Recovery Unscripted Podcast - Episode 17

Featured Guest: Sarah Zucker, Clinical Psychologist, AToN Center

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Today’s guest is Dr. Sarah Zucker, who serves as clinical psychologist with the AToN Center treatment program in California. She sat down with me at the Innovations in Recovery conference in San Diego to discuss her presentation on a client-centered motivational interviewing approach to discharge planning. She also shared her passion for being a recovery ally and gave us some practical tips that we can all use to be better allies to those in recovery around us.

One of Zucker’s first experiences with being a recovery ally was co-founding Aztecs for Recovery, the first collegiate recovery community on the campus of San Diego State. “College campuses are recovery-hostile environments. There’s not a lot of support for people who are newly in recovery or are trying to stop or cut back on their use,” Zucker says during the interview. “We know that social support pretty much is the most important factor to sustaining long-term recovery so it really just tried to increase that for students.”

Now in her role with AToN Center, she loves to help each patient participate in creating their plan for life after treatment through Motivational Interviewing. “[Motivational Interviewing] really helps people to align their actions with their goals and their values,” Zucker explains. “It is a collaborative conversation between experts because the client is the expert in their own life. Nobody’s been with them as long as they have.”

In this interview, Zucker also offers a substantial, valuable list of ways that everyone could be an ally to those in recovery. “I’ve thought of ally-ship much like people are allies to the LGBT community or the black community or other marginalized groups,” Zucker says. It’s an ongoing process where you commit to being supportive and to speak up and to not let injustice go unchecked.”

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Podcast Transcript: David Condos with Sarah Zucker

Announcer: Bringing you unique perspectives from inside the world of addiction and mental health recovery. This is Recovery Unscripted.

David Condos: Welcome to another episode of Recovery Unscripted. I’m your host David Condos, and this podcast is powered by Foundations Recovery Network.

Today’s guest is Dr. Sarah Zucker, who serves as clinical psychologist with the AToN Center Treatment Program in California. She sat down with me at the Innovations in Recovery Conference in San Diego, to discuss the presentation she gave there on a client centered motivational interviewing approach to discharge planning. She also shared her passion for being a recovery ally and gave us some practical tips that we can all use to be better allies to those in recovery around us.

All right, here’s Sarah.

I’m here with Sarah Zucker. Thank you for being with us today.

Dr. Sarah Zucker: Thanks so much for having me.

David: I thought we’d start by having you introduce yourself and tell us a little bit about your personal story and your journey to doing what you’re doing today.

Dr. Sarah: Yes. I’m a clinical psychologist. I knew really early on that I wanted to go into psychology. That was going to be my major all along. Even I think like middle of middle school.

I went to UCLA and majored in psychology. I was able to do some work there with people with obsessive-compulsive disorder. So that was a really great experience. I minored in LGBT studies which was exactly what I wanted to be doing, so psychology and then doing some volunteering work, and work for credits in the LGBT community.

My first practicum experience, was at Salvation Army Adult Rehabilitation Center. It’s a six-month program where people work to pay for their treatment. So they’re working like eight or nine hours a day. It’s set up kind of like an army and you really fall in line with the program or you don’t get to stay there anymore

But it was an awesome experience. I was there for two years and that was my first real clinical experience. Then I interned at San Diego State University and Counseling and Psychological Services. But I worked in the Aspire program after my internship, which is alcohol and other substances prevention, intervention and re-directive effort. Is a three session motivational enhancement therapy model for students that got in trouble for drugs and alcohol on or around campus.

It’s really innovative that my two supervisors developed the whole thing. And being in recovery myself, it was kind of interesting different way to look at things, because there were a lot of people that really didn’t want to change their use at all or who had different ideas about how they wanted things to look. So it really gave me a chance to change how I looked at recovery, and at treating people with substance use concerns.

Then my fourth year there, I co-founded and co-coordinated Aztecs for Recovery, which is San Diego State’s first collegiate recovery community. We did some really cool stuff here on campus. It’s got a lot of students involved. We’re able to really spread the message about reducing stigma, doing advocacy for people in recovery.

We had a support group that was Stage of change inclusive, which just means that anybody, at any point in their recovery journey was welcome. So we had some people that just were trying to smoke weed one less day a week, and then some people that had been in recovery for a few years, and they actually worked really well together to support each other.

Then I made a recovery ally presentation that I would give to different departments on campus. Vesti Police Department, which was so cool that they wanted to do that. They really wanted to learn how to better support students that had struggled with addiction or substance misuse, and then just different departments. That was something I was really proud of.

Just on a whim, I went on a tour at AToN because one of my colleagues had a client that went there, and I was just totally blown away. That’s where I work now, at AToN center. I was really moved by like they saw recovery how I saw recovery which is that, no one thing has the market cornered on recovery and that everyone has their own journey and it’s really person-centered, where we adjust to meet the needs of the client. We don’t ask the client to adjust to meet our needs.

David: You mentioned a little bit about your work at San Diego State, establishing that collegiate recovery program. Could you tell us what motivated you to create that, and then what that programs mission was?

Dr. Sarah: Sure. And this is a whole movement. It definitely was not my innovative idea. But, that we’re all trying to do a similar thing that college campuses are recovery hostile environments. There’s not a lot of support for people who are newly in recovery, or trying to stop or cut back on their use.

There’s a huge misperception of drinking and using culture on college campuses where, because we spend time with people who have similar behaviors to us, we think that there’s nobody does anything else here but that. When we knew that’s totally not true, there’s so much else going on.

It really tried to empower students that wanted to be in recovery or just reduce their use, that they had people that knew what they were going through and would be there to support them. And it just tried to acknowledge the stigma that students face, how it can be isolating that college is a stressful time anyways.

So if you don’t have any support, we know that social support pretty much is the most important factor to sustaining long term recovery. So it really just tried to increase that for students. And in the short time that it got going, it did a lot of good. They did a lot of fun stuff. They did a lot of stuff to be of service. It was really cool to see it go from nothing to something.

David: Yes. And so now, as you mentioned, you’re at AToN center, could you tell us a little bit more about your current role with them?

Dr. Sarah: Sure. Yes. I’m a clinical psychologist there. I run usually two or three groups a day. We do psycho-educational groups where we try to teach people skills. We’re based in cognitive behavioral therapy, but we also teach a lot of mindfulness stuff which is really important to me.

Also we see every client once a day for individual. So, they’re getting a lot of therapy there, which I think is really helpful. We work as a seamless team to give the client all of our diverse experience. Then I presented Monday, so that was part of my role.

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David: Yes, and speaking of your presentation here at the conference, you presented on a client centered and motivational interviewing approach to discharge planning. To get into that, what are some of the challenges that you see setting up an effective discharge plan and making sure that it is in fact client centered?

Dr. Sarah: I think there’s this misconception that discharge planning is something that happens at the end of treatment and is it’s own separate thing. And to me, especially through the research that I’ve done, recently realized every single thing that we do in treatment is discharge planning. And the whole team, not just the clinical team, but everybody can be involved in a good discharge plan in their own capacity, from nurses, to the resident assistants, to the outreach people. It takes a village to create a good discharge plan.

The challenges with discharge planning are that it’s not very rewarding off the bat. It’s a lot of work, it’s stressful. I think it’s interesting that we ask the clients not to make any big decisions in early recovery, and then yet we want them to commit to a sober living for six months and turn over. However much money, that’s a huge decision. So really just respecting how challenging that is.

I think we forget if you’re in recovery yourself, or if you’ve ever struggled, how quickly we forget how hard that time is and how vulnerable people are, which is why I talk about motivational interviewing. So I think that’s a very compassionate way to help facilitate clarity for our clients.

David: You mentioned motivational interviewing as a part of that. Could you describe what role motivational interviewing plays in the creation of this discharge plan, and then why treatment professionals should use motivational interviewing?

Dr. Sarah: Sure. Motivational interviewing, it just is a client centered approach that helps to facilitate change and reduce ambivalence, which is the very natural process that when we have two choices, we’re often torn and it’s very normal to be like, “I kind of want to do this, but I also want to do this”.

We learn about the way that we feel about things through our own voice and talking about it. So it’s a really different approach in that, instead of me arguing and confronting you, I’m going to empathize with what you’re saying and I’m going to help you to facilitate to talk about why you want to make changes.

To me, motivational interviewing is the most client centered and supportive way to honor people’s individual journey and choices while still giving them the best chance for success. And it leaves conversations in a way that the client would want to revisit them because so often, we’re just planting seeds.

We know a lot of people have more than one treatment experience. It would be great if on the first try, it just worked out. I’m glad we’re doing more research to try to figure out where we’re getting it wrong.

But if you have a bad treatment experience and they’re not satisfied, they’re more likely to relapse sooner. We know how important discharge planning is to create a supportive environment upon discharge. Motivational interviewing is a supportive, loving and effective way, to get people to act in accordance with their own values, and not necessarily what we want them to do, but to elicit that motivation that’s already within them.

David: Yes, and getting them to open up and figuring out what they want and then helping them to see that, and what they need to do to get there, right?

Dr. Sarah: Yes, it really helps people to align their actions with their goals and their values. If your value as a recovery which for most people that come to treatment, even on an intervention somewhere in there they want whatever recovery is to them. Just showing where action is inconsistent with values, and just getting them to live a more value driven life, I mean that’s all of our struggles. I have values and I fall short all the time. I really like this lets people find their own way while also sharing your expertise. I think I had mentioned to you that it is a collaborative conversation between experts because the client is the expert in their own life. Nobody has been with them as long as they have and you’re really honoring that.

David: Yes and absolutely, they know who they are and what they’ve been through and what they want better than anyone.

Dr. Sarah: Exactly.

David: You touched a little bit earlier on, I think it was the Aztecs in recovery, about the idea of being an ally. That’s something that is awesome and I think everyone who is in this community or in this industry or knows anyone in recovery, would say how I can do that. Could you tell us some ways that anyone can be an ally, to even just those around them?

Dr. Sarah: Sure, people who struggle with addiction or who are in recovery are a marginalized group, where they face different forms of discrimination. 27% of employers said they would not hire an otherwise totally qualified candidate just because that person was in long term recovery. We also know that 23 million Americans experience addiction, and 63% of people say that addiction has an impact on their lives. It benefits all of us to be thoughtful of these things.

I thought of Ally-ship much like people are allies to the LGBT community or the black community or other marginalized groups. It’s an ongoing process where you commit to being supportive and to speak up and to not let injustice go unchecked. It comes from there and this is totally people’s choices, it’s not something you have to. But if you, want these are things you can do.

Another one is to dispel myths. There are so many myths about addiction. That it’s just immoral, failing and that it’s just really sad. Another one is that people on recovery are unreliable or can’t be trusted, that you never know what they’re going to do next, they’re going to steal your stuff [laughs] at any moment, when really people who are doing well in their recovery are probably some of the most trustworthy people. That if people are having a slip or a relapse, that doesn’t just come out of nowhere. It’s not like all of sudden they’re just going to self-destruct at any minute.

Then the main one is talking about stereotypes. We have this stereotype that an alcoholic is someone drinking out of a paper rag under a bridge, a homeless person, and that bugs me because that person is totally worthy of treatment as well, and support and love. But that’s how we distance ourselves by creating those stereotypes.

Also on the college campus, people that I say, “I’m too young. I have my whole life ahead of me, I’ll do it later” and that you’re not too young to make a decision to work toward your physical, emotional and spiritual wellness.

Then using respectful language. I really like to let people identify if they want to call themselves an addict or an alcoholic. I use person’s first language. People would say substance use concern or, I don’t know, whatever people want to say. But I let people label their own selves instead of me doing it for them. Also using respectful language like not calling people junkies or alkies or stoners and really thinking about what you’re saying when you minimize use like that because that’s someone that’s struggling.

Then there’s lots of ways just in day to day interactions that you can be helpful. The main one is not assuming that everyone drinks. If you have a new coworker and just even checking in to see if they drink before you’re like, “Hey, do you want to go to happy hour?” We just assume that that’s what everybody does and it’s just nice to not have that be the automatic go to. Doing activities that don’t center around drinking or using, like just being open.

If you have a friend that’s new in recovery or who needs some additional support, doing different things without being willing to get out of your same routine, if you guys drink or use together. Talking about drinking ahead of time. If you’re having a party and it’s at a bar, if someone’s new in recovery, just letting them know, “Hey, this is what’s going on. Do you want to join me or not?”

People in recovery, they’re not sensitive people that need all this extra help. This is just if someone’s new in the process, and you’re not really sure yet what they’re comfortable with. People in recovery can go anywhere and do anything. They’re not fragile, but it’s just a courteous thing at first. Just meaning that they’re individuals and just asking if you don’t know something, like, “How do you want to be called?”

David: Just not being afraid to say I don’t know.

Dr. Sarah: Exactly.

David: It seems a lot of it is about educating yourself on in the macro level, but then also on what this individual.

Dr. Sarah: Yes, exactly. We get conditioned, yes, not to ask questions or that we should know what to do and then we get scared. It doesn’t have to be that. The other main thing I want to say, is keeping people’s story private until they give you permission to share it. Never outing anyone as in recovery or NAA or anything like that, until for sure that that’s okay with them, so that people are in charge of their own story.

Then there’s a lot of these you do if you’re hosting a party, having options for people. If you go to a party and there’s 10 different drinks and then there’s water off to the side somewhere, that really sends a message to people, we don’t care about nondrinkers. Just not assuming again that everybody is going to be doing that and having some options for people that don’t drink. Then the main one at a party is just creating a culture of consent and letting people say no, being respectful of, “Okay, do you want to drink?” “No thanks” and then not being, “Why?” No is not an invitation to just keep pestering.

David: You mentioned that you’re in recovery yourself.

Dr. Sarah: Yes.

David: How would you say that going through that process of addiction recovery firsthand, has helped you as you turn around and help other people?

Dr. Sarah: I have my own journey and course to recovering. It really shaped who I am. I feel a few of my identities have intersected to make me the way that I am. I study inner sectionality and how different identities come together to create layers of oppression. That’s really important to me, then being someone in recovery and not doing it exactly how everyone else did it, every step of the way, sometimes I felt judged or ostracized and maybe that was my own stuff, I don’t know.

I do feel there’s sometimes this rigidity, black or white thinking, and I really don’t like those group norms. I really just like living into your own self be true. To me, if someone says they’re in recovery, I’m on board. I don’t need you to show me your qualifications or anything. I believe there are so many different ways to be in recovery and to empathize with struggle. I just really don’t ever want anyone to feel alone, or that they’re doing it wrong. I really would just want people to be autonomous and free and be able to live in accordance with their own values and support them in that. I operate from the most respectful level possible or try to, and then see what people want and how they can feel supported.

David: Yes. But then we’ll just wrap up with this last question, and you’ve devoted a lot of your time and your life over the last several years to this industry and helping people find recovery. Could you tell us a little bit about why you would say that helping people in this way is important to you?

Dr. Sarah: This is my little corner of the world where I can be helpful. I know about this professionally. I soak up all the research that I can. But then also personally, this is where I can do the most good. I don’t want anyone to be suffering alone. I also think our industry is important but is always hopefully moving towards doing better. There’s much more to know about how to be effectively helpful, and I just want to keep pushing that and learning that and doing that so that we’re always doing the most that we possibly can to get a message out to people, that you don’t have to do this by yourself and you’re worthwhile and okay just as you are.

David: Yes, because there’s a great need out there.

Dr. Sarah: Definitely.

David: Well, thank you for being with us today, Sara.

Dr. Sarah: Thanks for having me.

David: Thanks again to Sara for sharing that with us. Now we get to close the show by featuring another powerful story, as part of our ongoing series called Hero of the Week. This week story’s comes from Katie D, who shared it on heroesinrecovery.com, a grassroots movement where over 1,400 people have contributed their stories.

After experiencing the journey of recovery within her own family, Katie decided to leave her 20-year marketing career in order to focus on the new calling, being an ally to other families in recovery. Katie says one of the biggest challenges during her daughter’s recovery from heroin addiction has been repairing the relationships in their family. She decided that she wanted to share openly about her journey to provide hope and education.

She has now dedicated her life to guiding others through the overwhelming process of finding quality treatment for substance abuse and personally coaching families through their recovery journeys. As Katie says in her story, “I know for me personally it was so difficult to reach out for help, because at the time, I saw it as a form of weakness and I felt shame. I want people to know that this is more a sign of courage and strength to say this is too big for me. I need the support and encouragement of others.”

Thank you Katie for sharing that and helping to break the stigma around addiction and mental health issues. If you would like to read Katie’s full story or share your own, visit heroesinrecovery.com.

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This has been the Recovery Unscripted podcast. Today, we’ve heard from Dr. Sarah Zucker, Clinical Psychologist with AToN Center. For more about their services, visit atoncenter.com. Thank you for listening. We’d love to hear from you. So, please leave us a review on iTunes or your favorite podcast app and let us know what you think. See you next time.

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