. Do you think that there's still like your program is seen as a punishment or as help Cause, like I could, I could see it being not that you guys do anything to make it, but like no, no, no, no yeah. You know, like I think sometimes, like even when you admit you like it's help, it can feel punitive.

Speaker 3:

It really can and so, like in our program, we have relationships with all the larger health systems so people can be volunteer to come Like we really think you need help.

Speaker 3:

We see you trying, it's time you need the help and some people come to us too, but that you know there's a lot of stuff that goes into remaining sober and healthcare professional programs work because there's in general five years of monitoring, like three to five years. Allied health professionals they generally monitor for three, and doctors and PAs and therapists generally get five years of monitoring and that's random drug screens and a lots of times employers will pay for them, which was people don't know like they can just have it done while they're at work. They go to Ock, they get selected, they go to Ock Health and have a drug test that day and people come in kicking and screaming, even when they self refer and think about it because you're facing something and now you have to process all the ceilings you have around it, whether it's your own guilt and shame or feeling like I inherited this and I didn't ask for it and I'm mad and I didn't want it and that's the same process that anyone with any disease goes through, right.

Speaker 2:

There's the anger, there's shame. No, true? I mean, I can speak just like I have a rare disease and like I feel like everything you're saying hits home, for like that exact thing, like processing that, you know yeah.

Speaker 3:

And alcohol is so normalized and like I'm using alcohol as an example, in some states it's cannabis. Like we, if you go out to a party and you're not having it, you're not drinking. That night People will be like, oh, you're not drinking. We would never say to someone, oh, you're not smoking cigarettes, oh, you're not smoking a joint. Like it's just alcohol has become so normalized culturally. It's like very much part of our culture as we live and breathe in a day in and day out basis.

Speaker 3:

Like my mother's family was from Italy and owned wineries in Italy and made wine. So like wine was something that was always around. You know, like most of many cultures, you're raised with some kind of a parity for you know drink. Or you know in South America there's some. You know people chew on a cocoa plant for altitude sickness. So it's not like unique to our culture, but it's just something that's seen as quite normal. You know, in the rise of psychedelics we're not hearing people going oh, you don't do ketamine at home. You know, with Mind Loom or one of those apps, because that's still stigmatized. But the truth is, in healthcare people have access to medications that are addictive. They're addictive, you know they have access to medications that are used scientifically, with micro dosing, that people try it on themselves too.

Speaker 2:

So it's Do you think that's one of the unique kind of like things about healthcare that you don't see in other substance abuse populations? Yeah, that they can, they have so much access, but it like it makes sense, like I have been in times where I couldn't get access to my medication and like you know what, like if I had a pad I can't. Like I've been in that much pain where it's, like you know, I could have seen myself in those like very dark moments and that's no different than I think, right, like your why doesn't really change. Like crossing that line, right Cause, like everyone's why feels very real to them.

Speaker 3:

Yeah, it does. And you know when you are let's say, you have unmanaged depression, right, and you're a resident A lot of the issues start in residency and you are overwhelmed but yet you're an anesthesiologist. So you just decide I'm going to try and microjose. You have access. You have access to things that are that are used commonly in anesthesia or in other pre-experimental procedures. We all have access. Well, I don't because I don't prescribe, but you know I have access to people with those things. So if someone is that desperate they may extend that and there is some research to support that.

Speaker 3:

Healthcare professionals use different things in the general population, like they're more likely to be using discarded fentanyl and discarded you know ketamine and verset and propofol, like things that are quite powerful. That's why you see a lot of health systems really tightening up on on PIXAS systems. You know it's common in healthcare Nurse practitioners to say you know there've been many cases over the years where people are writing their own scripts or writing them to a family member and getting them filled for a like quote, unquote family member. But it's really that Because when you are, when you, when the physical dependence is there and the disease is active, it's no different than someone on the street saying I'm going to go by a pill that they're telling me is this in the hopes that it really is, that they know, logically, that may not be. You know, um, adderall are sent and all that they're buying on the street, but they're taking the risk because their body is withdrawing and they are dependent. So, yeah, yeah.

Speaker 2:

And I think you know it's so funny In school. One of the things like that we were taught very early on was you know, know what you can't like, what is your trigger points? I like what you can't kind of I forget the word like basically just like, know where you can't go, essentially right. And for me, substance abuse, just with like my family's history was somewhere like that was just automatically like, just difficult for me and it's very hard for me to draw those like lines, you know, and to make sure a parallel process, counter-transference, all that stuff isn't a hurry. What do you think like? What do you think it is like that drew you like? You know, like I don't think the work is for everyone.

Speaker 3:

No, so it's not for everyone and I can honestly say in graduate school I got placed at a drug rehab. It was called the Oksan Center. It was on Long Island. Originally from New York and I I'm from New York I love New York.

Speaker 3:

I love New York and so I was working in my clinical internship for, and doing my thesis research at a substance abuse facility and that's what I wrote my thesis on. And I really, you know, I knew I had family members, like in my extended family, who struggled and had been in treatment and what I realized is most of them had some kind of. It began innocently, like I never met one person who woke up and said I'm going to go out and buy heroin on the street and just become a heroin addict Because what the hell? Like? Sorry, I hope that's okay to say but I have never met one person, you know, and I was working with adolescents at the time.

Speaker 3:

The adolescents had, they had pain, deep emotional pain that led them to their first exposure and then dependence formed and they all had backgrounds at it. But culturally people have covered it up so many generations and generations, right, there's always just oh, that's Uncle Charlie who passed out on the couch. You know it's been covered up because it's uncomfortable and mental health's uncomfortable. And like you said, christine, we all have those areas that were like, not for me, like I can't do it, and most of us have been in therapy. My graduate program encouraged us to be in therapy and I remember fighting it and it was like the best thing I ever did.

Speaker 2:

Me too. And while you always like you can't graduate unless you do, and it was the biggest blessing. Yeah, it really was.

Speaker 3:

It really was and it's interesting because, like it was something that I didn't have a lot of exposure to until my internship. And then I started researching and I love research. I'm a little bit of a research nerd, but the more and more I sound was like so many of these people had things that they never asked for to happen to them and no one asks for genetics to load them with something and you never know until the exposure right. So you don't know you're an alcoholic until you're exposed to alcohol and then you can't stop drinking and a lot of people have really amazing coping skills and were taught amazing coping skills and it's not until something like a pandemic happens and they realize they're just drinking a little more. They had more downtime.

Speaker 3:

The work they were doing wasn't allowing them into the job. Some days their hours were cut back, they had to dress like they were going into a hazmat situation which looked like something out of ET with the white suits. I mean, if anyone ended up in the hospital at all during the pandemic, you know that you just kind of like swabbed, like something out of the set movie with Ebola and their outbreak like movie outbreak. You know when people come in in suits and would swab you first and it was really an experience that people's coping laughed like they lapped your coping skills broke down.

Speaker 3:

And it broke down and people comforted Like you find that way to comfort yourselves and so for some people they didn't realize alcohol was an issue for them because it's not something they engaged in with any regularity. So they didn't realize they had a dependence or a predisposition to a dependence.

Speaker 2:

One thing you said that I constantly say to a lot of my clients for different situations, but I think it really rings true here too no one, if you get to start at the outcome right, and the outcome is like I'm going to be an alcoholic, I'm going to hit rock bottom, I'm going to lose my family, this right Like who would choose that for themselves? No one, and that's exactly no one, would choose the steps that get to the outcome, and so this isn't a choice, you know, like that people aren't making. From my experience, like I think people forget, like, and I think a younger version of myself, when that was really hard for me, as like a young practitioner, right, like you know, I look back at baby me I think this version of myself, you know can, could have handled substance abuse much differently.

Speaker 3:

Right.

Speaker 2:

Like that's kind of not how your career goes, but in the beginning, like I really struggled because of my personal relationships, like well, you chose that instead of us. Right, like you could have lived, but you did it.

Speaker 3:

Yeah, and I think it's a hard thing for a lot of society to get over. They see that is like and AA uses like a phrase like basically it's like a moral character flaw. But it's not a character flaw, it's a disease, and I think that people have to remember. Like you know, they may have chosen to engage socially and be exposed to something. Sometimes people's first exposure is the dentist. Years ago in the 90s and the 80s, they were writing out opiates all the time. I got my wisdom teeth out, I think they gave me like coding and all this other stuff For me. I'm actually like biologically allergic to those things, so I ended up with a rash and had a flax system and all sorts of terrible stuff. So I mean that.

Speaker 2:

Your natural contact questions are okay.

Speaker 3:

Like my, consequences are different, but I definitely think that people think people always choose the exposure, because we live in a society where alcohol is so normal and someone starts by having a glass of wine here and there and you don't want the bottle to go bad. So you have another and you don't know, you're like loaded with the predistosition. You don't choose it. You may have exposed yourself intentionally or unintentionally, but it's not a choice and I think it is hard. But it's the same reason. Mental health is hard, right. You can't see it, you can't touch it, you can't feel it. It's not a mass.

Speaker 2:

A society is not good with things that we can't see. I mean, it always makes me laugh, right, Because we found a way for cancer, but really chemo makes someone look like a cancer patient. Cancer is just a replication of your proteins. You know what I mean.

Speaker 3:

You can't see cancer.

Speaker 2:

That's not editing out. You can't see cancer happening, right, but chemo makes you lose your hair and that makes it tangible. But these things that are, like you said, happening, just like all mental health, are really, really hard, and I think that that's why it was so important for us during. October is substance abuse awareness month, and we're really trying to get the message out, because there's so many misconceptions. I know we just talked about a few, but are there any other misconceptions, holly, that you would like to point out? I mean, you gave a break in the beginning about.

Speaker 3:

Yeah, one of the things I want to say is because you need help does not mean you were messed up or there was something wrong with you. I have had more people sit in my office for assessments and say, wow, I must be really messed up and I'm like you're human. You're human. We all have genetic flaws. We might know some of them now. We might know some of them in 20 or 30 years. We don't know what our genetic flaws are until they express. We are human and flawed. There is no quote unquote perfect human specimen, because we are vulnerable to disease and genetics play a huge, huge, huge role in that and that.

Speaker 3:

When I people sit in my office, I'm like normal people, healthy people, go to therapy and get help. Normal people, healthy people, deal with substance use and I had a colleague who it's a physician, who is someone I tremendously respect, and he said once there's nothing wrong with being an alcoholic. There's nothing wrong with being an alcoholic. There's everything wrong with being an alcoholic and drinking, but there's nothing wrong with being an alcoholic. And I really it struck me and I really just was like and I said to him I'm going to use that phrase, I'm using it with everyone at those male first, because I think the stigma is what we put on ourselves and what society puts on us and people have shame over, they feel like they must be bad because they quote unquote allowed some you know a substance to take over but they didn't allow it. And it's really shifting that mindset that we have to really work on as a society and you're not messed up or flawed or wrong or bad human because you struggle with substance use issues. I mean, it's just nothing about your character.

Speaker 2:

Oof, I those. Those hit hard and I love, just like the conviction in which, like you, have those like ready to dispel, like poop, poop, poop, just spelling the stigma. I love it. So, holly, one last question for you. You know, maybe you're not the one that's struggling with the substance, but maybe you have a friend or a family member. What is your kind of your best advice or a tool or a tip you can give them on how how they can support their loved ones?

Speaker 3:

You know, I think that supporting your loved ones comes with educating yourself and that that sounds like a really like how am I helping someone if I'm focusing on learning as you learn and you focus on learning, you're going to learn how to set the right boundaries. So you're giving a safety net for your loved one but you're not enabling behaviors as they, as they fight the disease, like you wouldn't allow a diabetic to throw their insulin out. You're not going to. You're going to have a safety net in place for that and you're going to have a safety net in place to have your loved ones go to treatment. And setting boundaries is a really important, important part of being supported to your loved ones. Boundaries are healthy, they're good, they're structure and it helps people find their own motivation for getting well. Because it's scary, it's very scary to get well. That is what I hear the most. It is scary Because what am I going to do? And so being kind of that supportive structure around, like if you kind of think of like no-transcript, when you're building a house, they're scaffolding and stuff right, there's all these pieces around structure being built. Educating yourself as a loved one is saying, okay, I may not be the person to give to address this with them, but I'm gonna find someone who is. If you're being harmed by someone who is kind of in the throngs of the disease, it's setting the boundaries to keep you all safe. It keeps them safe. You know jail. It keeps you safe physically and structure and boundaries are really important and working with healthcare professionals to understand it.

Speaker 3:

Treatment centers will talk to families for free. You do not have to pay to talk to a treatment center. People will give you their phone numbers. You can reach out and you know. The Substance Abuse and Mental Health Administration, samhsa, online has lots of guides NIH health guides. Nida the National Institute on Drug Abuse, has guides on how to talk to family members. There's amazing resources out there. But education is the key and really the key to having success moving forward, even when it's yourself, like if it's someone who says they need help, knowing maybe they need monitoring. It might feel like punishment having to get drug tested, but maybe that's accountability they need. I like that To remember to like quote unquote take the medicine. Like do the work If you are on meds, take your meds.

Speaker 2:

The good mindset. That is a great mind shift, I think. Change like take away the punishment and consider it accountability, like that's a lot that, Holly.

Speaker 3:

Right. I mean, if a diabetic went into a diabetic coma because they keep eating, you know copious amounts of sugar and have a blood sugar of 500, you know we would say you cannot continue to do this and then kill yourself. Yeah, you're gonna kill yourself or this is how we can help you and you know it's no different. But education is key and we educate for everything. Like you go to the hospital, you get checked in, you send you a packet when you go home with education. I remember that when I had my son. I remember that when Yana's appendix out, like we got this whole thing about recovering in aftercare, yeah, and I think we have to do a better job. But you know education and understanding like the disease process is key, holly thank you so much for being here with us and sharing your expertise.

Speaker 2:

I know I love working with you. I know we love working with Medkai and the work you guys are doing there. Again, just thank you, thank you. Oh, thank you so much and.

Speaker 3:

I love Kibana, which is why I got involved. I love helping healthcare professionals and really pretty passionate about it.

Speaker 2:

If you enjoyed this episode go ahead and leave us a review. We love hearing from you guys, and it means the world to our small podcast team. Lauren and I will be packed next week for another brand new episode of You're Always Fine. Until then, mind your health. Seriously, you're fine. You're fine because you have the power to access your place of peace anytime you need it. However, if you get stuck, we're right at the palm of your hand to help Check out our show notes for this week's source list, recommended content and Kibana live group schedule. We'll catch you next week for a brand new episode of You're Always Fine.

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Kristine Hoestermann

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Theresa Thomas

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