Adapting Treatment to a Postmodern World
Featured Guest: Christopher Pasquale
Postmodernism is changing the way people view absolute truth. So, how should the clinicians on the frontlines of addiction treatment respond to this cultural shift?
We’ll answer this with outpatient treatment director Christopher Pasquale on this episode of Recovery Unscripted.
David: I’m here with Christopher Pasquale. Thank you so much for taking the time to be with us.
Pasquale: David, thank you for having me. I appreciate it. This conference has been excellent and every foundations conference I come to, I really enjoy. The people are super nice. You guys really do a great job.
David: All right. Well, thank you very much for saying that. Yes, so for this conversation, let’s start by having you give us some of your backstory, some of your personal journey to how you got started in recovery in this world.
Pasquale: Absolutely. I am 38– no, I’m 39 years old. [laughs] I just had a birthday. I’d say, about 15 years ago, in 2003, my younger brother passed away. He passed away from substance abuse in induced. He accidentally committed suicide. That sounds strange but, he was using at the time– we both were using at the time and he got into a huge fight with my father, went out into the garage, and was attempting to manipulate my dad. He put a rope around his neck hoping that my dad would open the garage and see him like that and then, freak out, and say, “Hey, you need to go somewhere kind of thing.”
David: Kind of cry for help.
Pasquale: Exactly. My brother had done that a couple other times, and typically, my family would respond with, “Oh, no we need to take care of you and do whatever we can to help.” Which was great but, oftentimes, it was coupled with some enabling and whatnot. What happened, we were told that he actually fell asleep and not and an often. It was just tight enough for him to cut the blood fall off to the brain, and he died breathing the whole time.
They ruled it pretty much accidental. It didn’t seem like he was trying to but, it’s interesting because what it taught me was, even in the manipulation, bad things can happen. At that point, it was obviously, on the wrong track with my brother. He was at a different level than I was at the time, but it told me to, “Hey, you need to change things around.” And–
David: So, that was what was a turning point for you.
Pasquale: That was the big turning point. The very next day, I reached out to my local pastor that I had known my whole life, and I just said, “Listen man, I need help. I need to learn how to live.” So, we just started to meet every single week. I started to get involved in the church. He taught me how to live. He took me through some spiritual things with regards to the Bible and church and getting involved and, eventually led me to be a youth pastor, and I started a youth program that got very successful. I went to college and worked at the college with the young people, the younger people there at college, and just led me to this world of helping people and working with people.
Funny story is, as I was finishing up my bachelor’s degree in politics philosophy and economics, I had interviewed for a job at a jail I thought for a teaching position. I really wanted to teach History and English. So, I thought I was going to be teaching History and English, but it turned out that the job was actually to be a counselor in a substance abuse program inside the jail. At the time of the interview, they said, “We’d love to hire you.” I said, “That’s terrific.” I said, “But, I’m still in school. I’m finishing up. I have a few more months.” They said, “We know. We’re not able to hire you then, you’ve got to be done with school.” I was like, “Okay.” So, I just continued to work.
At the time, I was working for a non-profit. I was the director of the nonprofit and just working and one of the board members of the nonprofit said, “Chris, we really like you.” She was a top executive at Chase Bank, and she said, “We’d love to have you on our team. I’ll pay for your licensing for Series Seven and all these different things.” I was like, “Wow, this is amazing.”
I went through the interview process. The starting pay was 80,000, and this was back in 2007, and I was like, “Wow, this is great. Coming out of college making 80 grand? I’m super excited. So, I went through the whole interview process, I got hired, and then, the interesting thing is, I got a phone call from the jail and they said, “Hey, we’ve been waiting, you are now graduated, correct?” I said, “Yes, I finished up now.” Then, “Well, we want to know if you still want the position.” I was like, “Wow, can I think about it?” So, what I had in front of me was a job working at Chase Bank making 80,000, and then plus bonuses and all this other stuff or a job working in jail making $32,000 a year.
David: That’s very different options.
Pasquale: Yes. I called my dad and I said, “Dad, I know this is crazy that I’m even contemplating this, but what do I do?” He said, “Chris, you need to be able to have a job where you wake up every morning and you are excited about going to work. That you’re doing something that is producing you a feeling that you’re helping in some way and that you can go to sleep at night.
I said, “You know what? You’re right.” I chose the $32,000 a year– a $34,000-a-year job. The funny thing is that, about six, eight months later, everything crashed and all those executives at these banks and stuff didn’t have jobs anymore. So, that’s an interesting way to take a step back and go. Okay. Well, I put it in God’s hands and I felt like I chose the right thing, and life is taken a really cool trajectory where I went and got a master’s degree. I have a master’s degree in mental health counseling.
I moved to Florida where helped to start a treatment center. Then was there for six years and left to kind of start my own with two other buddies of mine that I’ve been able to be in it from the beginning and actually, build it to where it is today, and it’s amazing. I feel blessed every day to get up and go to work. RECO Intensive to me, it’s an amazing program. We have a very good reputation in Delray Beach. We work closely with foundations and other really great treatment centers around the country. We only do intensive outpatient. We have level four far certified housing. So, our clients are able to live with us and go to IOP and then, they’ll do 45 to 60 days with us and transition to sober living.
In that time period, we get an opportunity to really teach them about life. They spend 30 days in treatment, now, they’re out of that bubble and now they need to learn about life. So, we get them for that time period and teach them life skills, help them to find a job, help them to balance and save money, help them to shop, how to take care of a house.
Certainly, with a culture that we currently have, it’s so important because a lot of the young people that are coming into treatment have never worked before, have never even had a bank account.
David: Because they started so young.
Pasquale: Started so young and the culture of our society develops young people in a much different way than even was 15 years ago.
David: Yes. We’ll get into that and more, dial in. Though backing up, so, that job that you took at the jail, at the prison, what was that like? Did you enjoy it right off the bat and it sounds like it’d be challenging too.
Pasquale: It was certainly very challenging and I had no idea what to expect. So, they did this really great training. It was a two-weeks long, and it wasn’t in the jail. It was actually offsite somewhere and you were in a classroom. They taught you all kinds of really cool trainings, trainings on rational emotive behavior therapy, trainings on how to search a bank. You go through, I mean, really intense training on how to work with the inmates.
It was fascinating to me, and I was so blown away, and I was so excited every day because, I was learning all this new information. I went to school for politics, philosophy and economics and I knew philosophy very well from the ancient Greek philosophers to modern philosophy. Studying culture and how philosophy drives culture based on what people believe and their world views.
Then, to take that philosophy and then to apply it to substance abuse counseling, I saw the connections right away. I saw the connections between, the basic philosophical questions that all humans ask themselves. Who am I where, am I going, and how do I get there? Looked at it from a counseling perspective and how individuals don’t necessarily ask those questions out loud, but if you’re to peel away all the other questions that they ask, it eventually comes to that. Who am I, where am I going, and how am I going to get there? Some of the trainings that they had, rational emotive behavior therapy, the founder of REBT was a philosopher and he developed REBT around philosophy. Even, the application of it, we’re studying ancient philosophers and Socrates and how you interview and question clients, and talk to them. I saw the bringing together of this world that I didn’t know existed and it got me super excited.
David: Yes, that’s interesting. You wouldn’t necessarily think those two things got in there. Then you came down to Florida. You worked in the treatment field for a while and then you started RECO Intensive. Give us some insight into the process of why you decided to start that.
Pasquale: We, David and Brian and I, we looked at the way treatment was done. David, our founder, had a vision for how to bring a lifestyle into a treatment center. Let me see if I can explain that. The lifestyle of someone in recovery and sobriety, its action packed. There’s a lot of fun, but it’s challenging. Some of the things that he loved doing growing up, skateboarding, motor cross and skiing and snowboarding and all those things.
Myself, I did skate boarding and bicycling, those things were super challenging. They were hard and you got hurt, you fell, you broke things, you scraped things, but that lifestyle of that grind of being out there every day. I remember spending eight hours a day practicing a 360 kick flip, and I needed to have it happen.
David: It was worth it because you were motivated. It was your thing.
Pasquale: Exactly, and bringing that lifestyle into treatment. That mentality, that thinking that grind, that joy, that happiness that came when you landed that. When I landed that 360 flip from the first time, and everyone around me was just, screaming and cheering, because we were all just practicing the hardest trick we could think of. When you landed and you ride it off, there’s that feeling that comes over you. It’s just this joy, and really what are people lacking I think in this world is joy. I think we lack joy. Real gut heart joy. It’s, we go through the motions a lot of times. We go through the motions. Even clients who are newly in recovery, they go through the motions of going to a meeting, doing the steps.
You do all of these things looking for that joy, looking for that happiness. Unfortunately, it doesn’t come that easily, and I think people are really desirous of real joy. We took this idea, this lifestyle. We took this other approach, and even in the talk today, I mentioned it. I think treatment centers and clinicians for a long time, the way that it worked was, you stood at some imaginary finish line. When a new client came in, you could see them down the path and you scream to them, “Hey, listen, recovery is over here.
You need to get to this finish line and you’re going to be okay.” The reality is that, and the way treatment I believe and David and Brian, what we believe is that, treatment is meeting that person as soon as they walk in the door and taking that journey with them. Really walking with them-
David: In whichever direction it goes for them.
Pasquale: Whichever direction they’re walking. You try to force them down a certain path and what happens? They wind up fighting you. Again, when something goes wrong, they look at you, there’s no responsibility there. “Well, I didn’t want to go this way. They made me go this way.” This culture our society has built individuals to, they’ve given them the ability to not take responsibility for things. I think a lot of people nowadays lack responsibility for their own choices that they make because, the world has caused me to this. Or, because you said this, it offended me this way and now that’s why I react this way. Truth is, is that you need to take responsibility for your life.
We work with them as soon as they walk in the door to say, “Listen, this is your life, your path. I’m here to help. I’m here to guide. I’m hungered to give you anything you need, but the reality is, you have to make the choice. When you make a bad choice or you trip or you fall or you stumble, I want you to be able to take responsibility for that stumble, that trip, that fall, that direction, because if not, then you’re never going to grow.” That’s the way we looked at it, the way we saw it, and we wanted it to be fun. We wanted it to be exciting. RECO tagline is, “Let’s get back to a brighter future.”
We believe that at some point in somebody’s life, they saw their future and said, “Man, I can’t wait. I’m excited. I’m excited for my future. I’m excited for what is in store for me.” We want to get people back to that place. Almost like that child-like joy that came when they thought about what they were going to do in their lives. That’s where we’re at with RECO. That’s our mission, is really to treat people as human beings, to love them, to bring them into the fold, into the family, to treat them like family. Ultimately though, allowing them to choose their path and helping them along the way.
David: Yes, absolutely and you’re getting into it a little bit here at the conference. In moments of change, you presented on the philosophical shift that’s been happening in this industry. To start, could you introduce us to the landscape right now related to philosophical beliefs, especially about how treatment, maybe “Should be done.”
Pasquale: The philosophical shift that I’m referring to took place in the mid to late 20th century, and it’s modernism to postmodernism. From a world perspective, culture perspective, Western society perspective, we have shifted from modernity to post-modernity. Post-modernity, basically the basic tenants or beliefs of post-modernity lie in the in the belief that there is no objective truth, there is no absolute truth. That you can’t tell me what I should or shouldn’t believe, that I’m allowed to believe whatever I want. What’s good for you is good for you. What’s good for me is good for me.
There’s no absolute authority, you are your own authority in life. That’s post-modernity, that’s the basic concept and understanding of post-modernity. Really, when you think about treatment, we operated in a very modernistic mentality. Even though culture shifted from modern or postmodern, we remained in that modern mentality, which was, I have the authority, you do it my way. If you don’t do it my way, it’s not going to work. We force people down a certain path and say, “This is the only way that it’s going to work and you have to do it that way.”
Treatment was like that. It’s like standing at that finish line saying, “Hey, you want to be okay? You need to get to this finish line, the one that I’ve created, because if you try to go any other direction, it’s not going to work.” To give you an example, a person comes in, they walk in the door, they say, “I don’t want anything to do with God and do not tell me anything about 12 steps. Not going to happen. I don’t want to hear it. I don’t believe in it. It goes against my postmodern worldview. It’s very religious. It’s dogmatic, and then I don’t want nothing to do with it.”
Now, as a treatment provider, I could say, “Well, then this isn’t the right treatment for you, because, you know what? 12 steps is the only way that we believe that you’re going to able to get sober.” For a long time, it was like that. Treatment looked that way. Now what we’re realizing is, is that, we really shouldn’t do that, one and two, it isn’t the only way. I know that’s scary to hear sometimes but it really isn’t the only way. There are other ways. I had a young man who came into treatment, he said, “Don’t give me God, don’t give me 12 steps. I said, “Well, listen, man, you need to do something, you can’t just not have a recovery program because, a recovery program, AKA is just life.
It’s life, that’s what we’re discussing here. Your life has to have something built into it.” He said, “Okay, well I like yoga.” I said, “Okay, we’ll go to yoga four or five times a week, and make that a part of how you’re going to live your life.” He did and he stayed sober. Then, eventually, wound up finding God and participating at a church and volunteering and all of that. If I told him, “No,” right from the door, “You’ve got to go to this.” Only resentments would’ve grown. He would’ve felt like he couldn’t talk to me because, I have this belief and I was forcing him to believe that way.
Maybe we’re onto something different here. Maybe we need to look at something different. As time has gone on, and that was like about three or four years ago, as time has gone on, we have given other people opportunities. What we’ve seen is we’ve seen smart recovery come up. We’ve seen celebrate recovery. We’ve seen refuge recovery. We’ve seen yoga and meditation, people really holding on to that and utilizing that as their recovery program.
Now, 12 steps is just one of the ways that people can engage with a community of people who are recovering. That philosophical shift, that mindset, we need to make that shift and realize that we’re not working with people with a very modern mindset. If we come at it from this authoritative place, we’re going to lose them. We need to change.
David: Yes, because the culture in a lot of ways is really working against that.
Pasquale: Exactly, culture has worked against, is not working from that modernistic point of view. Therefore, if we’re trying to fight against an entire cultural shift, we might as well pack it up and call it a day.
David: As the new generations come up, you’re just going to lose them more and more.
Pasquale: That’s right. That is the responsibility of the treatment provider, to engage and understand culture so that we can shift as it shifts. Now, that doesn’t mean that we let the clients do whatever they want, or-
David: There’s no rules.
Pasquale: There’s no rules, because rules exist. If we’re going to fight a world view, we’re going to lose. If we can recognize the worldview and then, utilize it to help us get to the heart of what is actually going on. We’re all humans, there’s that underlying core that, it doesn’t matter what your world of view is, we’re going to connect in that humanness on some level, some part, some way. Let’s play in that area and work with the worldview.
David: Yes, and this is interesting because, you work as a pastor?
David: There’s absolute truth in some parts of that. How do you describe how that plays into it and how you’re able to look at both of those things?
Pasquale: Here’s the thing, even with, I believe with Christianity, there are different sex, there are different denominations, there are different ways that people practice. That’s I think where you can accept the differences and find where you can connect. Even though I might be a part of a certain denomination and you’re part of another denomination. You might experience God in a very different way and practice your faith in a very different way, but we still believe there is a God. Therefore, we can communicate and talk and experience that together on the same page.
Well, that’s the same thing with working with clients. There’s something in there that they believe, whether they realize it or not, and not even necessarily about God. Just in general, there’s a belief that they hold. We’ve got to figure out what that belief is and connect with them on that level. If we can connect with them on that bottom level, and really that gut human, realness level, everything else will fall into place, but we just have to start there. Sometimes, we attempt to do the other first, and then again, we hit a brick wall. Excuse me.
There is something that we can connect on regardless of who you are, where you’re from, or even what religion you are. There is something that we connect, and that’s that, we are human beings and we have worth and value. If we could build it there, we can go somewhere.
David: Yes, and its finding those foundational pieces and not getting too caught up in the peripheral stuff, and letting that distract or become a real fight.
Pasquale: That’s right, and if you don’t mind, I’d like to read something here because exactly what you said is right on point. There’s a philosopher and author, Dr. Ravi Zacharias, and he told the story about going to Ohio State University to do a speech. He says, he was minutes away from beginning his lecture, and his host was driving past a new building called, the Wexner Center for the Performing Arts. Dr. Zacharias, the guy driving him said, “This is America’s first postmodern building.” Dr. Zacharias was confused for a second, and he goes, “Well, what does that mean? What does a postmodern building mean?” He says, “Well, the architect said that he designed this building with no design in mind.”
When the architect was asked why, he said, “If life itself is capricious, why should our buildings have any design and any meaning?” He has pillars that have no purpose. He has stairways that go nowhere. He has a senseless building built and somebody has paid for it. Dr. Zacharias said, “His argument was, that if life has no purpose in design, why should the buildings have any design?” The guy driving said, “Yes, that is correct.” He then asked the question, “Did he do the same with the foundation?” Absolute silence. Imagine a foundation built like that building.
It would crumble, because, the foundation, you can’t have it with no purpose and no meaning. I believe that the foundation of every human being, there is a desire for meaning and purpose. If we can get to that foundation, the way it looks on the outside, we could play with that. You can build a pillar that has no purpose, go ahead, but your foundation is going to be built like any other foundation, like every other human. That’s where we need to connect.
David: Yes, wow, great analogies there all around. Then, taking this into context, what are some new interventions, guidelines, ways that you think have the best chance of reaching people in this current cultural climate?
Pasquale: Carl Rogers, philosopher, psychologist. I think his philosophy was built for a time like this. What he believes was that, there is a level of respect that every individual has, and the therapist needs to have that kind of respect for that person. Its client centered, person-centered therapy. That’s what it’s called. It’s the idea that, there’s unconditional positive regard. Regardless of who you are, where you’re from, what you’ve done, I will look at you as if you have value and worth. I am not judging you on your outside. I’m not judging you on the things that you’ve done. I’m not even really judging you on the things that you say. I’m going to have positive regard for you because you’re a human being.
Roger’s philosophy, this idea that we connect on that foundational level, and I need to see that. First and foremost that needs to be in my periphery and I need to see that. Then I can work with you. Excuse me. Rogers also believed that most people struggle with incongruence. Incongruence means that, the ideal self doesn’t match with the self that is living, behaving, acting-
David: In reality.
Pasquale: In reality and that’s where the incongruence takes place, and that’s most people’s issue. That there’s an incongruence, that ideal self, not matching self. In order to bring about congruence, we need to teach individuals to recognize that this ideal self that you have in mind has limits. There are things you can’t do. If you go around believing and operating as if you can, much like the postmodern individual has grown up. Everybody gets a trophy, you’re always a winner, you’re always great and wonderful. You could do whatever you want. That’s not really true. I hate to break people’s bubbles here, but you have limits.
Your intellectual capacity may not be able to make you an astrophysicist, that’s okay. You’re five foot five or me, I’m five foot seven. I’m not dunking a basketball. Do you know what I mean? There are limits, accepting those limits, creating an ideal self that is based in reality and then, working towards that, but all along, still loving who you are, still recognizing that this is who I am. I want to be this, but I can work towards it, and I’m not setting unrealistic expectations for myself.
David: You can still have goals within the framework of what you can be, what you can do, and not be discouraged thinking about what you can’t do but think about what you can do.
Pasquale: That’s what I always try to do with my clients, and that’s a big intervention for us. Instead of sitting there and asking the client questions about their behavior and stuff like that, I say, “What do you feel is important? What’s important to you? What kind of values and morals do you have? What do you believe about yourself in regards to your future that you can hold onto and start to build towards?” As opposed to just again, you’re hitting them over the head with a Bible. Hitting them over the head with an alcoholics anonymous.
Instead of that, I want to find out what they believe is important. What do they see as valuable and how can they transfer from where they are currently to that ideal self and create some congruent. Recognizing even the small things that they do and giving themselves a pat on the back. I tell them all the time, so you guys beat yourselves up too much. I’m not beating you up. Your parents aren’t beating, who’s beating you up? You are. You’re creating your own barriers to your treatment.
David: I know you’ve been involved with Rico building it from the ground up. You’ve been involved in with the actual creating the programming and that kind of thing. How do you go about that creation process? Examining the clientele, making sure you’re meeting their needs and then, making sure that the treatment is adapting toward the patient’s need?
Pasquale: As an IOP, one of the things that we recognize didn’t happen in most intensive outpatients is, we have a treatment team meeting every single morning, which I attend. I also continue to run groups. I am actually involved with the clients on a regular basis. I meet with all the therapist to get an understanding of their caseloads. What’s going on in the community, where are our clients out. I observe the cultural shifts and I listen to people and I get involved with a lot of what’s happening on the day to day basis. Which allows me to understand where we’re at, and sometimes we need to make programmatic changes to fit the type of client the community that we have and so we just do it.
Instead of remaining static, we want to always be observing and learning and really understanding where we are at so that we come with our best and we are able to shift things and allow for that client to fit. Allow for the program to fit for that client.
David: Do you have an example off the top of your head?
Pasquale: Just recently, what we saw was that, I believe in season’s right. I believe that even though most of these people and even ourselves aren’t in school anymore, we still operate very seasonally.
David: In that academic calendar?
Pasquale: We do, it’s funny because I watch like the trends in the year and always around fall or like September, October time period, there is just like chaotic mess that takes place with clients. There’s always a number of clients that get crazy and do things and relapse and all this kind of stuff. It always happens around September, it happens around Thanksgiving, Christmas time. There is this flow and I’ll call it out, I’ll say to the staff, I’ll say, “Listen, the next couple of weeks, it’s going to get a little crazy. Just make sure that you guys are on top of things and you know what’s going on and low and behold it happens.”
I can call in every single time and I think it is because of the academic calendar. I think we still operate that way, summer time’s coming, it’s like, “Wahoo.” We are going to go nuts and people still do that. Recently, we saw that shift taking place. What we did was, we literally changed a whole entire day and moved one of the days a bit. Friday was typically a day that because it is four day a week IOP.
Friday was a day that we did other things like, they went food shopping, they did the food pantry, beach cleanup. We do this project with the clients every week where if they are utilizing a food pantry or if they don’t have a job yet, then they need to go and give back somehow. They’ll give to the city and we’ll go clean up the city at Delray Beach. We’ll go to the beach, clean it up, they’ll process it, talk about what that is to give to somebody else. On Fridays I said, “You know what? We are done.”
Fridays, now it is going to be Wednesday and Thursday and Friday is going to be full program days because, that three day weekend is causing a bit of chaos. We just changed the whole schedule I added in an extra gender group because, we had a lot of relationships starting to build with male and female. Let’s throw another gender group in there and now we’ve got gender group five-days a week. We’ll make changes-
David: Gender is separate you mean?
Pasquale: Yes, separate. We’ll make those changes right in the immediate and the staff is great. They are flexible, they recognize the need for it in order to meet the needs of the clients.
David: Yes, that’s great to have that flexibility for sure. All right well I’ll just wrap up with this final question. Everyone who gives their life to this mission has their own personal reasons for wanting to get up and keep doing it every day. Could you rather start by summing up why this mission of finding the best ways to meet patient needs the best you can and further this cause, why is that so important to you?
Pasquale: I really enjoy looking at the world, understanding society and culture and applying the needed changes programmatically, belief-wise in order to reach that individual. I believe that every person, there is a way to touch that core of them. There is a way to just make that light bulb go off or something happens and it clicks. I remember for myself, sitting in a philosophy class and we are reading through the dialogues of Socrates.
We’ll play those dialogues but Plato wrote them, Socrates said them. We went through the allegory of the cave. Allegory of the cave is about an individual being released from this darkness, this cave where he saw nothing for what it was. It was all just shadows and false light and he was released from this cave and sent out into the real world. He saw the sun for the first time, he saw grass for the first time, he saw birds, he saw butterflies and he soaked in all of these truths. All of this reality and what Socrates says at the end of it, he says, “It is the responsibility of that individual to go back into the cave and release the other prisoners.” For me, that’s when I felt like my mission is, I’ve been granted this ability to see the light and see things for what they are, it’s my responsibility to go back and release the prisoners to get out of that cave, to get out of the darkness, and to come into the light.”
David: Yes, it all comes back to philosophy?
Pasquale: That’s it, that’s why it’s amazing. It really is.
David: All right well, Chris, man thank you so much for your time and for being with us.
Pasquale: Absolutely, David, thank you so much.
You May Want to Know:
- Medication-Assisted Treatment vs. Abstinence-Based Treatment
- FRN Research Report October 2011: LGBT Inclusive Integrated Treatment: Understanding Patient Needs in All-Inclusive Treatment at Michael’s House
- Opiate Addiction: Strategies for Creating Long-Term Sobriety and Increasing Treatment Adherence