Dr. Gerber:         00:01          Podcasting from the base of Lake Tahoe in the Eastern Sierras comes The Medicine Wheel. We are a group of progressive physicians seeking solutions and enlightenment while surfing the seas of big data and summiting mountains of research in an effort to make the practice of medicine more personal and medical knowledge more accessible and empower you, the listener, to be as healthy as possible. Now, The Medicine Wheel. Hello everybody.

Dr. Sean Devlin:    00:34          Welcome back to The Medicine Wheel. We are privileged today to have a friend and a colleague of mine. Her name is Taylor Tremayne and she's an alcohol and drug counselor who works here locally. She's come in to share some of her wisdom, insights and advice about the mounting problem of substance abuse and addiction disorders and how she as a counselor deals with those. I'm very excited to welcome her and I'd like to say thank you again for coming by this evening.

Taylor Tremayne:    01:06          Well, thank you for having me. I'm excited to be here.

Dr. Sean Devlin:    01:09          Absolutely. Absolutely. It's a pleasure. I know that you're very young in this field and I maybe you can kind of talk to us about how you actually ended up as a drug and alcohol counselor. It's certainly a unique profession, a very noble one, and something that we're desperately in need of having more of talk to us about what that path look like for you.

Taylor Tremayne:    01:27          So that path was actually kind of funny. I accidentally took a substance use and addiction treatment counseling class in school. I thought it was an elective credit ended up not counting for that elective credit, but I needed to minor. So I decided to take that minor. And through that I was able to create good relationships with some mentors and some professionals in the field and I fell in love with the counseling and wanted to pursue it. So here I am about three years later after my minor and I've been practicing for two years providing counseling.

Dr. Sean Devlin:    02:01          Can you talk to me a little bit about the kind of cases you're dealing with in the type of clientele you care for?

Taylor Tremayne:    02:07          I'm strictly with substance use counseling clients right now. I also provide case management, but the rural population is completely under-served. When we have clients who are needing a higher level of care or a different resource, it's very hard to get them referred somewhere. Transportation is a major issue. They have very limited, and there's very... There's actually almost no public transportation to get them to cities or places where there are the resources that are needed. And a lot of times they're on wait lists because of the need in the state.

Dr. Sean Devlin:    02:47          Wow. I mean, that's a such a travesty. I think that a lot of our listeners and viewers are probably privileged if they're, you know, accessing a podcast. To have transportation, to have access you know, whether it be public transport or private transport to get back and forth to doctor's offices, to counseling visits. I mean, what a shame that, you know, because of a transportation issue, they can't access the kind of care they need. Is there anything you guys are doing it to sort of circumvent that issue?

Taylor Tremayne:    03:16          Well, yes. So we not only provide a mental health and substance use care, we provide child care before and after school programs. We have a medical clinic, they're their own agency, but they come up and use our building to provide medical care. We have home visiting services, we work with the senior centers; We try to address as many needs as possible when we can. Because we are a nonprofit, we're limited in funds, but when we can, we try our best to help with the transportation issue, whether it be providing cash or money to be able to get a cab or transportation. We work with the Sheriff's office and the fire departments as well to try to get people where they need to go.

Dr. Sean Devlin:    03:54          So on your average day when you're out in these rural areas kind of talk to me about the sort of the age ranges and then the sort of diagnoses that you're dealing with with these folks.

Taylor Tremayne:    04:07          So with my clients specifically, I'm seeing actually teenagers all the way to elders. I have experienced with all age ranges that no one normally under the age of 13, I haven't really served. I work with juvenile probation also so I can provide services to kiddos that are coming through there. And then I've also worked closely with the courts. So sometimes you get a lot of court mandated clients. Those are more my adults and older individuals who may have gotten in trouble or are being asked to have an evaluation or counseling done for some other reason.

Dr. Sean Devlin:    04:42          So for these folks who are kind of mandated to see you, it's kind of like, you know, they've got to establish a relationship with you kind of or else. Tell me about how that is compared to your clients who are kind of under their own autonomy coming to see you. They're not pressured into it but are trying to get help themselves.

Taylor Tremayne:    05:00          It's definitely a challenge. When it's a mandated client, they often don't want to be there. And I acknowledge that. That's something that I put into our first encounter. It's like, "I know you don't want to be here, so how can we make this something that doesn't feel so punitive?" Because I'm not a punitive measure. I'm not, I don't, I can't force them to stay, can't force them to come. So I really try to focus on how can we make this something that you want to do or can benefit from rather than you have to be here and I'm just going to kind of put all this stuff that you have to do in front of you. Let's collaborate and make this something that you're going to benefit from.

Dr. Sean Devlin:    05:36          Okay. Well that's a nice way to turn it around so they can use it and look at it as a positive experience versus a punishment. I think a lot of folks who are been incarcerated or challenged in this way view anything that's mandated as some form of punishment. So I, I, that's a lot of wisdom that you share there and how you can turn turn that story around so they can be empowered by it. Let's talk a little bit about some of these younger clients. I mean, when you say 13, 14, 15 years old, I mean, you know, when I was in junior high, I, I, you know, would see people using marijuana and some alcohol, but not to the extent that I hear about these days where it's just pervasive like gross alcoholism and gross substance abuse that's even life-threatening. Can you talk a little bit about some of those cases?

Taylor Tremayne:    06:21          Yes. So cannabis and alcohol from my experience are two of the major ones I'm seeing with the younger population in the rural Nevada. A lot of when I'm conversating and working with these kids is that they're saying, "Oh, there's nothing to do. There's nothing to keep my time. There's nothing that's engaging." And so they're going and using substances rather than providing their time to something else. Sometimes it's a family learned dynamic. They're seeing their families or they're engaging with it with their families, and then it moves from that to doing it on their own or doing it with their friends and it's becoming a major issue. And if they're getting in trouble for it a lot of them have been at school, caught with something that they shouldn't have at school or a situation of that nature.

Dr. Sean Devlin:    07:06          Yeah. You bring up something really important is introduction. How do these children get introduced in your opinion do you think is through the parents family members or is it through their peer groups at school?

Taylor Tremayne:    07:18          For me it's hard to say on that one. I think there's components to both. It's very interesting. The kids I work with, it's, I've heard from family, you know, "I've seen my parents do it all the time and I've gotten it from them" or "I was out with my friends and my parents don't know that I'm doing this." So it's a give or take. I would say. I can't distinctly say one more than the other.

Dr. Sean Devlin:    07:41          Do you ever find yourself dealing with a parent, child client situation where you actually will counsel both the parent and then separately their child?

Taylor Tremayne:    07:51          Not in my situation. I have the scope to be able to do some of that. The parent is involved, especially if the child is a minor, they have the right to be involved in any information, but I'm not normally counseling them together or separately at the same time, I would refer one of them over to another provider most likely.

Dr. Sean Devlin:    08:16          Now I know that you put together a short PowerPoint that we're gonna kind of go through to help the listener and the viewer understand kind of what you do and how what you do may be something that may be a appropriate for them or a family member or loved one who's suffering or struggling with addiction or some sort of substance abuse that can be harmful. So if you don't mind, once you go ahead and take a look at the PowerPoint and then we're going to refer to this and we'll show this up on our screen. Basically you would simply titled understanding substance use or abuse. Let's talk a little bit about how you make diagnoses or how those diagnoses are come to. And then when you get those clients, what do you do in and around those diagnoses?

Taylor Tremayne:    08:57          So I operate out of the DSM Five that's the newest version of the Diagnostic Statistics Manual. And when I'm regarding diagnosis is when I'm engaging with a client and doing an evaluation, I'm looking at how their substance use is impacting their life. Is it impacting their ability to work? Are they not getting to work because they're hung over or still experiencing effects from the substance use? Are they craving the substance use or substance? Are they trying to cut down but are unable to on their own? I'm looking at if they're putting themselves in physically hazardous situations, whether that's driving or even just are they regularly getting in fights when they're using whatever substance it is? I'm looking at withdrawal and tolerance if they're needing more or the same amount that they've regularly used is no longer doing it for them. And basing off of 11 criteria that the DSM sets out there is now mild, moderate, or severe use of a substance. So based on how many criteria they meet will be determined of where they fall on that scale. And then for treatment you actually refer to something else called the ACM, which comes after the DSM. So, and DSM is when I'm working for diagnosis and then I'm looking at the ACM to figure out level of care for the individual.

Dr. Sean Devlin:    10:18          Okay. So it's sort of a diagnostic as well as a treatment sort of manuals.

Taylor Tremayne:    10:23          Yes, they're both in there to be your guidelines of how to get these individuals in the right place that they need to be. And I wanted to touch on something important in the DSM that's come about. It's this client centered language that they use now. It's no longer addiction or dependence. It's substance abuse disorder and then the mild, moderate or severe to put the person in control saying instead of "I'm an alcoholic", saying "Dave is an individual with an alcohol use disorder."

Dr. Sean Devlin:    10:55          Now, I understand. The vocabulary around this can be sensitive for some folks. Early in my training there was a lot of shame around a diagnosis of alcoholism or drug addiction. And you're saying now that there's been a paradigm shift in how we use that vocabulary to not necessarily label but to describe it in a softer fashion. Do you think that's made an impact? I, I know you're new to the field, but have you seen or heard from other practitioners anything that would suggest that that change of vocabulary has helped in this process?

Taylor Tremayne:    11:35          I would say yes. It's more of an empowering thing for clients rather than having to say, "I'm an addict" or "I'm an alcoholic." They're feeling more comfortable saying "this is just an issue I have. It doesn't have to define me. It doesn't have to be an end-all-be-all it's something that I can work with and that I can work on and continue to grow from."

Dr. Sean Devlin:    11:57          When you look at diagnoses that are associated with the substance use disorders sometimes they're affiliated or associated or come concomitantly with mental illness. How often do you see a patient come in with let's say a history of alcohol abuse disorder that they would also have some other underlying medical condition or mental illness?

Taylor Tremayne:    12:23          I would say very often. They are not mutually exclusive. They are more so on the substance use side, it's very often that they have a mental health diagnosis or disorder. I cannot diagnose that nor treat that. But if they come in and they say "I've professionally been diagnosed with something else", my recommendation is that they get treatment that encompasses both. And whether that's through one provider providing treatment for both or if they're seeing me and then maybe they've got a psychiatrist that they're also seeing, then I would have a release of information signed by that client to be able to coordinate with the other professional that they're seeing to make sure that care is being given without stepping on the other professionals' toes. And making sure that they're getting an encompassing care.

Dr. Sean Devlin:    13:13          So this sort of collaboration, obviously he's encouraged on all levels of medical care. So that's good to hear. I want to move on to this next slide and talk a little bit about these treatment levels. And you talked about this a Sam or American society of addiction medicine allows you some guidance in how you take steps for the treatment. Right? So talk to me a little bit about how that works.

Taylor Tremayne:    13:35          So how this works is there's different levels as you can see. Level one, probably the most common, is outpatient. That's your one hour a week group or individual counseling, psychotherapy talk therapy, and then you go up from there. So 2.1 is intensive outpatient. That normally includes nine hours of counseling or work being done by the individual within a week. And then you go up from there: partial hospitalization, you're getting partial services during the day, you're not staying overnight or having to be there all the time. And then from 3.1 to four, oftentimes I think get clumped together as residential treatment. But there are different levels within that. So that's why I thought it important to put that in there. But they are where you are staying at a facility. Some are low intensity, so they're not as encompassing or they're not all the time staff or something of that nature. And then you have your medically managed where you're 24 hours medical care, everybody's kind of around and always there for any emergencies or anything of that nature.

Dr. Sean Devlin:    14:39          So your role mainly is in this early intervention, outpatient setting? Primarily? Primarily, yes. Okay. And when patients or clients, they come to see you this on a regular schedule and during these sessions you guys are involved in basically talk therapy, cognitive behavioral therapy... Kind of describe to me what happens within that treatment session.

Taylor Tremayne:    15:03          Within the treatment session, it is talk therapy. Different techniques will be used. I use a lot of motivational interviewing. That's kind of my groundwork for what I'm doing. I'm there to be a reflection in a mirror for the individual. I'm there to help them get where they want to be. I'm not there to determine where they need to be or tell them how to live their life or what they should be doing. I'm there to reflect where they want to get and how we can get there and how maybe their past patterns and substance use have impacted them, not getting to where they want to be and how we can change that and motivate them to get there.

Dr. Sean Devlin:    15:35          Yeah. And these sessions, they last only about an hour or so?

Taylor Tremayne:    15:38          Yup. They are normally on a weekly basis.

Dr. Sean Devlin:    15:42          What do you see your success rate like? I understand is a lot of recidivism. A lot of people fail, whatever it be, counseling or medical intervention or a combination of the two. What do you see the biggest stumbling block for folks who ended up sort of falling off the wagon again?

Taylor Tremayne:    16:00          You know, it's hard to definitively say, but I think a lot of, a lot of the work I do revolves around coping skills and a lot of people can go out and be in recovery or sobriety for many years. And then a major life event happens and sometimes they just fall back into those patterns because it's something that makes them feel good and it's something that reminds them of like, "Oh, I don't have to worry about it. I can escape the situation" in a sense. I don't know as of numbers or anything, but I would say that's probably a big one that leads to relapse or not being able to keep their sobriety for length a of time. And sometimes you hear a lot about the rock bottom. People have to hit that. It's sometimes true. People need, you know, they've done multiple treatment centers, they've done multiple counseling sessions, they've done all kinds of stuff and they still continue to use. And there's a level of motivation that people have to have, but also an understanding that the brain has changed when you're using substance. The brain is a chemical lab basically. And so you're introducing these substances and it has an effect. So there's a lot to encompass in how you approach it.

Dr. Sean Devlin:    17:09          Well, you bring up something very interesting. And that's the concept of sort of trauma knocking people off of their sobriety pathway and that comes in many shapes and sizes. What do you think is the most common trauma that you hear about that causes somebody to go back into using?

Taylor Tremayne:    17:29          From my experience, one of the biggest traumas that either initiates use or gets someone to break their sobriety and relapse would be a death of a loved one. That's just from my experience, the most common one I've heard. Parents dying or siblings or close friends dying. That's been a major one that I've seen in my experience. As far as a whole or on a bigger level? I'm not sure. I think it could be different for everybody.

Dr. Sean Devlin:    17:59          That's a very interesting. Let's go onto this third slide here and talk about the dimensions on the ASAM.

Taylor Tremayne:    18:05          Yes. So these dimensions are how I determine that level of care. There's six of them. And when I'm doing this evaluation, I'm looking for diagnoses. And then I'm also looking for the support systems and things they've got in place. I'm looking at do they have potential to withdrawal or have they been. Are they reporting any diagnosed biomedical conditionsyou know, scoliosis, cancer, those kinds of things. And I'm seeing if they do have that, how their substances use interacts with that. Same with emotional, behavioral and cognitive. Do they have any previous mental health diagnoses? If yes, is their substance use interacting with those? Readiness to change we're looking at these stages of change and where someone falls, you know, pre-contemplation, action, all of those kinds of ideas.

Taylor Tremayne:    19:07          So does someone want to change? Are they expressing motivation and preparation to go and do the change? Are they still thinking, "I'm not really sure if this is a problem." And then I'm assessing that relapse and continued use. I'm looking at their history. Do they have an extensive history of substance use or a small history of substance use? What is the potential for them to continue to use? And then the recovering in living environment, do they have people around them who support sobriety, who support them getting help or are they going back to home where people are going to be using around them or trying to get them to use and not providing a support system?

Dr. Sean Devlin:    19:47          Well this is amazing. The way you sort of talked us through it reminds me of the show "Intervention" on A&E on cable TV. I visually went through my head, these cases that I've seen on the show where there's some that just sit down and they're like, "it's time. I have to do this or I may die." And there's others who are like running out to, they're addicted significant others, jumping in the van and driving away. And all this sort of resonates when you see these stories of these poor folks unfold. What do you see as some of the signs that your client is going to be on a good track? I mean, what do you look for in those sessions?

Taylor Tremayne:    20:34          Readiness to change is a really big one for me and seeing what they're saying. Some people will be like, "I don't have it, I don't abuse it. I just do it for fun. I have no issues from it. It doesn't impact my life negatively at all." And then I have others who say "I lost my kids to do this. I need to get my kids back. I want to be a good parent. I want to have a good life and be on track and be a good person." Not that people who are using substance aren't good people, it's just their motivations are different. And so I'm really looking at what they want and what they're expressing to me because that's going to be my idea of where they want to go forward or whether that, if they want to go forward at all.

Dr. Sean Devlin:    21:14          When you know, one thing that is set very curiously with me is the families of these addicted or I would say substance abusing folks on the show were like, no matter what their background, they were all coming together to try to help this one individual. And many times it'd be five, six, eight people there plus the mediator, the counselor. And even then in the face of all this outpouring of love and support, they could actually thumb their nose at that and go "meth, heroin, alcohol, whatever, something else meant so much more to me than this love and connection" with their intimate community that they would leave that. So what that tells me is that the level of I would hate to say the mind *fuckery* that goes on with these substances is beyond the pale. And, and how do you overcome that in so many, in so many circumstances when that's the choice that they've made over and over and over again, and that's how they self satisfy. It seems like your job at times must be incredibly difficult.

Taylor Tremayne:    22:20          It is. One of the last slides in this presentation that we'll get to, kind of where you're coming from, is this moral model idea of addiction is that, you know, it's a choice and they choose and they're choosing it over their family. They're choosing over their kids, they're choosing it over and over and over. There is a level of choice, but there's also other factors that can be compiled into it. And so as the provider, I think it's important that we assess that and we see where we're standing from. So I like to come from more of a bio-psycho-social idea of I want to encompass all, I want to encompass your biology, I want to encompass your environment, your raising and all of that, not just your moral choice and encompass who you are as a person. What led you here, why are you continuing to use, what is your fear of stopping use so that I can determine why you would choose to go use rather than go to a treatment. And it also can be overwhelming. I mean, even for someone who's not using substances to walk into a room of eight people who all love you and it's pouring out that love and pouring out, that support can even be an overwhelming for someone not on substances. So when you're stimulated, that can be even more of a reason to run. Right?

Dr. Sean Devlin:    23:32          That's excellent. Well, let's go on to this next slide and take a look here. About comorbidities, this gives us a little idea of how brutal this problem is. So let's talk about some of these statistics.

Taylor Tremayne:    23:46          Yes so in the most recent stats I could find are from 2016. So of 19 million adults who had a diagnosable substance use disorder. Uin the past year, 8.2 million had a co-occurring mental health disorder, any mental health. So that's about 43.3% and then of that 19 million with the substance use disorder, 2.6 had a serious mental illness. So that's about 13.8%. And this lines up with some other research I found, which says about give or take, 50% of people who are being seen for substance use are going to have a mental health diagnoses, which I agree with from my experience that they are.

Dr. Sean Devlin:    24:23          So this is sort of an at risk community, they're going to be prone to having, and whether it be self-medication or self soothing or whatever they're trying to do to treat themselves. This is, they're kind of at risk in general. Yes. Okay. All right. Let's go on to this one. So these are types of treatment and, and obviously these are some medical ones. Can you talk a bit about them?

Taylor Tremayne:    24:44          Yes. So medicated assisted treatment, this is where you hear about like your methadone, your know Trek zone. Suboxone used to be a one, but I never can I get that right. This is where people are going to prescribe or to medical professionals and getting prescriptions or going to a methadone clinic and mat treatment has high success rates. In conjunction with talk therapy that's they have the best...

Dr. Sean Devlin:    25:16          ... Little more chance to stay on the wagon.

Taylor Tremayne:    25:19          Yes. They have a better rate through medicated assisted treatment being that it helps with the withdraw symptoms because a lot of times when you're seeing people using heroin or meth or things like that, even they'll will say that "I want to stop." But when they start hitting those withdrawal symptoms, they are so nasty and ugly that they can't take it and they want to continue to use because they want to avoid those withdrawal symptoms even when they don't want to use. So Matt is great for that and to help someone slowly get off and to provide the talk therapy and the medicated assisted treatment to alleviate some of those symptoms. Now that doesn't come without controversy. A lot of people don't agree with mat treatment because it is medication. They say, you know, you're filling one addiction with another and how do you curve that? How do you work with that? So there are controversies against it. It does have success. It also has that. And especially when you see like your AA communities and your NA communities. They are against Matt treatment because they want you to be sober from everything.

Dr. Sean Devlin:    26:25          Yeah. And, and I'll be honest, I, I've sort of straddled the fence on this because I have seen exactly what you describe is that by taking away that a safety net of avoiding, you know, the potential pitfalls of physical withdrawal you really expose these clients to really horrendous potential physical side effects from coming off specifically heroin. And that is something that I think nobody looks forward to. And I've been in situations you know, working in the rurals and then even at burning man where patients would be in acute withdrawals and we don't have the resources that they need in the middle of the desert at a festival while they've got a bucket they're sitting on and *shitting* their brains out and they're puking the other one. You don't want to see anybody go through that and let alone for a long, prolonged period of time where they're trying to clear their system and, and recover. So I, I agree that definitely medications do play a role. But then on the flip side, I can say that certainly some of the most successful folks that, that have kept clean have been actively involved in NA and AA. So I can see both sides and I think I basically just handle it with each individual and, and treat them in this holistic way that you described. Which is probably the wisest thing. So take each cases as it comes.

Taylor Tremayne:    27:41          And that's, that's part of why I love my job is because there is no black and white. I can't have you walk in and be like, here's six things. Take this. You'll live a happy life and live forever. You know, it's really, it is a relationship. It's a different kind; definitely an odd relationship when you're creating that therapeutic relationship. But it's so great because you are listening to this individual. You're providing them with something that they want and that they don't normally get. It's not often that we are going throughout our day and throughout our lives and people are like, what do you want? How can I help you get there? What is the true you? Give me the rawest you you can be and I'm here to listen and not judge you.

Dr. Sean Devlin:    28:22          And that's excellent. And you know, since I've known you, that's something that I really picked up on was there was a level of presence and wisdom that is beyond your years. So I always appreciate that. And I know it was one of the first things I mentioned to you when we met. But let's keep going on. I know our listeners are excited to see what's coming up here.

Taylor Tremayne:    28:38          So talk therapy, I just wanted to touch a little bit on their licensure limitations. Like I talked about before, being a substance abuse treatment counselor, I cannot diagnose nor treat the comorbidity. So it is a little bit of a tricky situation there, especially if you know someone has a previous diagnosis and is getting the mental health treatment somewhere else. That coordination of care is going to be super important and just making sure that you're not overstepping your bounds or overstepping your scope of providing the treatment. So that's also an interesting thing, but just something to be aware of when you're working with individuals under just the license of a substance use counselor that you're not overstepping your limit.

Dr. Sean Devlin:    29:22          Sure. And that's wise. And I'll let you talk about successes down here. I know there's multiple modalities and multiple levels of therapy, but personally what have you seen through these therapeutic relationships as sort of positive success stories? Anything that stands out for you?

Taylor Tremayne:    29:40          You know, I've had a who really have warmed my heart and I've seen walkout very happy, which makes me feel good that I've been able to help them. Some of my favorite successes for me have been my clients who... I Had a client who has mandated, who came in and was like, "how are you going to help me? I'm only here because I have to be." And, you know, three months in, I had him crying in my office talking about the real stuff and talking about what's going on. And then when it came that his mandated treatment was completed and he had successfully met his treatment goals he asked to continue. And I count that as a success and I've had a couple of clients like that and that's what I would count as a success for me is that, you know, they found benefit in it and wanted to continue until they felt that they were ready to go because counseling is not meant to be every week for the rest of your life. We are there to help people be self sufficient. We want them to go off on their own, but we want to be there for them until they're ready to do that.

Dr. Sean Devlin:    30:44          That's wonderful to hear. Let's go on here to the models of addiction. I know we just touched on some of this earlier, but can you go into a little more in depth about this?

Taylor Tremayne:    30:54          Yes. So your moral model is the one we were talking about where it's, you know, you're choosing this, you're doing this, it's all an option. You know, it's that, you know, drugs are bad, don't do it kind of mentality. A lot of law enforcement kind of comes from this idea of moral model. Disease model is where you see like this is a disease I have, it's a medical condition. I have no control over it. Socio-Cultural where your background is, your environment, you're raising psychological model, your predisposition to it or any other mental health diagnoses or anything of that nature. And then you have the bio-psycho-social which kind of puts them altogether, smashes them and wants to look at the whole person, the whole outlet.

Dr. Sean Devlin:    31:41          And it sounds like that's kind of the model you prefer.

Taylor Tremayne:    31:44          Yes. For me as a provider on a personal level, yes. I like to look at all of it. What's going on with you as a whole for you.

Dr. Sean Devlin:    31:52          Great. Now, let's talk a little bit about your it sort of day-in and day-out processes. I mean, you know, I know it's not necessarily your traditional, you sit down and see one patient and then you do the next. I mean, what administrative roles do you play? I mean, do you help coordinate care? It sounds like you're doing a little bit of social work as well.

Taylor Tremayne:    32:14          Yes. So counseling does not come without case management. You know, you have clients who have other needs and those needs are important in the counseling setting. You know, they're not being able to meet certain bills or or you know, housing is oftentimes something we see along with transportation. So you're also providing those case management of like, okay, let's try to find some resources for you on that level as well. Where can we get these other things that you're needing? And you have your notes that you're writing for each client and you're having these releases of information, which I mentioned before permission from your client to talk with other people. So whether it's another care provider, their doctor, their lawyer, their court judge, anything of that nature, anybody that they want you to share information with. Even if I were seeing say like a 24 year old individual and he wanted me to be able to express with his mom what was going on, I would have to have a release of information or else I wouldn't be able to share whether or not he was even a client of mine, even if she were to know.

Taylor Tremayne:    33:18          So there is a lot of background legwork that goes into it that clients don't see themselves. And as a whole, I don't think people understand about counseling is there is a lot of background leg work that you're doing. It's not just, okay, client, all right, have a good day. And then I'm done. I'm going through, I'm doing research for them. I'm reaching out to their other providers or individuals that they would like me to and sharing information so that we can get them back on their feet and moving towards where they want to go.

Dr. Sean Devlin:    33:47          Great. Well, you know, there's one thing here at least in the Northern Nevada and Northern California area that we've seen a lot of and that's homelessness. And I know that there's a strong correlation between substance abuse, mental illness and ultimately being sort of disenfranchised from society by losing your home, vehicle, a safe place to find shelter. Can you to me about what your clients kind of deal with on that level? Because you kind of alluded to it earlier.

Taylor Tremayne:    34:12          Yeah. We have clients who deal with all of those. It is hard as a provider because there are certain limitations and boundaries that are set that I can't give them rides places I can't do those and especially being a nonprofit and the situation of the area we're in. I mean all of the homeless shelters are full and they're overfull and it's really difficult right now to address some of those needs. And that's very difficult as a provider to be providing treatment when some of these basic needs aren't being met. Because at that point it's going to be hard for the treatment to stick because it's just like that illusion the analogy of school kids, you know, when they're hungry and they're not being fed and in school trying to learn, they're not gonna retain anything. It's the same goes for treatment.

Dr. Sean Devlin:    35:00          Yeah, if your basic needs aren't even met, I mean last thing you're going to be worried about is "I've got to give up the booze. In fact, the booze may be the only thing that I cling onto."

Taylor Tremayne:    35:08          Yeah, and so you know, it's, it's very tricky because I want to see people do well and that's why I'm in the position that I'm in and I do the work that I do. And it's really frustrating and difficult as a provider on a treatment level because I know these basic needs aren't being met. But then also on a case management level of like, I don't have resources to be able to get these basic needs met in the first place. So it is definitely something that clients have experienced or when they first started treatment were fine and then all of a sudden now they are homeless or something of that nature.

Dr. Sean Devlin:    35:42          Yeah. Or they're in the process of hitting rock bottom as you encounter them. Well, you know what, I have been thrilled to have you here and it's been awesome. Listening to not only your background, but a little bit about the story of what you do and some of the tools you use. I want to know if you can share any pearls for our watchers, listeners, viewers in and around whether it's a family member, even themselves, what are the key decisions, what are the key things that they need to do in an effort to get the kind of help that you provide or that a social worker might provide or a psychiatrist or psychologist might provide? I know you can speak locally, but in general throughout, at least the United States, where might people go to get that kind of help? Just to start that ball rolling. Like, you know, they just pulled the needle out of their arm and they're just like, Whoa, when I wake up I gotta to stop doing this. What do I do?

Taylor Tremayne:    36:33          You know, it's hard to say. Hospitals, they could probably give you some good resources of where to go. Any mental health place you've got. You also have like your suicide hotlines and they now have substance use hotlines and things of that nature so that you can call an 800 number and they can find your resources wherever you're at. And I really say that if you as an individual are thinking about that maybe your substance use is starting to be an issue, that you go and explore options or, and as a family member to not be pushy, to not overbear someone because ultimately they've got to choose to do what they're going to do. And so, you know, I just encourage people to treat everyone like a human. Everyone is human, even if they're using substances or not. We've all made mistakes. We've all done things that we're not proud of. And so it's not fair to shame or put the stigma and help alleviate that and empower the individual to do what they want to do. Or if it's yourself to empower yourself to go forward with your goals.

Dr. Sean Devlin:    37:34          Well simply with folks like you out there, I am going to say that these issues that many of those folks face are going to be able to have solutions found for them. I've been very impressed by the information you shared today. So thank you again for doing that. This is Dr. Sean Devlin and this is the Medicine Wheel. We'll invite you to listen to us on a regular basis and I just want to say thank you Taylor. It was awesome.

Taylor Tremayne:    38:01          Thank you for having me.

Dr. Sean Devlin:    38:02          You bet. Blessings.

Outro:
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