Podcast: Addressing Stigma in Rural Communities Through Art and Workshops [#34]
Today, we’re talking about Stigma in rural communities with the Recovery Center of Excellence. We’ll discuss everything there is to know about Stigma in rural communities specifically related to opioid use disorder. The campaign applies the practices of education and contact through art and workshops in rural Appalachian communities. It uses art to dismantle stigma and to humanize those affected by the opioid crisis.
The Recovery Center of Excellence was established by HRSA’s Rural Communities Opioid Response Program to address morbidity, mortality, and other harmful effects of substance use disorder (SUD), especially relating to synthetic opioids. They’re adapting best practices to address needs in rural communities and disseminating resources widely. They’re also implementing programs to expand treatment and recovery resources in rural Appalachian New York.
Stigma in rural communities
Opioid use disorder (OUD) is highly stigmatized, and this stigma stands in the way of our progress in the opioid crisis. In rural communities, individuals with a substance use disorder (SUD) such as OUD have less access to providers and resources. Stigma and a lack of anonymity are additional barriers to seeking care. Healthcare providers who have stigmatizing views may treat individuals with OUD differently or not offer certain services. Stigma stands in the way of patients’ and providers’ utilization of medications for opioid use disorder (MOUD).
Stigma can negatively impact a person with SUD in many ways, including their mental and physical health, housing, work, and relationships. The pain and isolation from being stigmatized can also result in more drug taking.
Solutions
Research shows that stigmatizing beliefs around SUD can be reduced by bringing people into contact with a person who has the stigmatized medical condition and educating them about effective treatments and the potential for recovery. Education and contact that humanize people with OUD can shift attitudes and perceptions. Building awareness that OUD is a chronic, relapsing, yet treatable condition can help promote hope among individuals with OUD, community members, and healthcare providers. Efforts to reduce and address specific types of stigma include:
Educational opportunities for healthcare providers and support structures such as clinical supervision. Education as well as contact have led to reduced discomfort, increased responsibility, and reduced stigmatizing attitudes toward people with OUD.
Marketing campaigns to educate the public about OUD and treatment, developed and implemented collaboratively in communities.
Churches supporting individuals and families impacted by the opioid crisis in the Appalachian region, recognizing and attempting to diminish stigmatizing attitudes.
Episode Links:
Transcript
Dave: Before we start the show, I wanna tell you about the Prevention Leaders cohort with my partners at HueLife.
This is the last month to get signed up for cohort number five. Yes. Cohort number five, kicking off in March with our first session going in April of 2023. This journey has five intensives that transform personal facilitation and leadership skills. It's really focused on developing capacity, skills and abilities of prevention leaders to create an inclusive, engaging and participatory environment.
Human experience will be at the center of this learning journey and in between those intensives, engagement with accountability partners each other and support by mentors will, will enable you as a prevention leader to build stronger relationships, support systems, and continue your learning together much beyond the program. So there'll be a link in these show notes for that as well.
If you are interested, send me a message. If you know somebody that might be interested, send this info along to them as well. Space is limited and we're kicking off pretty soon.
Dave: Hey everybody. This is Dave Closson from DJC Solutions, and you're listening to the Prevention Leaders Podcast, the show that brings you conversations with like-minded and driven prevention professionals from across the globe. All right, so for today's episode, today we're talking about stigma in rural communities with Lee and Tedra, a team from the recovery center of excellence.
We'll discuss everything there is to know about stigma in rural communities, specifically related to opioid use disorder. They're gonna unpack one campaign that applies the practices of education and contact through art and workshops in rural Appalachian communities,
it uses art to dismantle stigma and to humanize those affected by the opioid crisis. A lot of fascinating information and fascinating work going on. So without further ado, welcome Lee and Tedra.
Tedra: Thank you so much. It's a pleasure and honor to be here.
Lisham: So excited to be here. Thanks so much for having.
Dave: Now little backstory for the listeners. I've been doing some work with some folks in Kentucky in Prestonsburg, and they were telling me about these big murals and how they're, they're connected to, to stories. About opioid use disorder and like Dave, you need to to meet the folks that that make this happen, that created this campaign. And alas, here we are to have a conversation to learn more about what y'all do. But before we really dig into this awesome campaign and the great work. I'd so take a moment and let you introduce yourselves a little bit for our listeners. Now, Lee Tedra, who wants to go first?
Tedra: Lee, you go first cuz you've been with the with the project for a lot longer than I have.
Lisham: Sounds good. Well, we can, we can go by alphabetical order of our last so I am, Leah Shrek. I am a, a clinical psychologist and an assistant professor of, psychiatry at the University of Rochester, and I also am a research investigator at the VA Center of Excellence for Suicide Prevention.
At the va, finger Lakes Healthcare System outside of Rochester. you know, a lot of my work involves working with, uh, individuals with substance use disorders, suicide prevention, chronic pain, some sort of combination of the three. and I was sort of fortunate enough to, kind of help out with this project.
And so I, I've, I'm working. with the Recovery Center of Excellence, on the Stigma Project, the Suicide Prevention Project, as well as, another project, looking to increase, treatment engagement among individual substance use disorders.
dave_closson: Goodness. Okay. I could just interview you about your different roles in all those different projects. They all sound fascinating. They all do. So glad you're here. All right, well, miss Tedra.
Track 1: Yeah, so I'm Tedra Cobb and I live in northern New York, so when I travel to Appalachia or anywhere else in the United States, if you say you're from New York, everyone let, says they love Manhattan. so I make it really clear. I live on the Canadian border in the. Very northern part of New York, five and a half hours north of Buffalo.
So, that's where I am from. I've lived there. I'm a transplant, I guess to the north country. I went to university there and stayed, and my background's a little different than Lee's. in that, I've done all kinds of different work. Started out in the New York State prison system as a Spanish speaking correction
counselor, Spanish is my second language. and left that to do HIV and AIDS work throughout the nineties. In the north country we call where I live the north country and started a community health agency. And since 2003 I've been a consultant. And so I've done lots of different kinds of work. But I have to say, being at, in the UR Medicine Recovery Center of Excellence has really been, the, the best work in my life that I feel that I've been able to do, with the best team that I've ever really worked with.
It's quite amazing and we'll talk about.
dave_closson: Yeah. Well, let's go right into it. Can you tell me a little bit about the Recovery Center of Excellence and it's marvelous, marvelous work y'all have going on.
Lisham: Yeah, sure. So we, essentially we have a, a range of projects that work to reduce the morbidity and mortality and, and frankly all, you know, other harmful effects that substance use disorders can have, uh, in rural communities. and we sort of, uh, have this special emphasis, or, you know, special attention to synthetic opioids, so like fentanyl and its analogs.
And so we are established by HRSA's, rural communities, opioid, response program. And we a essentially adapt best practices to address needs in rural communities through. disseminating resources, implementing programs, providing program, or technical assistance, to, to those who request it.
And so we use this ecosystem of recovery, in our approach. and, and essentially this helps create, uh, broader program access and, uh, community-wide support for best practices. And so we accomplished this through, uh, establishing partnerships in the community to provide, uh, patients with access to treatment.
Uh, and it sort of ends with, you know, communitywide, uh, we hope communitywide support for patients, in recovery and care management integrated into, primary care. and so, you know, we, we think about the ecosystem recovery with these, Five pillars. And essentially these pillars are, you know, to save lives, of course, engage the community, expand access to com, to treatment, assess and prevent, substance use disorders, as well as support recovery.
Lisham: And so, , you know, sort of, this is really broad and a lot of the, the, we have a wide, wide ranging, programs for this. So, you know, integrating behavioral health into primary care, addressing barriers to medications for opioid use disorders, facilitating transitions from incarceration, increase in treatment access.
through promoting, telehealth services, uh, medications for opioid use disorders outta primary care. and of course, you know, the stigma project that, which we'll we'll dive into further as well. But those are just some, some of the examples of the projects that we're kind of working on and helping others with.
dave_closson: Y'all do have a lot going on. My goodness. I was gonna take notes, but I couldn't keep up. Oh, doing some great stuff. And, listeners just know the show notes are gonna be filled with links including link to their Recovery Center of Excellence website, which is filled with great resources now. Let's, let's zoom in a little bit.
You talked sort of broad what, what you do there at the Recovery Center of Excellence, but let's focus in on rural America. What, what do y'all know about rural America and O U D?
Tedra: Yeah, so my, so let's, I'll back up a little bit and just say that I started as a consultant to UR Medicine in the Recovery Center of Excellence about a year and a half ago. And, and I started sort of on the tail end of what you've referred to as the art campaign. So the grant focus or this, our, our first focus was in Appalachia and, the, what we did was start with creating.
Relationships in two communities in Kentucky, Heineman and, and Prestonsburg, and use art to open up conversations and to learn about what people in recovery look like, what they think about, what their path is. So the artwork that we have, is interwoven into what we call a community conversation on opioid use disorder.
So when I started. As a consultant, right? I took that artwork and I took two videos, two very short videos, just four minute clips, and I looked at that and said, okay, if we were gonna do workshops in communities, what would we want from those workshops? And I think ultimately our mission, Is not to talk at, but to talk with if we really wanna address stigma.
So we use that artwork and we use those interviews to open up doors in communities to have these conversations. and the wonderful thing is we've actually been back to Prestonsburg and been able to do the workshop, uh, with them so that they could sort of see how we use those interviews and the artwork and just how they're really being able to speak with so many other people in the country about.
their paths to recovery. So that's a little bit of a, of a background. I like to say I go from rural America to rural America because. I travel for this project to West Virginia, Tennessee, Kentucky, North Carolina, Maryland. Some of those are Appalachian places because we've expanded. But this fall we were in Maine, Nogales, in Arizona and La Frontera, right on the border of, of Mexico.
So we've really been in a lot of places. I think we counted 38 states.
Lisham: And just, just to add to what, Tedra had mentioned as well, like, so we sort of know that, you know, research shows that like contact and education is, this sort of important piece in reducing stigma. And, the thing is like we, we, we wanted to sort of do more than just maybe, you know, have a pamphlet that described, You know, somebody's, uh, story of, recovery, and have it be much more engaging.
So first of all, the artwork is this, uh, engaging vehicle, to get the person's, uh, story across. And then you add the community conversation on top of that with, Tedra's, passion and how engaging she is with others.
And it really, really brings the life, the experiences of, a person. going through recovery of the substance use disorder and it really kind of instills that people with substance use disorders are humans, just like everyone else. and so, you know, between the artwork and the community conversations, it's a very powerful tool, to hopefully, you know, shift people's, viewpoints to, to ones that are less stigmatizing.
Tedra: Yeah. So I think one of the things that I think about is that everybody has a story. And so there are lots of workshops. And actually somebody said to me recently after a workshop, he said, I had no, I thought this was gonna be totally different. And I said, what did you think it would be?
And he said, I thought we would sit in chairs and you would show us a PowerPoint presentation and. So what we do in this workshop is the opposite of that. If we wanna address stigma, then we have to one, listen to one another. We have to be in a safe space to share our experiences and our stories. And the reality is that everybody has an experience or a story, and so we have to
that opportunity to stop and to listen and to be in that safe space and to be in a, room where people are just fully engaging with one another and that whatever somebody says isn't a judgment to somebody else, but is really their experience. And so for me as a facilitator, my job is of course to make sure that everybody is heard, that everything that people are sharing is in a safe space, but also that we sort of have that learning from one another. I'm gonna say one of the things that's really important here, I'm not from Kentucky, I'm not from Tennessee, and the first thing I say when I introduce myself is clearly from my accent, I am not from here. So I think what's really important is.
For me as a facilitator in a community to say, I'm not from here. I'm just facilitating the, the conversation in your community. And at the end of every visit, you know, we do what, what we call a train the trainer. So I wanna make sure, we all wanna make sure that we have facilitators, we call them facilitation leaders.
In communities so that they can continue the work because it's much more powerful from them to continue this work. And right now we have 150 facilitation leaders around the country. And what Chris and I do is we want them to know they're not on their own. We just had, our quarterly facilitation leader meeting where we share best practices.
We talk about the slides. We problem solve together. We listen to any kinds of edits that they might be making because of their community, because at the end of the day, it's about them knowing their community, facilitating in their community, and continuing this work.
dave_closson: let's dig into sort of what led to the community conversations, the, the art campaign. What, what were some of the, the, the challenges or the barriers that. You all saw when it came to rural America?
Tedra: So I can't speak to the beginning of the art campaign exactly, because I wasn't here. but I will tell you a strategy, let's say, and that strategy is one of trust. So it's getting, and even now, right? What we are continuing to do is meet new communities, get to know them, get to know either their coalitions, all of the partners, who they're working with, and then what it is that they wanna accomplish in their communities.
So I think this gets to that question that you asked about barriers in the beginning of the project, right? you know, you. Met with those two communities and worked with those communities to build trust and to talk about how to use artwork. but that model of trust we continue in terms of outreach, in terms of support and as Lee's referred to even the ecosystem of recovery and all of the other work and services and support and technical assistance that you are provides.
The core of that is always trust.
dave_closson: it. I love it. And we often talk, you know, relationships are the, the key. You've gotta build relationships and. Oftentimes folks like, okay, great, but how, , what do I do? And I always try to like shift their, their thinking a little bit to, instead of seeking to build relationships, just work to build trust and then, and good facilitator, fashion.
What, what kind of actions make you feel like you can trust somebody and let them sort of reflect on it and decide what those, those actions items should be. But the goal should be just like you said, trust from that trust will then come relationships.
Tedra: And I think to speak about barriers and trust, in rural America healthcare is fragmented. Uh, healthcare is difficult to access if you don't have a car, if you don't have insurance. Uh, we don't have enough medical providers if you've had a bad relationship with a medical provider.
So let's think about people with mental illness or in recovery or, many other things. We can think about all of the bears and if we've had a bad healthcare experience, if we were treated poorly, if we were treated with disrespect, if we were misdiagnosed. Those barriers become not just barriers, but just downright roadblocks.
And so as you're talking about this trust, what we are doing and what we are hoping to do is continue, you know, work in communities to get everybody to the table having these conversations. So every workshop is different because every person who steps in the door, Is different. So sometimes we have police, we have emergency, we have fire.
So sometimes we have those frontline workers. Sometimes we have peer recovery specialists or people in recovery. Sometimes we have doctors, sometimes we have people from the justice courts, sometimes. We have elected leaders. Sometimes we go in communities and we're missing some of those partners. And what I always say is, it's okay if we're missing those partners today because you are gonna continue the work as facilitation leaders and continue to build those relationships and in your community.
And then those people will be at the table, and then once they're at the table and the next time they'll invite more people. So it's. Growth, that the growth is slow. and that gets to kind of your, your question about trust. You can't walk into a community as an expert. You have to walk into the community just humbly as a guest.
dave_closson: Lee, what, what kind of, uh, challenges brought y'all to working in rural America? What, information told The Recovery Center of Excellence. Hey, we need to We need to support, we need to serve rural America.
Lisham: Yeah, so I think there's some, unique, some unique challenges to, uh, rural America. . so for instance, access, to providers and resources may be a little bit, more challenging. there may not be, you know, as many, providers available. And then of course, you, you're working with, you know, a little bit more area, than you know.
Centers as well. And so transportation, uh, and getting to, some of these places is a bit more challenging as well. and then there, there's also, uh, stigma as well. with mental health and substance use disorder, stigma. There's a little bit, there's more issues in rural communities maybe with like, uh, uh, anonym. and, and so if you have a, a treatment center that's located in sort of the town center and, somebody is going to the grocery store there and they see, somebody's car there, it, it, it can sort of start a, a, a conversation, uh, you know, around town, that somebody in treatment.
And so that really can be a big deterrent for somebody, seeking treatment, especially if mental illness and, and substance use disorder is stigmatized. and so, we can't necessarily like build up the town and, you know, create, you know, a million different resources and, and solve the transportation issue and all that stuff.
What we can focus in on, and what we do have maybe a little bit more control over is, having some of these conversations with the community, having this open to dialogue to help, uh, shed some of the, stigma around. Substance use disorders and mental illness, so that, you know, maybe there isn't as much shame about, going to seek out treatment options.
and, and, and, the, the community members or the providers, who maybe have some of these stigmatizing attitudes, hopefully we can, we, we can have a conversation with them and, and they can think about it with a more, uh, Uh, attitude.
Tedra: I can I follow up on that with just a point about the difficulty in rural America, cuz there are two things that, that Lee opened up here. One of them is we think about, and I mentioned that a little bit about if you've not been treated well by a provider, But there's also, sometimes what happens is there are providers who wanna be leaders and they wanna be offering these services, but there's also sometimes judgment in a community against those, or fear of judgment for those providers on the front lines. So I think rural America's really hard, because you can't hide. So you often, we talk about having a family history, maybe people's names, uh, in a rural place or there's a family history of substance use. And so there's generational barriers or generational stigma against families.
Um, so I think there's a lot that is, That are challenging maybe in a rural place that that are different in urban places. I think the other thing for us that we really tried to get to is that we don't have a pros scripted definition of stigma. What we do in the workshop is we want people to really explore the idea of stigma, that it comes from first perception to bias.
Tedra: To prejudice. And if you think about it like a domino, eventually that prejudice becomes sort of hardwired into structure. So we see things in terms of structural stigma, like the court system or police or healthcare. and so. for us in the workshop, it's really getting folks to say, to, to almost define for themselves what is stigma and how do I explain this to somebody else?
Because I think that's really the challenge is to be able to say to somebody, this is what stigma is and this is why it's hurtful, and be able to communicate that in just I call it normal human words so that we can understand one another.
dave_closson: Oh, so definite, definite unique challenges in rural America. And you'd already said, you know, each community is, is gonna be different.
All right, so during the intro, talked about my friends in Kentucky and the, the murals. I'd like to hone in on that just a little bit and the, the impacts of, of using art, of incorporating art into your campaign.
Tedra: Yeah, so I think. If we were to take a step back and think about what opens doors for creativity, what opens doors for storytelling? We've always used art. We use art in music. We use art in poetry. We use art in the spoken word sculpture, and of course in painting and portraiture. So this campaign started using art and portraiture and.
Charmaine who had been doing art and using portraiture in the field of mental health and, and recovery and mental health, really was able to interview people in recovery and seek out their path stories, right? Their whole background and their stories, and capture them in beautiful portraiture and also in word.
Tedra: So that's how we sort of use the artwork here. what we've been able to do is work in other communities as well. Some communities have said, Hey, we wanna do an art campaign. There's a community in city Maryland that's been doing an art campaign this fall. We actually went to Nogales, which they say is, It's the border to Mexico.
They live in a border community. they're in a bilingual community, and so they wanted us to go to their community and to do the workshops with them. We actually met them in May at the, summit. so we had a National Taking Action Summit, which we can put the link to that also, afterwards because there's so many resources from that.
So we met this amazing group of people from Nogales and they invited us to their community. And so what we did as a team is said, you know, it's wonderful that we have this workshop with voices from Kentucky, but what if we could take this workshop and add some more voices from other communities? So while we were in Nogales, we did three more interviews of people in recovery who are leaders in that community.
so we went to that community. We did. A whole week of workshops, train the trainer. and that community is gonna take the ball and continue to do those workshops, and as facilitation leaders, but they're also doing murals in their community because that's the art that they use in their community to speak to one another and to do story.
Tedra: So, so that's really important. And then just to follow on with that, we will be doing some L G B T Q, interviews or interviews in the queer community so that we also have some more diverse voices. So at the end of this grant year, we expect that the workshop will be a little different than what it is now, because we'll be adding, those, those voices to this.
dave_closson: Wonderful. And listeners. Go to the show notes, click the links, look at the visuals of the artwork, to, to see them in person takes it to a whole nother level, a whole nother experience to stand there before it's, I'm looking forward to seeing some of those murals once they get, finished and put up there as well. So when it comes to the t o t for the empowering the community leaders to go out and be a facilitation leader. what does that look like? What do they do? What does that mean to go out and facilitate conversations in their communities?
Tedra: Yeah, so I always think about. Because I'm in a rural place, I think about it that many people wear many hats. So the people who have come to the workshop and who wanna be facilitation leaders as the trainer, and in this case, I'm not just the facilitation leader, but I'm really the trainer, right? I wanna get them ready and competent.
I ask first, are you doing this in other areas? And most of the time people are, whether they're peers and doing peer work or whether they're in public health and doing workshops. But a lot of people are already either facilitating or they're running a coalition. So we're really building on those skills.
Tedra: So yes, they're going to use facilitation skills to do. The, community conversations in the community, but they're also going to, these are transferrable, right? Dave, you're, you're a facilitation leader. You're a trainer. You know that the more we do it, the better we get at it. And so our mission really is to also build them up so that as they're facilitating this workshop, they're also doing more of it or doing it more strongly in their other areas. So actually one really good example of how we've been able to support a community. We were in Cherokee County in Oklahoma and working again, that the relationship started at the Taking action summit and two of our presenters from there, we went to that community.
and, facilitated a community conversation, but also worked with them on one of the workshops that they do, and helped them to workshop their workshop to make it more interactive, more listening, less talking. So again, just getting back to your core question is what does the train the trainer do? The train the trainer, sort of
fundamentally just gets people comfortable with the workshop, which again, isn't a PowerPoint presentation, but it's facilitating a conversation. So we really talk about, we talk about stages of behavior change. We talk about people being ready to listen to one another and where they are and, and how they are. Who they are when they walk in the room and how ready they are for those conversations. And then sort of who they are when they leave. we also talk about different styles and making sure that when we're doing workshops, we're always accommodating the quiet people and the talkative people and different thoughts.
And, and then the other thing we really talk about is we, in the workshop sometimes we're talking about trauma. We're talking about loss and grief. We're talking about different people's paths to recovery, so making sure that the facilitation leaders know that they're facilitating. And at the end of the workshop, the beauty of it is that the takeaway for everybody will be different.
Every workshop will be different. It's really about the conversation.
dave_closson: My good friends at Hue Life Irina and Stephanie like to say that they're changing the world one conversation at a time.
Conversations really can change lives. They can change the world. Yeah.
Tedra: And I, I think, yeah, I think the one thing I would say to even follow that too, is, , everybody's path to recovery is different,
everybody's path to substance use is different. And so in those conversations, hearing. From people in recovery is really important. I can tell you I've been in a lot of workshops
I did h I V and AIDS work in the nineties where people who had H I V weren't ever allowed to be at the table. and I look at where we are now. and making sure that people in recovery are at the table in every decision. When we're talking about funding, when we're talking about treatment, when we're talking about, you know, barriers that the people who have the lived experience have to not only be at the table, but equally at the table, not as the special guest presenter, but equally at the table.
So I'm digressing a little bit, but I think. When we're thinking about those conversations and why we call it a community conversation, everyone in that room is equal. Every facilitation leader brings that forward and makes sure that the mission is always for that sort of equality and that path, and having grace for one another in those paths and listening to one another.
Really trying to be free from judgment because that's when we really get to tackle stigma.
dave_closson: Absolutely. And we all are very comfortable with the term facilitator, but we may have listeners that they've heard it, but they might not really have a, a full grasp of what all it entails. And I'll throw my 2 cents out there and let y'all add onto it. Correct whatever you would like. But the, the beauty of
facilitator or facilitation is that you as the facilitator, you bring the process. The, the how and the people, the participants bring the knowledge, the wisdom there to share. All you're doing is bringing the process and a part of the, the design and designing that process is to create that safe space, that non-judgmental space.
The experience at welcomes all with profound respect and also, Is having multiple ways for people to share their voice. They may not be comfortable standing up in front of a room full of people, but their voice is important and we want them to feel comfortable sharing it. So having different methods, different means for them to still be able to be an active participant, however they feel most comfortable, especially in these conversations.
Yeah, that's my 2 cents. What'd y'all think?
Tedra: That is it. A hundred percent. 100%. That's it. And that's why we call it a community conversation. It's not a training on stigma. You know, we, we have Dr. B at the university and she does continuing medical education training and sometimes I get to be her sidekick and we work together. She, she will then, as a doctor, she has that ability to do that training, right?
Sometimes we need that. We need to learn specific things. What you are talking about with that facilitation is the conversation and to me, that is just the perfect encapsulation of why the workshop, why a community conversation has been designed the way it is, and what we want our facilitation leaders to.
Lisham: As you guys were talking about this, it made me think about things from like the provider, perspective a little bit more as well. And I think, when they do these community conversations, you know, with healthcare providers, I think one really critical piece of it is that they're, they're modeling how a provider might just have more of a conversation. uh, with the person that's in front of them, uh, rather than kind of going through and doing check boxes where they can't, can't, uh, maybe allow themselves to think, you know, just a little bit deeper, about the person that's, in front of them.
And I think that modeling is, absolutely critical. not only in terms of like, you know, uh, being open to the transmission of information that happens during the community conversations, but again, helping them see how it can be beneficial when interacting with, the person in front of them in the, in the clinic or
hospital.
dave_closson: Yes. And these, these conversations, the community conversations, y'all have, been facilitating and empowering others to facilitate. I'm seeing both the direct goal to, to address stigma, but also the, the experience is a goal in and of itself, that, that experience is, is what's gonna create connection.
That's what's gonna inspire, that's what's gonna empower and motivate folks to, to change.
Tedra: if I could, Dave, I wanna sort of talk about one of the ways that we're me not measuring, cuz that seems like a, a funny thing, but really one of the ways that I'm always learning and each community continues to learn and that is that we really end with people sharing their takeaway.
What was your takeaway from today? So I think if I could, some of those takeaways are, One, I, I hear over and over again, everyone's path to recovery is different. people in recovery. And when I say that everyone's path, some people have chosen to use M O U D or mat. Some people do a 12 step program.
Some people start with a 12 step program and do a different one. . So it's always different. Some people are very faith-based and that when we are free from judgment in our conversation during that, Beautiful two hours together. It's not a a full day, it's just a couple hours. Then people are saying, oh, I didn't realize that, or I didn't understand that.
And it gives us that opportunity. So one, the path is different. I think that sometimes people in recovery will call themselves or refer to themselves using different words. So if I. I wouldn't say that person is an addict, that's stigmatizing. But if someone in recovery says, I am an addict and this is who I am, or this is how I refer to myself in this moment in time, we have conversations about that in the workshop and we give people the opportunity to sort of communicate that.
So people often at the end will say, as a provider, I didn't understand. Why this person would refer to themselves using stigmatizing language. Now I understand that now I can sort of be a better listener and not, not even judgmental about the person sitting in front of me in recovery and, and again, what their path is.
So I think those are very two big takeaways. And the other thing is people really just sharing their stories. so those I think are really important. Things that we have to continue to do. One of the things that I would say is that we've changed the workshop a little bit because of the community. So those takeaways have been consistent.
One of the things that we've done is we've asked the question, we've sort of modified to ask the question, what are you seeing in your community right now? Uh, we weren't doing that in the past. We were sort of. A little less open-ended. Okay, with the question, what are you seeing now? We are hearing on the ground methamphetamine, fentanyl, and methamphetamine. And being in some communities, fentanyl, being in different ways in communities, we're getting people who are in the community who have not been necessarily talking to one another to share what they're seeing on the ground.
Sometimes it's Narcan and that. Two Narcan doses is not enough. so we're seeing these kinds of things. I'm throwing a lot out here, but if we are not talking about the changes that are happening so rapidly now on the ground, we are going to miss stuff. And so one of the things I would say is our biggest takeaway is to make sure in every workshop.
We facilitate that question. We get everyone from every walk of life who's in that workshop to talk about what they're seeing, and then we say, we need to continue having this conversation. So at your coalition meetings, at your public health meetings, at your justice court meetings, keep having the conversation, what are we seeing today?
Because three months from now it might be.
dave_closson: Absolutely that open-ended question. Oh, so powerful and so much data, real-time data. Like you said, things are changing very fast, and without that information, without that data, we're gonna be way more behind than we already are.
Tedra: Yeah. And quite frankly, public health data's always slow, right? I mean, we're, we're always looking at old data, and that's why if we are not, if we're not talking to one another right away saying, oh my gosh, we just saw three overdoses on such and such, or, oh my gosh, we're seeing kids using this.
We're seeing this on Facebook, or TikTok or Twitter, if we're not paying attention to what's happening in every communication aspect in our community and then talking to one another. We're gonna miss things. And at the end of the day, we wanna save lives, right? We, we wanna have a healthy, happy, warm, loving community to one another, and how better to do that.
But by really sharing and getting down into the nitty gritty with one another in a non-judgmental way.
dave_closson: that question, what are you seeing right now those responses that you get to that question speaks to the, the atmosphere, the experience that you have crafted and your facilitative leaders have, have crafted in that folks. Feel safe. They have that trust to be able to share that raw information, that real-time, raw information.
Tedra: Yeah. I would say sometimes even in that conversation, what are you seeing now is that some people, if let's say we have a room and there are people doing harm reduction and other people doing prevention, those are two different things. Sometimes the people in harm reduction will say, this is what we are seeing.
And the prevention folks will say, I don't really know what that is, they don't have the same experiences. And again, that's the important thing about sharing is that not every service provider necessarily has the same training or mission or purpose or has the time for that. So if we can carve time out for one another, especially like I said in our coalition meetings, in our public health meetings, I always encourage people, go to your legislative meetings and tell them what you're doing.
They have public comment, you know, they have time. so make sure that you're there and your voices are heard and they see you as really positive people in the community and get to know you as people because once we get to know one another, that that stigma starts to wash away as well.
Lisham: I just want to add one quick thing to kind of this right now too. Uh, so I think what happens is, one of the things that seems to happen when people don't talk about things, it builds the mystique, it builds, you know, the fear and shame potentially. or One of the many important things.
the stigma campaign and the community conversations is it puts, uh, these issues to the forefront and it really encourages further conversation. And with that, it, it can kind of, the mystique of substance use and people with substance use disorders kind of sheds away the fear about talking about it comes away a little bit.
people learn that not all people with substance use disorders are dangerous or, uh, lazy or it's their fault. the, these sorts of things can kind of, uh, come down with these kinds of conversations and, and, you know, having, some of this, artwork, you know, displayed prominently in the community. so I, I, I think you know it, it's sort of another critical.
Lisham: Piece to this that, you know, not talking about something is really just kind of, kind of build it up more and make it stronger. And this really, this campaign I think really attacks that head on.
dave_closson: Yes, it, it, it creates space to talk about the, the norms and those perceived norms within the, the community, the culture as well. And yeah, my, my friends at the Montana Institute do a ton of work around positive community norms and, and pulling those out and showcasing the positive cuz the positive does exist. there's a quote from Dr. Jeff Linkenbach that they say perception is reality. Then misperception is reality. And so trying to, just like you were saying, Lee, having those conversations to then break down those misperceptions, say, well, my story's a little different. Things are a little different than you think.
Tedra: Well, also, I think it gets to why do we have the perception, where did it come from? And in order to break that, right? So that perception, leading to bias, leading to prejudice, leading, leading to stigma. How did it happen? Was it in my family? Was it in my school? Was it in my community? Was it in my social status? right. So, I've worked with a lot of communities on something called Bridges Out of Poverty. So we talk about communities, and one of the things that, you know, I'm digressing a little bit here, is that we now even talk about trauma informed care. We talk about, the things in recovery that we didn't have before, we didn't talk about before. And I think that that helps us to understand people's history and then how did they become the person that they are, and where did that perception, reality, not reality, or whatever accurate, not accurate, where did it come from? And also, why do we hold onto it?
dave_closson: Oh my goodness. I, I feel like we're just tiptoeing on what could be an amazing deep dive standalone episode right here. I'd love to just dig into this more, but we've been chatting for quite a while, so before we hit stop record, I've got one more big question for you before we end,
putting you on the spots. My final question for both of you, and we'll we'll go to you first Tedra for our listeners. If you were to say, if you're gonna remember one thing from this episode, remember this, what would it be?
Tedra: It would be to talk to one another. It would be to listen and to talk to one another, and to have grace for one another's stories. without judgment as much as we can. but that's it. I think it really is about listening, about sharing and giving people that opportunity to fully express who they are and, and talk to one another.
We are not doing that, and we have got to do that more and more.
dave_closson: Oh, wonderful. What you got for us, Lee?
Lisham: you know, to, to kind of piggyback on what Tedra was saying. You know, part of it might be, Feeling like you're taking a risk. When I say take a risk, I don't mean like, you know, speeding down the highway. I'm really referring to you know, maybe some, some fear or something like that, that you, you, you know, you're, you're concerned or worried about how you might, might come across.
And, and so part of it's about kind of taking that risk and having that conversation, uh, with a person, uh, so that you're, you're, you're allowing yourself to be in that position to hear about others' perspectives, share your own and kind of come together to, you know, figure out, a solution to, to an.
Tedra: Yeah.
dave_closson: yes, indeed. And from our very first email thread planning this, you both and your entire team live. The together is better pillar that, that that's how you roll and, and I so appreciate it and you are changing lives and you are changing the world through each and every conversation that you have and that you facilitate.
I can't thank you enough and send thanks to the team as well for helping make this happen. And listeners check the show notes. There's gonna be a lot of links to some amazing artwork ways you can get connected with the Recovery Center of Excellence, both their website, their social media as well, and, and join in on the conversation. Thank you both Tedra
Lee. Y'all are amazing.
Tedra: Thank you so much. It's an honor.
Thank you.
Lisham: Awesome time. Yeah, had a great time. Thank you so much for this opportunity.
