Flipping the Script on Addiction

0:00:13 William Moyers
Hello, everyone, and welcome to Let's Talk. Our podcast series produced and delivered to you by Hazelden Betty Ford. I'm your host, William C. Moyers, thanks for joining us today. Today we're going to talk with Emily Piper and Jeremiah Gardner, and in the interest of full disclosure, they are my colleagues at Hazelden Betty Ford. Emily Piper is the Vice President of Advocacy at Hazelden Betty Ford and also the General Counsel. Welcome, Emily!

0:00:39 Emily Piper
Thanks!

0:00:40 William Moyers
Jeremiah Gardner is the former Director of Communications and Public Affairs. Welcome, Jeremiah!

0:00:45 Jeremiah Gardner
Great to be here.

0:00:45 William Moyers
And our topic today is smashing stigma and really debunking myths. Around addiction, treatment, and recovery. Emily, why do we need to smash stigma?

0:00:58 Emily Piper
Well, I think stigma is at the root of a lot of the problems that we experience when we're trying to advocate for a better future for people with mental health conditions and substance use disorders. It really is a bias that is a foundation that creates problems for people all across the country. The millions of people with substance use disorders and those in recovery as well.

0:01:20 William Moyers
And Jeremiah, how has stigma played in your life?

0:01:29 Jeremiah Gardner
Well, I think when I was struggling with substance use myself many years ago, I just didn't understand it. I didn't have any exposure to recovery or any knowledge other than movies and what I saw in popular media. 

0:01:40 William Moyers
Hmm.

0:01:43 Jeremiah Gardner
So, I took a long time to get help. And did, you know, weird things like go to the library and secretly try to research what was going on with me. [chuckles] But most of all, I associated addiction with other people—

0:01:56 William Moyers
Yes.

0:01:56 Jeremiah Gardner
—And not me. And that's because I held stigmas too. And it's based on what our culture puts forth about addiction and what it doesn't put forth about recovery.

0:02:06 William Moyers
Yeah. Emily, before you joined Hazelden Betty Ford, you ran a 32-billion-dollar-a-year budget or biennium budget in the Department of Human Services. For the State of Minnesota. How prevalent are substance use disorders and mental illness in the population? In your perspective?

0:02:26 Emily Piper
Well they're extraordinarily prevalent. And but the problem has been that the money hasn't flowed in the same ways as it has for other really common disease conditions that people experience. And a large part of that is stigma and a lack of education. And really what that's resulted in has been just crisis response—

0:02:47 William Moyers
Mmm.

0:02:46 Emily Piper
—So trying to address people that are really, really sick and not having resources to prevent or really intervene, you know, at a level that could help them really recover more quickly. So, that's how it manifested itself, even though it was extraordinarily common, as Jeremiah said because people think they're alone. Because it is so isolating. 

0:03:10 William Moyers
Or that it's somebody else's problem, on the other side of the tracks, in some other community. 

0:03:15 Emily Piper
Exactly. It really wasn't until the opioid crisis started hitting suburban white households in the state of Minnesota—

0:03:21 William Moyers
Yes. [nods]

0:03:22 Emily Piper
—That people started to pay more attention and see themselves in the problem. And try to address solutions to solve the problems for our community.

0:03:32 William Moyers
Or the opioid crisis struck like it did not just in Minnesota but in red states just like it does in blue states. And I think to your point that the opioid epidemic really did level the playing field in terms of how legislators, policymakers, and the communities address substance use disorders in their own communities. It's everybody's problem. But we know that it's also everybody's solution and you've been, Jeremiah, so instrumental in mounting advocacy campaigns where people stand up and speak out. Why is it so hard to get people in recovery to stand up and speak out?

0:04:06 Jeremiah Gardner
Well first of all, one of the big myths is that people don't recover. 

0:04:09 William Moyers
Ah.

0:04:09 Jeremiah Gardner
And, you know, in our world we know that people recover, we see it every day, we experience it, but out there, a lot of people think that it's a hopeless situation. That once you're an addict, you're always an addict. And that people don't really get well and thrive and become the productive members of society that you might look up to. But that's just not a reality. But, you would not know that reality, the reality that more than 20 million people in the United States are walking around in recovery from a substance use disorder. You wouldn't know that substance use disorders affect 1 in 7 people in their lifetime, or 1 in 3 families, unless people in recovery are the ones to stand up and speak out and let the world know that recovery does happen. 

0:04:54 William Moyers
Mmm-hmm.

0:04:54 Jeremiah Gardner
People struggling are experiencing substance use disorders are not gonna be the voices to educate the public. Only people in recovery can. So not everybody in recovery, not all 23 million people, need to be advocates and be public and open. But, those of us who are inclined to and who can, are in situations that allow us, we do need to. There needs to be a vanguard of us who are willing to do that.

0:05:18 William Moyers
Part of the challenge though has been a misunderstanding of the role that anonymity plays or doesn't play. And plays a critical role in protecting the confidentiality, the anonymity, of people in a Twelve Step program. But it has gotten in the way, has it not? In how we advocate at the state or federal level, the public level?

0:05:36 Jeremiah Gardner
Yeah well anonymity's been a big part of the recovery culture for years because AA, Alcoholics Anonymous, really launched what we know as treatment today. That was the beginning of everything that we know today about recovery. And because of that culture of anonymity, which was really a spiritual principle, it sort of bled into everything we think about addiction. So people have been led to believe that you can never talk about having experienced a health condition, or being in recovery from it. And that's just not true. Bill Wilson, the co-founder of AA himself, testified to Congress—

0:06:13 William Moyers
Hmm.

0:06:13 Jeremiah Gardner
—Was in newspapers. Marty Mann, the first woman to recover in AA, was very public as well. But what they knew was that some of us have to do it and we can do it most of the time without even talking about the Twelve Step fellowship or whatever path we may have. Because there are as many paths to recovery as there are people who need recovery.

0:06:36 William Moyers
Yes! Yes, yes. Emily, you as I said earlier, you served in State government for a long time. And really down in the trenches even though you had a big position and a big department, but you were down in the trenches of providing care. How important is it that policymakers, legislators, heads of agencies, hear from constituents?

0:07:01 Emily Piper
Well it's the most important. I mean, politicians are creatures of the people that elect them. And so, at their core, if they're doing their job right and wanna stay holding an election certificate, they're gonna listen to people and listen to their stories. That's why it always is so powerful to go testify before Congress. Or, you know, there's nothing more powerful than a woman, a mom who's lost her child to opioid overdose, telling her family's story. Or a story of recovery—

0:07:31 William Moyers
Yes.

0:07:31 Emily Piper
—Of a parent and what that's meant to their family. So that is always going to be what influences public policymakers, Republicans and Democrats, to influence change. 

0:07:43 William Moyers
The squeaky wheel gets the grease. 

0:07:44 Emily Piper
Absolutely! And it's the Board of Pardons, it's not just the legislature, it's in all of the halls of government. It becomes very, very important. 

0:07:55 William Moyers
Yeah. Emily, what about engaging the news media? And I throw that question to either one of you because I think you both can answer it. But starting with you first, Emily, how important is the news media in helping us smash stigma?

0:08:07 Emily Piper
Well news—I mean, news is difficult because it's so sensational. That's the challenge I think for us in our advocacy is the recovery stories are beautiful but they're not always the sensational ones. And so, trying to draw attention to, you know, the beauty of recovery I think has been our focus—

0:08:28 William Moyers
Mmm-hmm.

0:08:29 Emily Piper
—And is why stories are so, frankly to your point, important. Because they really are just as sensational as they are beautiful.

0:08:36 William Moyers
What kind of stories are there, Jeremiah?

0:08:37 Jeremiah Gardner
Well I think that, to add to that, the challenge is journalism has to consciously change the narrative. Because it's in popular media and news accounts that we have the stigma. And so, you know, constant images of needles going into arms or if there's any story about alcohol, it's always, you know, pictures of alcohol, people swigging it. You know, use of words like 'addict,' things that we've researched now and know immediately elicit negative biases—

0:09:11 William Moyers
Mmm-hmm.

0:09:11 Jeremiah Gardner
—We can change that language to use more positive terms. Instead of, you know, 'addict changes his life around,' it's 'Father in recovery inspires community.' 

0:09:23 William Moyers
Mmm-hmm. Mmm-hmm.

0:09:24 Jeremiah Gardner
And that can sound a little politically correct on some level, but it's really more accurate. And that's really what we need to do with journalists is help them see addiction in an accurate light and portray it in an accurate light. So the public gets a fuller portrayal of what substance use disorder is and what recovery is.

0:09:45 William Moyers
Do you think the opioid epidemic has made the media and policymakers more receptive to focusing on not just the problem but on the solution?

0:09:57 Emily Piper
I think it's helped. I mean I think it's changing. I think it's moving in that direction. I think we have a long way to go. I mean that's one of the difficulties with the conversation around harm reduction. We all support harm reduction. And harm reduction efforts. But, I mean, ultimately it's just one piece of the solution that we need to be talking about—

0:10:17 William Moyers
Mmm.

0:10:18 Emily Piper
—And focusing on, even though it's what gets a lot of the attention.

0:10:21 William Moyers
Mmm-hmm.

0:10:22 Jeremiah Gardner
I think the dialogue is improving a lot, but I think it's something we've gotta wrap our heads around, the idea that we're always going to have to confront stigma. One of the realities of substance use disorders is that the symptoms are often negative behaviors. 

0:10:35 William Moyers
Yes.

0:10:36 Jeremiah Gardner
And so there's always gonna be that sort of, you know, those sorts of messages and images coming into our lives, in our families and in news media accounts. And so, we always have to be sort of confronting that with the other realities. If we're going to sort of keep the balance.

0:10:55 William Moyers
Yeah, there is a problem, we have to acknowledge that, but if we just acknowledge the problem then we perpetuate that there's only a problem and we don't acknowledge the solution. We don't get to encourage that solution. Emily, why is it that there's not enough treatment available? I mean there's a perception out there that treatment doesn't work. Or, you know, that you've gotta hit bottom before you can pluck somebody from the abyss. Why does that exist, why is there that belief, and why are there not enough resources for treatment?

0:11:28 Emily Piper
Well I don't have all the answers. I do think part of it comes from the de-institutionalization movement.

0:11:36 William Moyers
Mmm.

0:11:37 Emily Piper
Earlier, last century, de-institutionalizing people, bringing them into community, people with substance use disorders, mental health conditions, people with disabilities, and then not adequately resourcing community interventions and community solutions.

0:11:53 William Moyers
Mmm-hmm.

0:11:53 Emily Piper
I mean the extreme is substance use disorders and mental health, where insurance didn't cover care until very recently. And I think the disease conditions themselves were more stigmatized than others.

0:12:08 William Moyers
Mmm-hmm.

0:12:08 Emily Piper
But, I do think it is inadequate funding for community-based intervention. Sort of without the support of institutions as one of the big public policy root causes of why we are where we are today.

0:12:24 William Moyers
Yeah. [gestures to Jeremiah]

0:12:25 Jeremiah Gardner
It's expensive, that's the other answer. [Moyers chuckles] We've made a lot of progress over these last ten years, in some ways, I guess. There's a lot of grant money flowing into communities for projects, harm reduction is getting a lot more support. Community-based recovery supports. But one thing that hasn't happened during the opioid crisis is people aren't getting more treatment. Residential stays, for example, have gotten shorter during this crisis. But I think we're always looking for the least-cost solution just like as individuals we're always looking for the least-cost solution. [chuckles]

0:13:00 William Moyers
Sure! Save some bucks somewhere. Yeah.

0:13:02 Jeremiah Gardner
Yeah, save some bucks, whatever's the easiest solution. And I think the hard reality and we know it from the stories that you showcase on this podcast and that we see it every day in our work, is that a lot of the success stories are people who are engaged in some level of care and support for a long period of time. 

0:13:21 William Moyers
Mmm-hmm.

0:13:22 Jeremiah Gardner
And that's expensive. And it's a reality that we have to confront as a nation if we're really going to have hope of turning the tide in the way that I think we really want to. 

0:13:34 William Moyers
One of the other myths, particularly as it relates to Hazelden Betty Ford, is that it's not affordable. Or that only famous or rich people go there. What's your response to that, Emily?

0:13:45 Emily Piper
Well, people think that because that's the way it used to be. [Moyers nods] Before insurance would pay for people's coverage for their care, it was really a barrier for many, many people to get access to us.

0:13:58 William Moyers
Hmm.

0:13:59 Emily Piper
And so people were left trying to figure out what to do on their own. Or with other providers. Without really good information about what quality looks like to help their family members or themselves. And so, I mean, it's a sad, hard truth that I think we have to live through and try to address, that people think that we're for the rich and famous, or that it's cost-prohibitive. Because treatment historically, and our treatment as part of that, has been.

0:14:29 William Moyers
And it's not true anymore, right? We had Bob Poznanovich, our Vice President of Business Development on for a podcast, and he talked about 97 percent of the patients that access our system of care now, do so with their insurance. As it should be.

0:14:42 Emily Piper
Yeah. It should be. And it still is really hard for people. They have to—the residential treatment level of treatment in particular, you know, money shouldn't be a barrier but it still is even without that, really hard for people to leave their families—

0:14:55 William Moyers
Yeah. Yes.

0:14:57 Emily Piper
—Their communities. To come and heal.

0:15:00 William Moyers
Well that's another part of what we need to smash which is that you have to go away to treatment, or that it's a '28-day program' [uses air quotes], which we once pioneered, we put a number on it, but it's not like that anymore, is it, Jeremiah?

0:15:13 Jeremiah Gardner
Yeah there's value to some people from getting away from the stresses of everyday life—

0:15:16 William Moyers
Sure.

0:15:16 Jeremiah Gardner
—But, you know, we're learning more and more that staying engaged in care and support of one kind or another for as long as possible, is really what matters.

0:15:25 William Moyers
Mmm-hmm.

0:15:26 Jeremiah Gardner
And so getting engaged with the community long-term is what really is gonna make the difference. We initiate recovery with treatment.

0:15:32 William Moyers
Mmm-hmm.

0:15:33 Jeremiah Gardner
Recovery happens as people continue with their lives. But it's very important, especially with people with severe substance use disorders, to have medical attention and to be able to address mental health. And to get good professional care. Many people though do, you know, change their relationship with alcohol and other drugs in other ways.

0:15:52 William Moyers
Mmm-hmm.

0:15:52 Jeremiah Gardner
And so, we need as a system, as a nation, to be able to create easy paths in for anybody to access recovery in one way or another and then get support from whatever that starting point is forward. 

0:16:09 William Moyers
One of the other myths, I wanna stick with you Jeremiah for a second here, one of the things that has perpetuated myth and stigma is the language. That our field uses or doesn't use to describe what we're talking about here today. And I know you've been a real connoisseur if you will, a real student of the language particularly over the course of history. What are some of the terms that we need to get rid of? 

0:16:35 Jeremiah Gardner
Well, some of them are very common. Words like 'addict' and 'alcoholic.' Things that are terms of endearment maybe for those of us who spend time in recovery rooms or recovery spaces. But that research now shows elicit immediate negative biases.

0:16:52 William Moyers
Hmm.

0:16:52 Jeremiah Gardner
And so, person-first language is much more appropriate. A person with a substance use disorder. A person experiencing addiction. A person in recovery from addiction as opposed to an addict. The research shows that if you use that simple shift in language the responses are much different. They even did research with clinicians, counselors, who should come to the table with the least amount of stigma inherent, but they even when confronted with those two scenarios, prescribed much more punitive solutions to the people who were referred to as addicts in their case notes as opposed to people who were referred to as people—

0:17:33 William Moyers
Mmm-hmm.

0:17:33 Jeremiah Gardner
—With addiction or substance use disorder. So that's just one of many, many examples of how the language that's become commonplace for us is perpetuating stigma. 

0:17:45 William Moyers
Mmm-hmm. Another myth is that the field of addiction treatment is not regulated or that the counselors don't know what they're talking about except for what they know in their hearts. Smash that for us, Emily. 

0:18:03 Emily Piper
Well, I think we've been a model for trying to change some of those myths by ensuring that there is strong, consistent, quality-based regulation at the state level. For the field. And for the field meaning substance use and mental health providers.

0:18:23 William Moyers
Yes.

0:18:26 Emily Piper
You know, the truth is that our clinicians are highly educated and often times have very personal and powerful connections to the work that they do. That's true with other members of the healthcare field that they feel personally inspired to do the work that they do every day and that's exactly who you want helping you heal, or your family member heal. 

0:18:45 William Moyers
Hmm. Mmm.

0:18:50 Emily Piper
But it has been difficult because there have been predatory actors out there, that are the sensationalized headline-grabbers that we have to, you know, address but then also make sure that people know that you can access quality care and that people can trust the system that they're entering into. 

0:19:09 William Moyers
Mmm-hmm. I know you're a graduate of the Hazelden Betty Ford Graduate School of Addiction Studies, so you have a clinical perspective in addition to your professional perspective in Communications and Advocacy, and also your personal perspective too Jeremiah, but another myth before we go here that I want you to smash is the fact that we have to let the alcoholic or the addict and I'm using, I know, staid language there. But we have to let the person with the substance use disorder hit bottom before they get well. Smash that for us. 

0:19:41 Jeremiah Gardner
Yeah, well, the reality is there is no bottom other than death. You know, anything prior to that is a potential way out. So, you know, substance use disorders exist on a spectrum.

0:19:55 William Moyers
Mmm.

0:19:56 Jeremiah Gardner
There's mild substance use disorders, moderate, and severe. And that's something to wrap our heads around because people with—if you're at the stage of mild or moderate and you can get help, you're gonna save yourself a lot of heartache, you're gonna save yourself a lot of family relationships and maybe work, and we need to encourage that. But I think the stigma, like I described with my own self, leads us to put it off and think it's other people until there's no other recourse but to wake up in a hotel as I did crying and reach out to a friend. 

0:20:34 William Moyers
Hmm.

0:20:34 Jeremiah Gardner
In desperation. But I, you know, just as easily could have recognized that something was going on if I were educated about it. You know, years earlier. And had a lower level of care and maybe got on the road to recovery earlier without reaching that desperate point.

0:20:50 William Moyers
Mmm-hmm.

0:20:51 Jeremiah Gardner
And you're seeing more and more of that because we're, you know, we're using more medications, outpatient care is more accessible. We have virtual options as well. And so there's a lot of entry points. And we just need to encourage people when your life's not going the way you want, talk to other people and ask for help. And you don't have to wait until there's no other options.

0:21:13 William Moyers
We could end on that but I'm not quite ready to end yet because I have two other questions. And then we'll wrap it up. Emily, to you first, as we move forward over the next couple of years, as a field, where do you see this field going in terms of its success and smashing that stigma and promoting greater understanding? What do you hope to see over the next five to ten years?

0:21:36 Emily Piper
Education and workforce. I think, you know, educating people who aren't already educated about substance use disorders. And mental health conditions. Providing resources for education. In medical schools. In law schools. In policy academies. In grade schools. So that people understand that it's a disease.

0:22:02 William Moyers
Mmm.

0:22:03 Emily Piper
And that it's very common, and what to do when they're experiencing it, or somebody that they love experiences it. 

0:22:10 William Moyers
Mmm-hmm. Mmm-hmm.

0:22:10 Emily Piper
And then workforce is just something we're gonna have to grapple with. How do we sustain a workforce that is sufficient and competent and capable. To respond to the crisis and get in front of it, ahead of it.

0:22:23 William Moyers
And that's primarily counselors, administrators, people who run treatment programs?

0:22:30 Emily Piper
Well it's mental health counselors in schools. It's having, you know, doctors and others, you know, in clinics, understand and be able to address mental health needs and substance use needs.

0:22:38 William Moyers
Yes. Yes. 

0:22:41 Emily Piper
So, it's those folks and you know it's the folks working in the systems now. But it's also trying to provide education and training—

0:22:49 William Moyers
Mmm-hmm.

0:22:50 Emily Piper
—For people that don't now see it as part of their job, but need to going forward.

0:22:55 William Moyers
And final question to you, Jeremiah Gardner. Again on the looking forward in terms of smashing system and promoting the truth. I want you, as our resident historian at Hazelden Betty Ford. [Jeremiah chuckles] Which you've really sort of embraced, it's not on your job doc but you're darn good at it, and it's really important for this reason. What can we learn from the past as we go forward in this field around advocacy?

0:23:23 Jeremiah Gardner
One, we've had to advocate from the very beginning at Hazelden Betty Ford. For 75 years. 

0:23:27 William Moyers
Mmm.

0:23:28 Jeremiah Gardner
You can imagine the stigma in 1949 when we started. A part of our mission from the very get-go was to educate the public. So that people would know what we're even about. But also that it's okay to get help and that help is possible. But there have been ebbs and flows and waves of positive progress, and then retreats based on in many cases public policy.

0:23:49 William Moyers
Mmm.

0:23:53 Jeremiah Gardner
And we sometimes flow more towards the criminal approach to addiction. The 'War on Drugs' [uses air quotes]. And sometimes we flow as we are right now to a more compassionate view. The late '70s for examples was a wave of recovery advocacy across the country. Led by a vanguard of people in recovery, prominent people in recovery, that put a face and voice to recovery. That disappeared in the '80s. And only through the advocacy of you and many others around the country did we start to turn the tide back toward a more accurate and compassionate view of addiction. Over these last fifteen to twenty years. And so, I think we need to realize that it's a delicate thing that we're dealing with because of what I said before. There's always gonna be negative things associated with addiction. We need to confront it constantly and forever more. [Moyers chuckles] And most importantly, make sure the world knows that recovery is possible and that's gonna start with the education that she mentioned. 

0:24:53 William Moyers
Yes.

0:24:54 Jeremiah Gardner
But not just by professionals. Also by people who are in recovery sharing their own testimonies and stories with the public. 

0:25:01 William Moyers
Well we appreciate both of you being the leaders that are gonna take us where we're going. It's nice to have colleagues like you all, but I find it very inspiring not only that I get to be a colleague, but that I get to learn from people who inspire me. [smiles] To continue to make that walk in the right direction, as we smash stigma and promote the reality that treatment works and recovery is possible. Jeremiah Gardner, Emily Piper, thank you so much for joining us today.

0:25:29 Emily Piper
Thanks!

0:25:30 Jeremiah Gardner
Thanks, William. 

0:25:30 William Moyers
[turns to camera] And thanks to all of you for joining us for another edition of Let's Talk, our podcast series that brings the issues that matter to Hazelden Betty Ford right to you, our listeners and our viewers. We hope to see you again sometime soon. [smiles]