Podcast: What's Wrong with Prevention? [#27]
Dr. Alex Elswick is a tireless advocate for people with substance use disorders. He currently serves the University of Kentucky as an Assistant Professor and Extension Specialist for Substance Use Prevention and Recovery. Alex is a trained researcher, recovery coach, and mental health therapist, as well as the co-founder of Voices of Hope, a peer-driven recovery community organization. But most importantly, Alex is himself a person in long term recovery from the chronic disease of addiction.
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TRANSCRIPT
Intro:
In prevention, we are all leaders, whether you're leading a nationwide prevention initiative, facilitating statewide prevention, community, your coalition coordinator, or a one person shop you are a prevention leader. How we show up in how we engage with others to create positive change takes all types of leader.
So sit back and enjoy these conversations with your fellow prevention leaders from across the globe for sharing their lessons learned best practices and strategies for success.
Dave: All right. Podcast listeners. Guess what? We have a wonderful guest in store for you today. The one and only Alex Elswick Alex. Welcome to
the podcast.
Alex: Hey Dave, thanks for having me.
Dave: Yeah, so listeners little backstory, Alex and I crossed paths, through, the Kentucky prevention. You, he was putting together an online course and when I was editing that, I was like, man, this guy's awesome.
I wanna talk to him again. So here we are. but yeah. Hey for our listeners, would you share just a little, just a little bit about yourself? I know we'll probably be getting know more throughout this episode.
Alex: Absolutely. Yeah. So I'm currently an assistant professor and extension specialist at the university of Kentucky for substance use prevention and recovery.
So it's an obnoxiously long title. a lot of times I just tell people I'm the drug guy. So I do all things, drugs . so my job spans prevention, treatment and recovery. I spend the majority of my time in the community, doing public speaking, running workshops and seminars and trainings, trying to build capacity for practitioners and people who work in the field.
and then I do a little teaching in the classroom and I do a little research to kind of keep myself, apprised of what's going on in the field. And then also co-founded a nonprofit that we may get the chance to plug shamelessly later on called voices of hope, which is a recovery community organization.
Alex: So we're, a community center for, for people who use drugs and people in recovery. and then I've got some clinical experience and, uh, and, and some other experiences with addiction as well. Pretty pretty broad cross section, honestly.
Dave: Right. what I hear is a lot of wisdom and a lot of different perspectives that you can bring to this conversation. There's no such thing as a shameless plug y'all are doing amazing work. So be proud, put it out there every chance you can. So what I normally do in my episodes, I like to reflect back on the fact that my path to prevention, looking back may appear somewhat. Random or sporadic or like I fell into prevention, but it was literally just life leading me that way.
Dave: Preparing me for the roles that I, I am serving in now. What led you to your current role with that really long title?
Alex: yeah. You nailed it on the head. I had the same experience. I did not set out to do prevention work or addiction work of any kind. In fact, when I, mm, 21 years old, I was, at center college studying for the LSAT because I wanted to go to law school simply and shallowly because I wanted to make money and drive a nice car.
And that's, that's all I knew about, you know, the world at that time. So, so it was life that kind of showed up and, and shoved me in this direction. So I ended up getting addicted to opioids when I was 18 years old, I actually had. Um, elective oral surgery to have my wisdom teeth removed, and I was prescribed Oxycontin.
And, you know, I took it the way that it was prescribed by my provider. Didn't take more than I was supposed to, or take it more frequently than I was supposed to or anything like that. Didn't abuse it, but it really didn't matter because I had a long list of risk factors for addiction. And, and so as you might imagine, that's, that's what happened.
I got addicted and, I'm sure we can unpack this some more if we want, but you know, addiction took me all those bad places that a person can go and really changed. Fundamentally everything about the way that I understand the world, about the way I understand addiction, about the way that I understand poverty, about the way that I understand mental health.
I think my spirituality, my politics, everything changed very quickly because of that experience.
Dave: We can certainly unpack that as much as you would like, I know my listeners know that I share about my, my choice to, to go sober and, and achieve it and live it. And for me, part of why I openly share it and talk about it is to help break down the stigma to help normalize, like, yes, give folks hope.
But then also for folks that might be, you know, struggling with addiction might not understand it. To give them that, that little insight to where they, maybe they can understand it as well.
Alex: No, I think you're, you're exactly right. And I'm, I'm happy to do that. I'll, I'll share some of my story here for that reason.
And also, because I think it helps to illustrate some important points about prevention, which is what we wanna come to talk about today. So, kind of briefly, first of all, I grew up really, really privileged, grew up in really fortunate circumstances. And that really matters when it comes to talking about my addiction and my recovery.
And we'll talk a little bit about that later on, but, but I went to private schools. My dad's a doctor, my mom's an accountant. I grew up, I grew up well, you know what I mean? I wasn't, I wasn't spoiled. I think my parents were disciplinarians and pretty hardcore in that sense, but, but I come from good people in a good home and, and I'm fortunate in that way, but I had a number of risk factors that, that I inherited from birth.
So the first was a genetic predisposition for addiction. So there's a ton of addiction in my extended family. secondly, and, and I think just as importantly from the time that I was really young, I've struggled with anxiety and I've been diagnosed, with three different anxiety disorders. So generalized anxiety disorder, social anxiety disorder, and Trico mania, which is a hair pulling disorder.
so quick note on that, I was, you know, I was really well adjusted up until the age of about 12, like really happy, really well balanced mentally. and then as many mental disorders do mine showed up through puberty through the adolescences and sort of that cascade of hormones. Creating a chemical imbalance and, and so trigger to Romania for me was pulling my eyebrows.
Alex: I would be so anxious when I was sitting in class that I would start subconsciously pulling my eyebrows until they were gone, gone, gone. And, you know, I reflect on that and just, if nothing else, I look back and go, you know, that's not quote unquote. That's not a typical experience for a kid. And so I think it was really good evidence that something was wrong before drugs ever entered the picture mm-hmm
Um, which is one of the main, you know, I'm really intentional about telling my story that way, because I want people to understand that for me, And I suppose I can only speak to my experience here, but for me, drug use was not about partying and it was never about getting high. It wasn't even about having fun.
It was always about relief. Mm-hmm it was just about trying to go from the negative to the okay. and that was from the very start all the way to, to the end of my addiction. Mm-hmm
yeah. I, as you can tell, like, I, I feel that, very much so for, for me, my mind was brought on from post-traumatic stress disorder for my combat deployment and an undiagnosed traumatic brain injury.
Dave: And I still have to, to struggle with that anxiety, that, that fear and the, the drinking it was. Yeah, it was just. Trying to feel normal or, okay. I, I had this, like, everything was just bottled up inside and I just wanted that relief as well. Yeah. Yeah.
Alex: Yeah. Thanks for sharing that. You, you can identify with the feeling of just, of even when you're trying to sit still and just.
There's just something difficult about that for some of us. And that, that, yeah, that alone kind of explains why there's a, an interest in trying to do away with some of your suffering. You know,
one thing I just gotta put out there too, is I, I did a lot of my, my work on myself learned, read, journaled and really focused on growth, but even still, you can't do it all by yourself.
Dave: You need. Somebody else you need others, you need that connection piece, that support. And so, yeah, that's just a call to action to folks out there. You, you you're strong as all get out, but connection, community support, you can't do it alone together is better.
Alex: Absolutely. You know, I remember telling people that, I've been a pretty.
I've been a pretty successful person. And for the most part, when I set my mind to do something, I can do it. And it's not a problem. Addiction is one of the few things in my life that I really thought I'll do this and I'll do it by myself. And I was all the way wrong and it had to prove me wrong seven or 10 times before I finally realized, oh, I've gotta let somebody else in to help out thing out.
Dave: yeah, absolutely. I mean, once I finally like. Flipped that switch said, I'm gonna work on it. I'm gonna work on myself. It still took several years before I, I am comfortable and confident in my sobriety. yeah. Yeah. anyways, we were, we were gonna talk about other stuff on this episode, but , this is, very, very rich, very rich.
You had said that there were risk factors that were apparent before drugs even came into the picture. How, how do you see that playing a part or playing a role when we, we talk prevention?
Alex: Yeah. In a big way. because we do in prevention, we spend so much time focusing on this is gonna be weird to say, but Imma say it anyways.
In drug prevention, we spend way too much time focusing on. And far too little time focusing on the people, the young people who might be using the drugs and what are the factors that might actually predispose them to using the drugs. And so much of our focus has been creating drug free communities or eradicating drugs from the face of the earth, which I think is a remarkably unrealistic goal.
when, when in reality, the things that, that, that the evidence says are effective are when we modify those risk factors. And so when I just think about it from my own experience, Obviously it's kind of, a hypothetical or revisionist history or whatever, but I look back and I wonder what would it have been like if someone had helped me to intervene on my mental health when I was 13 years old, so that I didn't have to spend 13 to 21 trying to manage it on my own, which I think is really the, the, the environment in which my addiction.
Dave: I may have just been talking, or having a similar conversation yesterday with, my therapist as well. just kinda, gosh, if, if, if folks talked about traumatic brain injuries, when I got back my rack, it wasn't a thing. If maybe like they, somebody would've screened me, evaluated me, sent me for some treatment for the TBI and PTSD was talked about a little bit, but not near how it is talked about the knowledge, the research there, like, yeah. Yeah, but I don't do well there. Right. I still like to stay focused on the growth and, enjoy the, the present.
Once I started focusing on that, what more folks would call posttraumatic growth like that? yes, that really drive really resonated with me, but, let's talk more about prevention. What is just flat out? What's wrong with prevention? Lay it on me.
Alex: thank you for asking this question. Yeah. You know, as I see it, there's plenty wrong with prevention.
And so I, I I'll try to give you some evidence also to support some of these claims, but the biggest problem I have is the one that I just said, which is that our war on drugs approach, if you wanna call it that our prohibitionist approach, if you wanna call it that, just say no drugs are bad, whatever, whatever we wanna call that approach, it's predicated on the idea that we can eradicate drugs from our community.
In fact, that's the stated goal most often, and, and there's a community right outside where I live that has a dare sign posted that says this is a drug free community. And I might be the first one to tell them, no, in fact, it is not a drug free community. Addiction is rampant in your community. so I, I think it's important to recognize that that's an unrealistic goal and part of the reason it matters.
Is think about it like, abstinence based sex education. I think it's the best way, the best parallel. So for years and years and years, what we taught in schools was abstinence based sex education. And we just told kids don't have sex. If you have sex, you're gonna get pregnant and die and it's gonna be all bad.
So don't do it. And we tried to scare tactics, just like we do in addiction. And the reality was the uncomfortable fact was some kids were still choosing to have sex. It may be uncomfortable, but nevertheless, it's a fact that some kids were choosing to have sex. And so after a while we got wise and we said, look, just telling kids to say, no is not effective.
What we need to do instead is we need to be realistic. We need to acknowledge that it is happening and work from that reality. So they can actually start to reduce harms associated with sexual activity. And it's, I would suggest high time that we did the same thing with drugs and. despite our best efforts with abstinence based drug education, the reality is about 10 to 15% of any room that you stand in is gonna use drugs and, and possibly become addicted.
And so I think a more effective approach starts from reality instead of living in the delusion of maybe we can eradicate drugs or have a drug free society, instead it says, Hey, some of these kids are gonna use drugs. Now let's get down to the granular level of trying to understand what's different about these kids.
What specific needs of these kids have that that can be addressed to change their outcomes.
Dave: Interesting. Interesting. So, What this is my own interpretation. when, when I've talked to other guests as well about recovery and the, the core principles and what brought them strength in their journey, I was hearing insights of what could be applied to, to prevention itself as well.
Lessons learned there. Am I reaching for a connection or what are your thoughts on that?
Alex: Now I laugh because two weeks ago or middle of July, I was in Louisville at a conference. And one of the presentations I gave at the conference was titled what recovery has taught me about prevention. That's exactly what you're talking about because the. Is remarkable because really same thing. We make the same mistake in addiction.
We spend so much time talking about the drugs and just saying, oh, if you would just stop using the drug all would be well. And that's such an, a reductive oversimplified view of what this person needs to do. Right. and so it's, it's, it's such a, a, a good parallel for prevention instead of focusing on talking about the drugs.
There's so many other factors that we would do well to, to, to shine a light on and make sure we're address. All these other things that research says actually are gonna impact the outcomes,
Dave: Putting you on the spot, hit us with some of those factors.
Alex: Yes. I'm glad you've asked. part of what I did at this most recent presentation was create just kind of a makeshift pie chart of all the most important risk factors for addiction.
Right? So we put up their genetics and mental health and trauma, peer pressure, all the things. And part of what I was trying to show is. Each risk factor. Isn't equally weighted. In other words, some risk factors present much more risk than other things. So for instance, your genetics represent half 50% of your risk.
It's the biggest risk factor for all of us, but unfortunately it's not modifiable. I mean, at, to, to this point, we don't have the technology to mess with DNA, right. Maybe, maybe in the future. But, so, so then we look to the second and third risk factors, the ones that actually are modifiable, and those would be mental health and trauma.
So we have about a quarter of the students in, in our schools are suffering some form of mental disorder. I looked at our statewide survey data recently and among 10th graders in the state of Kentucky 26% report experiencing serious psychological distress today. More than a quarter, which obviously with, within that umbrella of serious psychological distress, there could be any number of things that present risk factors for addiction.
so, so trauma and mental health being such big ones that we spend, we're gonna spend so much time focusing on teaching kids about drugs and telling them to say no, and yet we're never gonna screen for mental. We're never gonna screen for trauma. We're never gonna, we're never gonna address the things that the research tells us really clearly and loudly.
Alex: It's shouting off the page. These need to be addressed first. And instead we're talking about choices and we're off we're we're teaching refusal skills and these things that have some evidence base, but a very small evidence base relative to the impact of addressing mental health and, and trauma.
Dave: So talking risk factors, guess where I want to go next.
Let's talk about protective factors. What do you see there?
Alex: Yes. Yes. No, I love that shift because actually that's sort of the shift I'd like to see us make, because in a lot of ways, I think the, the war on drugs prohibitionist just say no approach is the negative risk factor focused approach. And instead, what I'd like us to see is what you're suggesting a strength based approach that focuses on protective factors.
So sometimes I call the, the scare tactics, negative prevention and what you're talking about positive. So a way of thinking about this is instead of focusing our prevention on how do we get kids to say no to drugs instead, you can focus your prevention on how do we get kids to say yes to something else, something better.
And so, we call those attractive alternatives. And so if it's okay, I'd like to give you three different examples of the way that attractive alternatives have to do with this research. Cool. Okay. All right. So my first example is rat. Which you may have heard if, if you've heard one of my presentations before I like to include this.
So I'll, I'll share it quickly. a lot of what we know about addiction comes from research done in the 1950s, researchers put rats in a cage, gave them two sources of water. One was plain water, and one was water laced with morphine. And over and over again, the rats would return to the water lace with morphine and they'd use it to the utter neglect of their basic needs.
They're not eating food, they're not mating. They're not having sex. All they want is. And so for a short period of time, that was our model for understanding addiction. And we said, Hey, if you get exposed to an addictive drug, you're gonna get addicted like that, and you're gonna use it till you die. Okay.
But about 20 years later, some other folks came along and said, ah, not a great study, not a, not a real good reflection of the way that people use drugs in the real world, cuz people don't live in cages. Right. So what they did was they create rat park, which is like heaven for rats. It's like. Hamster treadmills to exercise on and toilet paper rolls to crawl through.
And you're in this thriving community with all your rat buddies, and then they replicated the study. They introduced the same two sources of water, plain water, water lace with morphine, but in rat park, the results are completely different. The vast majority of the rats don't like the water LASO morphine, and those who do use it in moderation.
And what's so fascinating about this study is that the drug wasn't the. So, this is just to double down on my point that we focus too much on drugs. The exact same drug was freely accessible in both environments, but the results were completely different because in rat park, those rats had attractive alternatives.
They had something better to do than to do drugs. And when you look around, for instance, in my community in Kentucky, you know, we were talking about the flooding in Eastern Kentucky before we started the podcast today. a lot of those impoverished communi. There's nothing for kids to do on the weekend.
There's there's, you know, there's, there's just, no, there's no meaningful infrastructure. There's no way for kids to come together and have fun. That presents a huge risk in and of itself for, for drug addiction. So rat park provides us kind of the first glimpse of why attractive alternatives could matter how they can, even while drugs are still present, radically change.
The choices that people, kids will make. Another cool example comes from Carl Hart. Carl Hart is, a professor, at Columbia. He was, he's a get ready for this. Now he's a neuropsych pharmacologist. All right. He's just a very, very smart man.
and he does research on people who use drugs, where he actually administer drugs in a laboratory set, and he did a really cool study. He recruited into the study, people who are daily crack users. So we, we would probably say that they're addicted to crack cocaine and he brought 'em into a laboratory and he offered them a choice.
Alex: They could either have $5 in, in a, a $5 crack rock or which they could smoke right there in the laboratory, or they could have a $5. Based on what most of us have been taught about addiction, at least based on what I had been taught about addiction. I would've estimated that about 99% of the participants in that study, would've chosen the crack rock and left the $5 bill.
And I would be wrong because it turns out it's about 50, 50, about half of the participants choose to use the drug in about half, choose the money, but get this. Then when you change the reward and you make it a $5 crack rock or $20 bill. Like 90% of the participants choose the money over the crack rock.
And so, again, it's a, it's a simplified study, but that, it's just another way of saying, Hey, when people have a better choice than drugs, they'll choose something else. Even people who are completely and utterly addicted, despite the stories that we tell. Right. okay. One more for you. And then I'll get off the Diri and let you ask the question, right?
This, this is my favorite example of prevention, because I think it. It's arguably the best success story in the prevention world in on the, on the globe. And that comes from Iceland. So in 2000, and I'm sorry, in 1998, Iceland surveyed their youth and they found that about like 42% of their 15 and 16 year olds had been drunk in the past 30 days.
That's very bad. So when you consider that number in the United States, that number's almost always somewhere between five and 10%, and this was 42% so huge problem. they convened a panel of experts and they decided, Hey, we're not gonna do the, the, just say, no, it's not working here. We need to do something different.
And so what they decided was to, to provide attractive alternatives, to give kids better opportunities to be kids. So they had this massive investment in infrastructure and things. You know, hockey, rinks and gymnastics, arenas, and football pitches and baseball fields. And, and they gave every kid under the age of 18, these leisure cards that are kind of.
Dave and Buster's cards, right? So you can go to like an arcade or you can go to a movie theater and it was just a way to let kids be kids, to give kids opportunity, be kids. And then they surveyed again in 2016 and they found that the percentage of 15 and 16 year olds who'd been drunk in the past 30 days had dropped from 42% to 5%.
Just a remarkable reduction. And so I'll, I'll just finish this by saying there was a great article written in the Atlantic, a few years ago. And the title of the article was how Iceland got teens to say no to drugs. And it was a great, great article, but I would suggest one revision to the, to the, the author of the article, which is they didn't get teens to say no to drugs.
What they actually did was they got teens to say yes to something else. And that's what, this is really the. of Iceland. And so I just think it teaches us a lot about, a more effective approach to, to preventing addiction.
Dave: I have folks who can't see me, but I was over here just mm-hmm mm-hmm the whole time.
Yes. Yes. And, actually for the drug free America foundation, podcast, pathways to prevention, I'm scheduling an interview with folks from Iceland to talk about their prevention model. So y'all stay tuned, stay tuned for that. Yes. So there's at least two, two, yeah, I'll call it two last things I definitely wanna to get in while we're talking.
the course that you were working on, that you had made, you talked about dopamine and the way you articulated dopamine up and down regulation, and the impacts. That blew me away cuz I could actually understand it. I'm a prevention guy, but I'm not a, a science pro. Could you give us the, the, the spiel on that?
Alex: yeah, I think the best way to describe it without the benefit of visual aid, which is helpful, is that. When people use drugs over the long term, it affects many different parts of their brain, but the main part of your brain that it affects is called your limbic system sometimes also called your survival circuitry because it's the most important system in your brain to the way that you survive.
And what, what long term exposure to drugs does is it affects the feel good chemical in your brain called dopamine. And the way that it affects dopamine is by increasing it in the short term and decreasing it in the long. In other words, you know, when you use a drug, you get short term spikes in dopamine, that's the pleasure that makes you feel high or feel good, but over time, your body sort of adapts and compensates because it doesn't like going way up, way up, way up all the time.
And so it starts producing less dopamine. It does that by. Fancy process. We call downregulating dopamine receptors. It basically means it's just dissolving some of the receptors. So you have less dopamine. So that now when you use the drug, instead of taking you way up high, it's gonna bring you into balance, basically bring you to, to feel normal.
so your body's PR basically trying to adjust so that you can continue to use drugs and, and function. and, and the main consequence of this that I think is most important to understand is when you use drugs long, That your dopamine levels have gone down, down, down, down, down. They ultimately reach a point where it's a term called anhedonia and that's a great word.
Alex: So Anne means not, hedonia means pleasure. So anhedonia means no pleasure means this is a brain that's unable to experience pleasure, and that is the very best characterization of an addictive brain that I can give you or of a brain that's early, early in. So one of the most common questions that, that I, I get asked, when I'm out in the community is about relapse, is like, okay, I understand addiction's not a choice, but how could someone choose to return to use after they've been sober for 30 days or a year or 10 years?
And there's a much more complicated answer than this, but the simple answer. Because they're pretty miserable because it's really miserable early in recovery when your brain hasn't healed and you're still suffering from, you know, your isms and, and you know, the problems that we have. So, we could go for a much more complicated explanation of the brain than that, but I think that's sufficient just to show like the brain changes, whether you want it to or not.
When, when it's exposed to drugs over time.
Dave: And if I remember correctly, there's something about, the magic of three years.
Alex: Yeah. Good number. So if you look at not relapse rates, but recovery rates, somewhere between three and five years is where we see a plateau effect where, your risk of relapse drops below 15%.
That feels like just a random number I'm pulling outta the air. But the reason it matters is because that's about the risk of addiction and the general public. So if my risk of relapsing as a person with a substance use disorder is lower than someone else's risk of becoming addicted as a member of the general public.
Then we might consider that full remission. As, you know, there's plenty of a debate to be had. And I think a very healthy debate to be had about whether or not people fully recover or whether or not you sort of are continuously in recovery. but from a clinical perspective, your risk of relapse after three to five years drops significantly low.
Dave: And I gotta tell you one of the reasons that number like I held onto that three years is actually cuz in January, 2023, I'll hit my three year of sobriety.
Alex: that's tremendous.
Dave: Tell me about dopamine up, like boosting our dopamine. Yes. Come on. You know, I like the positive.
Alex: yes. And you're asking good questions.
I love where this is going truly. because, because you're exactly right. So the, the, the horrific thing about addiction is that the brain changes for the bad. The beautiful thing about recovery is that the brain changes for the good, and you know, left to, to its own devices. It actually, as long as you.
Discontinue using drugs, it kind of heals on its own, but there are some really important ways to accelerate that process so that people in recovery aren't miserable for too long mm-hmm . And one of the best ways to do that, as simple as it sounds is social interaction. So there's a cool study that was published in a journal called frontiers and behavioral neuro.
Fancy. And it basically showed evidence that when people interact, pro-social interaction, even the conversation that we're having right now, it actually upregulates dopamine. And so what that means is not only is it giving you a little bit of release of dopamine now that's making us feel good, but it's actually over the long term.
Also increasing our dopamine levels, which means we're gonna be happier. We're gonna be healthier. We're gonna be more well adjusted. Our recovery's strong. And so it's such a, it's such an important point to double down on that. Whether we're talking about prevention or recovery, people need community. And you know, if you think about the way that we respond to addiction in our country, we tend to do exactly the opposite.
We tend to disenfranchise people, ostracize people, disconnect them in every way, seemingly possible. When what they need is virtually the exact opposite. They need all the connections. In the world in order to upregulate the brain. So not only can you, you know, when you're supporting someone who's in early recovery, not only can you give them tangible support, helping with housing or, mental health services or whatever, but most importantly, you interacting with them is organic medicine for their addicted brain.
Dave: Yes. And, another plug to the drug free America. Podcast, listen to Dave H Ham's episode from the well communities in the UK, how they, they created community. They went out into the community to create the community hubs, to bring people together. And his analogy about the well being that in, in old civilizations, communities were built around the well, the well was the life giving source.
And if you, if you venture too far away from that, well, or the community. And you struggle to survive. yeah. It's yeah, that, I don't know why that always just gives me chills.
Alex: I love that. I love that. Well, it makes sense too. Cause it is, it is actually exactly what voices of hope is. So in the same way I say we, we don't focus on drugs.
We don't ask people when they come in, how long they've been sober if they used last. We're not concerned with that. What we're concerned with is your health and wellness, because what we know from the science and also from our own experiences is when you improve people's health and wellness, their drug use outcomes improve all by themselves.
But when you start by just trying to take drugs away from people, all you do is make them suffer all the more. and so I think it's part of what has enabled us to be effective with, with a different audience. As we're saying, Hey, we're not forcing you to do anything, but we are here to help you get healthier.
Dave: Every step of. . Yes. Yes. actually David said that, they just love them until they, they learn to love themselves. I just, it was beautiful. Beautiful. What, what else y'all got going on at voices of hope?
Alex: Yeah, we've really moved into. Okay. So let me start by describing it just briefly. We're a peer driven community organization.
So that means it's a couple things. One peer driven means. All of our 50 fives or 60 staff are people in recovery and they use their lived experience in addiction to help other people in recovery. But also we're a community center, which means we, we're not a residential treatment center. We don't have beds.
People don't stay overnight with us. but we engage a different addicted audience largely. So we engage the majority of people in addiction who either won't go to treatment. Or after they've gone to treatment or before they go to treatment, people who, you know, you used a term earlier that I love sober, curious people who are sober, curious, people who are kind of, you know, if you're a, a clinician on the podcast, you know, you're thinking about stages of change, people who are in precontemplation or contemplation and just.
Those are the people who get left behind by the traditional treatment apparatus. Cause the, the way we traditionally do it is we say, when you're ready to get sober show up at our door and then we'll do this thing. And, and that for many, many people that day just doesn't come. and so for us, it's, it's outreach to go work with them.
One of the ways we do that is through a mobile unit. So we have a van that goes out, with a recovery coach. And with a re representative of our local health department to, provide harm reduction services, recovery support services. So we're figuratively meeting people where they are, and then literally meeting people where they're.
Dave: And I would say, yes, you're providing those services with that, that outreach, but even just like you had said about that prosocial connection, just going out, meeting people and talking to them, starts to build then foster that sense of community.
Alex: Yes. One thing that we are starting to track now that we hadn't even thought of before, but just following up on that point is the number of people who we first meet through a pretty passive interaction on the mobile unit who a week later or a month later find their way into the center, because we started to, because we were able to go slow because we respected where they were and they could come in at their own pace.
And then they, then they're curious, and then they're like, Hey, those people were pretty cool. I wanna check out what this is about, you know, and the next thing they, that, that they know. They're sitting in our center.
Dave: Yes. side project I'm working on is, for first responders in not just overdose follow up, but also active outreach and active prevention to go meet folks where they are.
just some building, some fundamental knowledge on addiction and talking a little bit about motivational interviewing as well. Just all about meeting people where they are.
Alex: Well, that's beautiful. And you, you mentioned to me before that you have some first responders, who are listeners of the podcast.
And so it reminds me to mention, we also have a partnership we developed with our police department and fire department called a community paramedicine program. And so our community paramedics, are, are a group of people who do follow ups after an overdose, but they're not going. You know, trying to force people into treatment.
They're not going telling people what they need to do. They're really taking that harm reduction approach of showing up and saying, Hey, we want to help you. Is there, is there any kind of support that we can give you right now? And it's been a really cool, a really cool partnership for us with the police and with, and with fire.
And by the way, I should just mention my brother-in-law is Lexington police. So we, we have a tremendous amount of respect for first responders in the work that.
Dave: Yeah, I dig it. I dig it. So if I were to weave a thread through our entire conversation, that common thread, it would be wrapped around being person-centered prevention, treatment, recovery, community, building, being person-centered and humanizing folks.
Is that a, is that a fair thread? How, how would you articulate that common?
Alex: I think that's well said, like person-centered is a term that gets, so it's almost cliche now to, to the point where it loses its meaning, but I think you're correct. This is what we mean by person-centered it's it's instead of it's and it's what I mean, when I say stop focusing on the drugs and start focusing on the people, these are human beings that we're trying to prevent drug use in, right?
Like, don't forget that they have thoughts and feelings and hopes and dreams and all of those things can be. in order to do prevention. So yeah, I, I appreciate the, appreciate the questions that you asked. I think it really helps frame the conversation around it. Doesn't all have to be fire and damnation to do prevention.
You know, we can really, we can do things that encourage kids and support kids in a different way.
Dave: absolutely. and shout out as well to the folks at Tufts university, the hope, healthy outcomes or positive experiences talking about positive childhood experiences as well. I'm gonna have to recruit them for an episode as well.
Cuz you know me, I dig the positive yes, I love it. Oh, alright. Alright. so I just wanna open up any, any sort of, I've got one more question, but first, any, any other thoughts, points, anything you'd like to share with the audience?
Alex: Just one last thought it's not a big one, but another risk factor that I didn't mention that just over the past few weeks I've been thinking more about is academics.
Because I think I didn't realize the extent to which academics is actually a pretty big risk factor when kids fall behind in school. And so it makes me think again about how we respond when kids are found to be using. And is the right answer to kick kids out. Usually that's that the, the idea is, I just presented on a, on a study that compared the way things were done in Australia, when kids are found to be using drugs in school versus the United States and the basic outcome was the United States takes a much more punitive approach.
We're much more likely to involve police than Australia is we're much more likely to kick kids outta school. And the reason I mention it is because when kids fall behind academically, that increases their risk for a. So if we have a kid who's already experimenting with drugs and our response to that is to kick 'em outta school and put 'em behind another year.
You think about the cascading effects that's gonna have, not only is it gonna put them behind academically, which is a risk factor, but now they've lost the relationships with their classmates, which is a big social disconnection. We've already made a big deal of what, how important that is. Right. We could go on down the list.
So I think again, it's just like, do we really think we need to punish our way outta this? Or do we need to support our way outta this? And I think that's. Just a, a, a question for everyone to consider for themselves.
Dave: You got me thinking. Yes. yeah, so like when it comes to academics, I, I did really well in high school.
Didn't have to study and got straight. I, when I got to college, whole different ballgame, I, I literally had to learn how to learn, how to study. and that was a stressor mixed in with a whole bunch of other risk factors. Then the, the connection or the, the peer group connection. When I came back from my Iraq, I got back just in time to see my, my cohort graduate.
And so then that fall, I jumped right back into school. I was older than all the other students. I had this whole other life experience. I had the tra the traumatic brain injury post-traumatic stress, and yeah, that also made academics one hell of a challenge, too. Yeah, I, I can see, I can see the, the logic in that.
Alex: Yeah. And I think it's, the other, the other thing to mention about that is the kids who are most likely to be found in possession of drugs are using drugs in high school. They're the kids who are more likely to have trauma, more likely to have mental health disorders, more likely to be children of divorce or of abuse or of neglect.
And. That's always in my gut, my fundamental problem with any desire to punish people for drug use is from where I sit. Most people I see using drugs are using it as some form of a relief for their problems. And so punishing people for that, not only is it not effective, but it also seems particularly draconian.
And when you know, they have mental disorders or you know, that they've been traumatized, it, it doesn't strike me as the, the right thing.
Dave: Yeah. And, uh, my friends at the national Alliance for drug endangered children like to bring about and point that, you know, that that child that might be acting out in school may simply be they're replicating the environment they're used to at home.
It can be related to that, that home life, and they might need support. Just like you're talking about. Yeah. Yeah. That could be a whole ‘nother episode.
Alex: could be just like you said, loving people until they can love themselves, whether it's a, a fourth grader or, you know, a guy addicted on the street. I think it's the same thing.
Dave: And I wish I could take credit for that lion, but that goes to Dave H ham. good. He's he's the, the beautiful author behind that. Absolutely. Well, the way I usually close out my episode. Is just one last call to action to the listeners, or if you're gonna remember one thing, remember this,
what would it be?
Alex: Hmm. Say if you're gonna remember one thing, remember this, people who are using drugs need connection. And so even though our gut instinct might be to punish, to push them away to any number of things, Consider what it would be like to connect first. You know, they taught me, someone taught me in teaching the idea of connect before you
correct. So be before you go and admonish someone or tell them to do something differently, you've gotta build a rapport first. And I think it's even a similar
idea. So yeah.
Dave: I'm not gonna throw anything on top of that wisdom right there. Listeners, you got it. There was so much wisdom shared in, in this conversation. Thank you, Alex. And folks, if you wanna hear more. You heard it a big part of his job is to speak, to teach, to connect and support and help share the messages and the wisdom.
So don't be a stranger. He, he is open for connection and conversation. I'll, I'll guarantee you that, check the show notes for links to voices of hope. yeah, that's it, man. Let's close this one out.
Thank you very much,
Alex: Dave. Thanks so much for having me this a great conversation. It's awesome.
Dave: That concludes this episode. Thanks for tuning in. Be sure to hit the subscribe button and share this episode with a friend before you leave. And we look forward to seeing you on social media, because prevention is better together. Together. We are stronger.
