Demystifying Co-Occurring Mental Heath and Substance Use Disorders, Answers to All Your Questions with Maryann Badenoch, The Partnership To End Addiction

Hopestream for parenting kids through drug use and addiction
Hopestream for parenting kids through drug use and addiction
Demystifying Co-Occurring Mental Heath and Substance Use Disorders, Answers to All Your Questions with Maryann Badenoch, The Partnership To End Addiction
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ABOUT THE EPISODE:
When a parent hears "co-occurring disorder" from a therapeutic professional it can be scary, daunting and extremely confusing. Mental health disorders commonly accompany substance use in teens and young adults, and vice versa, yet it's hard to know which is which, is one more "primary" and how in the world do you go about treating one or both? 

Because co-occurring mental health and substance use disorders are more common than not, I invited one of the field's leading professionals to join me for a conversation to demystify this diagnosis and help parents find their footing. 

Mary Ann Badenoch is a mental health professional who truly understands mental health and substance use because she's a person in long-term recovery herself. Mary Ann heads up a caring and compassionate team of specialists and volunteers at The Partnership to End Addiction, where I have the pleasure of volunteering as a parent coach and support group facilitator. 

You'll hear  Mary Ann clarify things like;

  • how common is it that a young person has both a mental health and substance use disorder?
  • why do they commonly go hand-in-hand?
  • how can parents start to detect these issues and how do you go about finding the right mental health professional to help?
  • what are the risk factors for people who have co-occurring disorders? 
  • how do you differentiate normal teenage changes from more serious mental health issues?
  • what are questions parents should ask a treatment program to make sure they'll be able to treat both SUD and mental health disorders? 
  • can adolescents and young adults be on medications for SUD and mental health at the same time? 
  • and her words of hope for parents

Do not miss this gold-mine of information from an industry expert – and one of the most compassionate people working to help teens and young adults heal from mental health and substance use disorders.

EPISODE RESOURCES:

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Speakers: Brenda Zane, Mary Ann Badenoch
Brenda  02:00
Well, friends, it is good to be with you here today. It’s really been incredible to watch the growth of Hope stream over the past few months, this podcast has been such a labor of love, mostly because I started out not knowing anything about podcasts other than how to hit play and listen. So the fact that we are growing and having this small but mighty community of parents, working together to learn to develop your skills and find new tools and resources is really, really awesome. I honestly can’t imagine what it would have been like to have some of this information available to me in this format, when I was going through it. So thanks for being here. Thanks for sharing the information. Believe it or not, there are a lot of people who are still new to podcasts. And so the more that you share it, it’s just helpful for them to find because it might be an entirely new resource for them. 
Brenda  02:58
And I think you’re really going to want to share today’s episode because it is all about a very confusing topic that parents deal with, which is co-occurring disorders and my guest and I will be going deep into that. So I won’t spend a lot of time right now talking about what that is. But it is very scary and confusing. And so I recruited a highly respected and talented person for today’s conversation. Maryanne Badennoch Is the Clinical Director for peer in group services at The Partnership to End Addiction. I’m going to spend 30 seconds telling you that the partnership is one of the best-kept secrets in the world of substance use education, prevention and resources. So please take a look at drugfree.org. If you’re here, and you need some help, you’re trying to figure out what to do. These are your people. Everything they offer is free. And it is just the most incredible resource for you. So check out drugfree.org You can get parent coaching, you can get online support groups. They have a helpline it’s just amazing. 
Brenda  04:07
Maryann is a licensed professional counselor in the state of Texas in New Jersey, and she’s a licensed mental health counselor in the state of New York and Florida. She’s a member of the National Board for certified counselors and maintains a master addictions counselor credential. She’s also trained in gambling addictions and provides educational presentations and individual counseling on behalf of the New York Problem Gambling Council. She also maintains a small private therapy practice where she specializes in substance use and gambling addictions. And I could keep on going for another five minutes about this incredible woman and all her experience and credentials but I know that you really want to hear from her. So I will wrap this up by saying if you’re listening and you think that your son or daughter is potentially Dealing with a mental health and substance use issue. This is your episode, we go deep into the topic. And there are some really great resources that Marianne provided to me, they are going to be in the show notes. So go to Brenda Zane calm for slash podcast, and then scroll to find this episode with Marianne. So with that, please listen to now to my conversation with Marianne bad luck from the Partnership to End addiction.
Brenda  05:31
Marianne, welcome to Hopestream, this is a really honor, big honor to talk with you. I do because we volunteered. Well, I volunteered with your organization. I know what your calendar looks like. So I’m thrilled to have this time with you. And just thank you for being so generous with your knowledge and your expertise. So thanks for joining me today.
Mary Ann  05:54
Oh, thank you so much, Brenda, I’m delighted to be here. And I’m just always so happy to be able to do something for you. And other coaches that volunteered their time, it’s kind of a little way to give back.
Brenda  06:07
Well, it’s incredible. And this I’m so excited for today’s topic, because, you know, there’s some episodes that I do, I do some solo episodes where I’ll talk but it tends to be a little bit more from the heart, or some pretty straightforward, you know, material. But this topic of CO occurring disorders, dual diagnosis, it’s just on a whole different level that I’m not qualified to talk about. So that’s why I was really excited to get time with you because it is so common. It’s a really common question that I get. It’s a really common frustration, I think for parents who are struggling with trying to sort out and tease out what’s going on with their kids. So it’s very, very important. And I’m thrilled to have somebody who’s highly qualified to talk about it. But before we do that, would you just give us a quick background on who you are, how you came to be doing what you’re doing with the Partnership to End addiction, which I probably reference in almost every episode, when people are very aware that maybe just give us a little background on you so we can get to know you a little bit better.
Mary Ann  07:12
Sure, I’m happy to do that Brenda. So I work at the Partnership to End Addiction. I’ve been there since 2017. I originally came in to help develop the digital helpline program that we have. And I’ve segwayed over to being the Clinical Director of our volunteer services. So I work with our coach community. I oversee the online support community meetings. And I also work with our coaches to provide some clinical supervision and also some ongoing training and education for them from as they do the work they do with parents. I’m a licensed professional counselor. And I also do specialize in addictions. I have a master addictions, counselor credential. I have a small private practice. But I do keep it small because I’m pretty busy at the partnership. I also do work in gambling addiction as well, for the New York Problem Gambling Council. And what else can I say? 
Mary Ann  08:09
Well, I actually I’m why I’m doing this. I think a lot of people kind of want to know what why did you get into this. And I can tell you that when I was 17 I was reading Psychology Today magazine, while my friends were reading Teen Vogue, I’m you know, I do really my passion for psychology. But I ended up I went for my undergraduate work in business management. And then I went back for my masters in counseling psychology. And I specialize in addictions because I come from a family that struggled with addiction issues. My father was an alcoholic, and he died of alcoholism at a pretty young age. And I noticed myself going down that rabbit hole when I was in my 30s and made a decision to stop drinking myself and use 12 Step programs and really kind of embraced recovery, but also knew how hard it was for families and as an individual moving through recovery process, and also the shame and stigma that can be associated with struggling with substance use issues. So I kind of felt qualified to do this work. And also I have compassion for people that are struggling and for families. And when I work with people, they just know I get it. And that does make a difference in when I’m working with folks that are struggling themselves.
Brenda  09:29
It really does. I think it’s so powerful for you to come from a place of not just your own journey with substance use and living in recovery, but for you to have seen and experienced the family dynamics of that. It just has to be so helpful. And I do know that people really really feel your compassion for that. For those of you that are listening, Marianne kind of downplays everything that she’s doing. She’s got hundreds of volunteers in this program between the coaching and the online group facilitator. 
Brenda  10:05
So, The Partnership, I’m going to do a quick ad here for the support groups. Because every single Monday, Tuesday, Wednesday, and Saturday, there’s a live parents support group that you can just join via zoom, you can come on and hear from other parents who are struggling, it’s very low key. And so Mary Ann has up all of that all of the parent coaches, which hopefully, if you’re listening, you’ve been tapped into these resources. So it’s a lot in it, definitely take somebody like you to do that. Because you do understand what these families are going through and is really, really rough. So amazing. Before we get into co-occurring disorders, could you just give us a baseline of what that is, because it sounds to a common person like me kind of intimidating or confusing. And I think parents get this often and are confused. So maybe you can just give us a little baseline description or definition of what that is.
Mary Ann  11:06
Yeah, that would be helpful, because you do hear it referred to in different ways. So you’ll hear co occurring disorders, you’ll hear dual diagnosis, you’ll hear co morbid, and those are really just different ways of explaining the same thing, which is that an A co occurring disorder is really a more what we’re using today, that’s really defined as having both a substance use disorder and a mental health issue at the same time. And that’s really what it is. It’s just to diagnose disorders at the same time, and that’s what that
Brenda  11:40
means. Okay, well, that’s, that’s easy that I feel better about that. Because it does, it gets tossed around a lot. And I don’t know that it’s necessarily always understood. And for parents, you know, I just kind of reflect back on my experience, there’s just so much going on, when I’m thinking of either an adolescent or young adult, you know, maybe in their early 20s, you start seeing some things, and you’re like, Hmm, what what that is right, like, you know, it’s not necessarily, quote, unquote, I hate to use the word normal, but it’s just stuff that stands out behavior or things that are going on. And so, I guess, how common is it that people have a co occurring disorder? Um, is this something that? I don’t know, I just I don’t have any kind of grasp on how common this might be?
Mary Ann  12:34
Well, I mean, statistically, I think it’s, like 65% of adolescents that, that have a substance use disorder, also have a co occurring mental health disorder. Okay. So, you know, so that, that really helps, you know, you understand how high that risk is, for people with an underlying mental health issue to also have a substance use issue. If a person has a mental health issue, they’re still about 30 to 45% more likely to develop a substance use issue, because a lot of people self medicate to attend to underlying mental health issues.
Brenda  13:14
Right, right. Wow, that’s, I did not know that the number would be that high. So it’s definitely something you want to be aware of, which is why I’m glad we’re doing this. Because 65% If your kiddos are using substances, that’s  definitely a high number, I’m thinking. And well,
Mary Ann  13:31
when we talk about that, too, just to kind of qualify that, you know, we’re talking about it doesn’t necessarily have to be a very severe mental health issue. It doesn’t have to be a significant mood disorder, or schizophrenia or something like that. But it certainly can be anxiety, depression, a DD. So think of those things too, as qualifying there.
Brenda  13:53
Right? Okay. So it could be anxiety, it could be depression, it also could be like you said something more extreme, maybe bipolar, or something like that. So that’s a pretty broad range, which is why I think it is so confusing for parents, because you don’t know what you don’t know. And my child who got me into this whole thing was my oldest and so when it’s your first child to you don’t necessarily have a point of comparison. So I think for those parents, it’s hard. Also, if you only have one child, or if you have an adopted child, I would think that this could be confusing because you don’t have medical history necessarily. So I think we all kind of are familiar with the substance use some of this, the signs of that, but what would we maybe start to notice? What would potentially be going on that would make us go hmm, this is maybe something I should look into, in addition to the substance use or there’s are there things that we should be looking for?
Mary Ann  14:55
Yeah, it is hard because when you know typically the substance use will Start around the, you know, when a child’s becoming an adolescent. And that’s also when the signs of a mental illness can commonly appear. And, you know, it’s really it makes it hard. I mean, co-occurring disorder diagnosis can be very difficult for, for many reasons. I think one of the things when I’m working with a family and they’re trying to kind of discern, are these behaviors that I’m noticing, because of the using of substances? Or is this an underlying mental health issue, I’ll usually ask them to put on their detective hat. One of the things that I like to always find out about that’s so important is risk factors, with family history. 
Mary Ann  15:42
And as you mentioned before, it is a problem what I, when I’m working with people that are adopted that don’t know their family history, that’s a piece of missing information for them. But with most people to understand the family history, and what we’re talking about are like first degree relatives, like parents and siblings, is there any type of underlying mental health issues that you’re aware of, or you suspect that have been in the family, and, you know, that might be anything from depression, anxiety, you know, through bipolar or schizophrenia. And because really, if there is, if there is an account of some type of mental health issue, with a first-degree relative, there is an increased likelihood that a child would develop that disorder. So like, with depression, that’s like a one and a half to three times as likely that a child would develop depression symptoms, if a first-degree relative has depression. 
Mary Ann  16:43
And then the stakes go up really like with like, with schizophrenia, a child is 10 times as likely to develop symptoms or traits of schizophrenia, or Schizoaffective, if a first-degree relative also has that diagnosis. So family history is so important to know about. In addition to that, you know, sometimes I’ll ask people, if, and again, I know we’re all going digital now, but I used to call it you know, the photo album exercise, although the photo albums now online, mostly idea is to remember the child. So sometimes pictures will jog memories, like, let’s think back about the child when the child was a young child and child was an infant, when the child was a toddler, at the age of four, at the age of seven, you know, what was happening for them? Do you remember any certain traits that they had, which might be an indication that, you know, they had some underlying mental health issue prior to the start of using substances? So you know, sometimes we do that as a way to start really kind of building a better picture of of the child prior to starting to use substances.
Brenda  17:55
Right? That makes sense, because it gets so muddled at that point that you don’t know what you’re dealing with. So that concept of going back and really remembering and if I’m, I’m sure if you have a good therapist, counselor, whoever you’re working with, they’ll know the right questions to ask you to say, did you see this? Or did you see that? Because again, you know, when it’s your kids, and you’re with him every day, all day? It’s like, I don’t know, that’s just how he is right? Or that’s just what she does. And so that’s, it would be really helpful to have somebody guide you through that process, I would think.
Mary Ann  18:29
Yeah. And again, it is hard, because was one of the other things we talk about, too, is if if there’s been any period of abstinence from substances, are those behaviors or those concerning, you know, traits still presenting? So, you know, that’s the other thing to look at is if the child was not using substances, are those other things still happening for them? Because oftentimes, that’s the reason why a person might relapse, too, because they have an undiagnosed underlying mental health issue, and they relapse to try to get some comfort again.
Brenda  19:03
Right, right. Yeah, that would be I can see, like, if they were in a treatment program for a little while to say, Okay, here’s a period of time where the brain hasn’t been impacted by substances. And you could get a little bit clearer of a picture because I have so many moms who will say, I finally got my kid to agree to go to therapy or to treatment and they want to do these different things. But you know, the provider won’t do it because they’re smoking marijuana in a site. Well, yeah, cuz that’s good. That’s probably gonna mess up any way for them to diagnose what’s going on.
Mary Ann  19:39
That’s the hard part is you know, when somebody’s still using the substances, because even if they were to try to treat somebody while they’re still using whatever the drug or substances, it will interfere with the efficacy of the medic medication. So that is a problem. And I do know a lot of young people in particular want to use something natural? I hear that a lot. I’ve heard that a lot, in my experience working in the inpatient unit. And the thing that I always like to try to kind of educate people about is that, you know, it’s true that there’s always a reason why people are using substances, and if it’s to give them some comfort, or to relieve some symptoms, you know, sometimes that can be effective for a short period of time. The problem is that usually, there is a rebound effect on that. So that, you know, if you’re using anxiety, or alcohol for depression or anxiety, you might get some initial relief. But then the unfortunate thing is that after the typically your symptoms just get exacerbated. So your depression is a little worse, and your anxiety gets a little worse, and it just starts a cycle for people.
Brenda  20:55
Yeah, definitely. I could see that. And, and I think this is such a frustrating tipping point for parents, when they, they say, Okay, it looks like potentially, we have something going on here with a co-occurring mental health problem, and the kids just won’t stop, right, like the kids just won’t stop, they’ll say, Okay, I won’t do oxy, or I won’t take these other things. But there’s no way I’m giving up marijuana, like, that’s the thing I hear the most, and it’s so hard, because then you just are stuck in that cycle of, well, we can’t really treat this other thing, if you’re still going to be putting that in your body. So I think it’s, it is important to have some empathy for those parents who are really trying to help their kids and I and I believe that kids often want help. I say kids, I mean, adolescents and young adults. But it’s, it’s so hard to give that up, especially if it is working for them, if it’s doing something for them, it can get really, really tricky.
Mary Ann  21:59
I can always understand the person’s reluctance to give up a substance. I really do. Because I realize that it’s a terrifying, you know, notion, if you’ve been relying on something for a while for somebody to just just take it away. The idea sometimes is to work on trying to squeeze it out. When I talk with parents or family members, I think the most important thing is that they understand the why behind their child’s using, you know, because it is important to understand what it’s doing for them, you know, people don’t use, they use for a reason, and they continue to use for reason. 
Mary Ann  22:36
So I would say that that, that really is one of the most important things is to find out the why behind it, you know, and if it’s helping them chill out, or helping them you know, have less social anxiety or whatever it is that they feel it’s doing for them. That’s really important information. Because with that information, you can start working on some alternative strategies to be able to get some relief without using the substance. And that can start some of the activities or other things that would help the child would start helping to squeeze out the use of the substances, you know, it’s really hard to just tell somebody, I’m going to take this away from you, and then you have nothing to write to give you whatever it is that you’re looking for from that substance.
Brenda  23:24
Right. Good luck with that, like, take away your basically your band aid, and then that that nasty cut is going to be exposed to the world. And, and good luck with that. You know, that’s I feel like that’s what we do often, in you know, different words, obviously. But I think that’s how it can feel to our kids is like, Well, wait a minute, you’re going to take away that, ah, because that’s working for me, and I don’t have anything else to slot in that place. So I like your idea of kind of crowding it out and adding other things into where it’s like, okay, actually, this is feeling pretty good. And it doesn’t have all the downsides of, you know, fill in the blank substance.
Mary Ann  24:07
That filling if I ask people when they’re using, when they’re reaching out for anything to fill a void. If I use that language with people that are using substances or behaviors, you know, that in a destructive way, usually they really identify with trying to fill a void. You know, and that might be anything from boredom to some, you know, to their brain not being calibrated at being very uncomfortable in their own bodies or in social situations. So it’s, it is kind of, you know, that whole creating an alternative to fill the void. Yeah, for people.
Brenda  24:50
Yeah, that makes sense and an alternative that doesn’t come with all of the dangers and the risks and the health implications that the substance might come with. For a while it works, right? Like you said, for a while, it works fine. And you’re not necessarily seeing the downside. But then when you have these different consequences that start to happen, it’s like, Oh, hmm, maybe this isn’t so good. But it can take a while to get there.
Mary Ann  25:19
It does when a parents approach it like that when parents approach their child, and it’s hard. And this is the part of where you really have to be taking care of yourself, in order to be able to have that kind of calm person coming to the conversation, it’s with that genuine curiosity of that other person to, you know, to really wonder, What’s this doing for you? What is it feeling for you what need is it feeling for you, and and really wanting to understand that, instead of just, I don’t want you doing that anymore, stop doing that. But to actually find out the why behind, it really starts the conversation on a different trajectory for problem solving, little brainstorming, or just even for the child to understand that you’re, that you’re thinking about this beyond, you’re wanting them to stop, they already know you want them to stop, that’s probably pretty clear. So then it’s really that you have the interest and understanding what it’s doing for them and what they need.

Brenda  26:22
Right? Because then, and kind of going back to the co-occurring is, there’s so much stigma already with substance use, for the most part, maybe not in, you know, if your 16 year old, maybe your other 16 year old friends, there’s not so much but in general there is and then when you layer on a mental health issue that’s like us a stigma sandwich, it’s like a lot of stigma going on there. And so I think for parents, that’s hard, because we don’t want to say, oh, yeah, my child, not only is my child, you know, smoking marijuana every day, they also have XYZ, that there is a lot of stigma around that. So and I would imagine that a lot of what we might see. So if our kids are drinking alcohol, if they’re smoking marijuana, if they’re doing, you know, benzodiazepines, a lot of what we may see from the impact of using those substances could mimic a mental health disorder and vice versa. So how do you start to get some help to figure that out? Because like we said, you know, if you continue with the substances, that might not give you the ability to diagnose something else, like how do you unstart to untangle all of this,
Mary Ann  27:41
that is the tough part, because being under the influence of say, alcohol, can cause aggression, anger, outbursts, irritability, you know, all the things that also a depressed person might be presenting. So it is, it is difficult to see both and in the inpatient unit that I worked on some years ago. You know, oftentimes, they really relied heavily on parents, to really give a lot of information about a child’s background or that individual’s background. I think that you know, the family members or parents, especially when we’re talking about children really know their child best know what the child has been through in a lifetime. 
Mary Ann  28:24
So again, there could be we talked a little bit before about, you know, the family history, and that’s one aspect of it. The other aspect of it is kind of what else has impacted the child’s brain while they’re growing up. So gene expression can be altered based on environmental things, right? So chronic stress and a family trauma, a loss, whether it’s divorce, or death of a close relative, if there’s drug exposure, during pregnancy, or even in the household, and other like what we call adverse child experiences. So those are, again, anything from living in an area where there’s very poor medical care, or family that’s under chronic financial stress, you know, that kind of thing, or abuse and neglect, all those things can also impact a child can cause a child to become depressed, anxious, and also use substances. 
Mary Ann  29:21
So like that, that’s really where having that bigger picture about the person when you’re talking with a  Treatment Facility is important, because it kind of gives them the big picture to understand that this person may be struggling with some underlying mental health and, you know, issues as well as the substances. And they would be more likely to treat both and which you can do at the same time is, you know, treat both the substance use and also underlying mental health issue. In fact, it’s really vital that that happens at the same time.
Brenda  29:56
Yeah, I was just going to ask that because it’s I would love to find out a little bit more about maybe some specific types of people that you would want to make sure are on staff because that could be really disastrous if you found a program, but they only treated the substance use. So now you’re taking away the substance. That’s great. However, there’s this other side of the coin that’s not getting touched at all. So if a parent is looking for a treatment program, like all the letters behind people’s names confuse us, because it’s really confusing. We don’t know, you know, PhD lmhc. I don’t even know all of the acronyms but are there. If this is a concern, and you want to make sure that the program that you’re talking with could treat both? How do you do that? Like, how do you do that as a parent to be more informed and educated?
Mary Ann  30:53
Well, not to get too hung up on all the letters because every people can do something similar and have different letters. So I’m an LPC in two states on licensed in a couple of states on an LPC Licensed Professional Counselor and a couple states and the other states, I’m a licensed mental health counselor, and LM, HC. So it’s not that important to understand all the letters, but it is important when Well, first of all, it’s really important to find a true co-occurring disorders program. And really, probably the first step is going to my psychiatrist, and I would go to an addiction psychiatrist, somebody that actually does have a background in addiction, and as well as psychiatry, because it would be very important, especially if they’re going to be prescribing medications that they understand what potentially would be not advised to offer a patient. 
Mary Ann  31:50
But to get a diagnosis by going to see an individual psychiatrist is usually a good first step, because then that helps you understand what you would need in a treatment program as a next step. So that might be an outpatient program, depending on what’s going on for the child to the level of care that they need, or an inpatient program. But regardless, you know, to find a treatment program, that’s truly a co-occurring is not as easy as just looking at the way they advertise. Because I have seen a lot of programs that advertised as being co-occurring. 
Mary Ann  32:28
And it’s really like co-occurring light, because they mostly focus on substance use, and 90 meetings in 90 days and 12 Step programs and very little on the mental health piece. That’s not a true co-occurring program. So what you really need for that is you need clinicians that actually have a very similar type of background, say, as I do, where I have a mental health background, I’m able to assess the mental health. And then it can also assess, assess for substance use. And so you’ll find, you know, the question to ask is, are your clinicians, both trained in mental health and substance use issues, because when a person is assessing, they really do look through the lens of their expertise. So you will see somebody say with the alcohol is somebody under the influence of alcohol that you don’t know if they are, but they’re, they’re presenting with aggression, irritability, you know, moodiness, and the drug and alcohol counselor might suggest that they’re under the influence of alcohol or some other substances, whereas the mental health person would probably diagnose for depression, or some type of mood disorder. So it really is important to to work with somebody that can that wears both hats, and in treatment, co occurring disorder treatment programs. That’s exactly what the clinicians, that would be the background that they would have.
Brenda  33:54
Okay, so if you’re calling in, you’re asking, make sure to ask some of those questions. Don’t just take it at face value. If they say, oh, yeah, we treat co-occurring disorders, you’re gonna want to dig a little deeper into that. I would. Yeah,
Mary Ann  34:09
well, at most, you know, I know that. It’s hard because emotions run high when you’re looking for treatment programs. And I think a lot of times people feel that they’re at the mercy of the treatment program, like to get it their kid in, but for sure, know, to remember that you’re really the consumer. And you have the right to ask as many questions if you want to as a consumer of the treatment services to make sure it’s the right fit. So, you know, finding out whether or not mental health issues and substance use issues are treated by the same clinicians is one thing, that the program that there’s one program that provides treatment for both disorders, and that when they’re putting together a treatment plan, that the treatment plan has strategies for both the mental health and the substance use disorders and the other thing that happens too, because 
Mary Ann  35:01
I’ve seen this happen in a dual diagnosis unit that I worked on an outpatient unit, with people with more severe mental health issues. schizoaffective schizophrenia, somebody that might be on the autism spectrum, you know, making them go to 90 meetings in 90 days, or making them go to 12 Step programs, where they have to sit in a meeting isn’t really appropriate for a lot of patients. So what I like to see in a program is flexibility to work with the individual, based on their mental health issue and what they’re comfortable and capable of doing. To. It’s really important, because not everybody can comfortably sit in a 12 step meeting, depending on what they’re dealing with. Yeah,
Brenda  35:50
right. Even just ADH, I say just, I’m not minimizing ADHD by any means, because I lived with a child with it. But that is really hard, you know, to I never really thought about that. But that is a good question. How much flexibility do you have in your program? Because, yeah, forcing somebody who is, you know, removing substances. And I’m thinking, Well, let me finish that, that. So that would be very challenging. So I do like your idea of asking about flexibility.
Mary Ann  36:24
I’ve just was going to mention one thing, Brenda, about support groups, because traditional 12 Step programs are not only that, they will attend to the substance use issue, but not the mental health issue. So the idea of either going to going to both is important to go to an organization. And I’m always going to get the names wrong, I Nami is one and that’s for mental health issues. And there’s also one for depression and bipolar, though they have meetings. And so that would deal with the mental health issue aspect of the CO occurring disorder. And then you would also be going to a 12 step program or smart recovery, or other type of program for substance use. And And just one last thing that they’re not really that abundant, but at times you can find there’s something called dual recovery anonymous, Dr. Ray meetings. They’re not like everywhere, but they are around and that will actually be specifically for an individual who’s experiencing a co-occurring disorder. So that is a type of support group, a 12 step support group that you can find, although I can’t say they’re abundant, but they are around.
Brenda  37:35
Okay, that’s helpful. Yeah, that’s a really, really good point that a 12 step meeting is potentially going to help with the substance use, probably not going to help with a mental health issues. So I mean, and obviously, there’s, it’s not black and white. So yes, getting rid of the substances might drastically improve some areas of your mental health, but maybe not others. So that’s a really good point. The question I was going to ask was, as you start to remove the substances, so let’s say you’re you find a program that is able to treat both, could the mental health side of things get worse when you remove the substances, because what I’m thinking is if they’re using the substance to cope, and manage some of the discomfort from the mental health issue, what happens when you take away the substance? Would things maybe get worse before they get better? Like, what would you want to look for? In that?
Mary Ann  38:33
Yeah, I mean, that’s where again, if the person is starting to withdraw from substances, and they also have a mental health issue, I think it’s really important that that is done under the guidance of a treatment program or professional, that’s monitoring the progress. Because for the reasons you mentioned, there, you know, could be some benefits to using the substances that when taken away, may normally when people just take themselves off a substance, they will have symptoms, you know, their mood will be lower, or they might be more anxious, they may have trouble sleeping. And if you already have an underlying mental health issue, you start having trouble sleeping, that can really ramp up the problems, you know, for certain types of mental health issues. So it is really important to have somebody who’s monitoring that and also that’s offering medications to help stabilize the person while they’re going through or off the substances. And that’s really where it is important to address both at the same time. 
Mary Ann  39:40
I know that there are a psychiatrist out there that will want somebody be completely off the substance and then come back to me 30 days later, and we’ll talk about what might be there, you know, for you, but in that 30 days, things can really go wrong for people. So I’m not a believer in that. I’m more of a believer and starting to work with somebody with what they’re telling you they experience and believe them, and start to introduce some medications that will help start recalibrating the brain and giving them some relief. So yeah, it’s a sensitive time when there and when a person’s in early recovery with an underlying mental health issue.
Brenda  40:23
Yeah, that sounds like a very, very precarious and, and just sort of a fragile time. So, you know, cuz I do hear of families who are kind of tried to do this the home version and not go to a treatment program, but maybe detox their son or daughter at home. And so those are the things that I think about in that case, where that could that just sounds like it could be risky, depending on what you’re dealing with. But can so that was a question I had to is, can somebody with a substance use disorder be on mental health medications? Like, can you combine those two, or is that just No, like, you have to be completely free of using alcohol or any of that before you start using medications?
Mary Ann  41:16
Well, I mean, there’s a couple things, but one is that it truly if you’re, if you’re on a medication and using substances, it the medication will not be as effective, you know, it. So a lot of times people say don’t, you know, if you’re, if you’re going to be using substances, don’t bother being on the medication. I believe that completely. But it is true that if you are taking something like say, to help you with anxiety, and you’re also drinking, you know, those are two substances, whether it’s the medication that will depress your respiratory system a little bit so that you’re less anxious. 
Mary Ann  41:52
But if you’re also drinking on top of that, that is potentially dangerous. So it depends on the substances that you’re using, and what you’re doing. But for most people, at the very least, if there’s a starting to try to, if you will taper down or dial down the amount of substances they’re using, if they’re really making concerted effort to try to dial that down, while they’re dialing up on a medication that will help them help address the symptoms in a safer way. And they’re working very closely with a psychiatrist doing that. And again, at that, you know, it’s not just working with a psychiatrist, or the medication management, which is typically just what the psychiatrist does. It’s also working with a therapist, or coach to learn coping skills, because a lot of this is learning how to cope with the symptoms that you’re feeling and what you do when you feel triggered. And what you do when you’re having a hard day. And how you’re managing your lifestyle, your or your routine, which is so important for people with CO occurring disorders is having a regular sleep and eating routine, all those lifestyle things are really important to take into account as well.
Brenda  43:05
Yeah, definitely. And I’m so glad that you mentioned that difference between the psychiatrist and somebody maybe like a therapist or a coach, because I didn’t know that I actually thought that a psychiatrist not only manages medication, but would also be providing some therapy. So that’s very interesting. And I think that’s a good distinction. I have no, like, I will just admit that I don’t know stuff like that. I think a lot of people don’t know that. Because when you start dealing with insurance, and you start making all the phone calls, it can get so overwhelming, because at the same time your kids out doing crazy things are in your house doing crazy things. So thank you for clearing that up. So you’re really going to want to have a team approach which could be your psychiatrist, really dialed in on the medication side of things. And then also a counselor, a therapist, a mentor, or coach, whatever that person is or team of people to help with the lifestyle and the coping and the executive functioning and all of that, which is is a separate issue. Is that right?
Mary Ann  44:19
Oh absolutely is I know when I work with patients, that’s the one thing that I’m a stickler about is that if they’re working with a psychiatrist, I want to be able to connect with that person and to make sure that we are working together on a case and most people are willing to do that. I work quite a bit with advanced practitioner nurses, a PMS that specialize in psychiatry, they prescribe and I know with one that I worked with, I really enjoyed her because she spent time with the patient as well. She did do some counseling she did you know spend time with that patient, as well as prescribed meds occasion, although I still work with that person as well. But I found that there is a little more time taken with the patient when they’re working with an advanced practitioner, new nurse who specializes in psychiatry. 
Mary Ann  45:12
So that’s an alternative, if you’re looking for a psychiatrist, you can also look for an APN. And they have a master’s level degree, their nurse practitioner, and they specialize in psychiatry, they often can be really wonderful with patients and also able to prescribe just for another option. But the other thing though, is if there’s substances involved when you’re interviewing the psychiatrist, or the nurse practitioner, is to make sure they also understand that substances are involved, and what do they how do they usually address that when they’re working with a patient just want to make sure that they’re not prescribing anything that could be addictive in nature?
Brenda  45:57
Right, right. You don’t want to give your your kiddo who’s experimenting with Xanax a, you know, really heavy 2d Best it hasn’t been? That could be disastrous, so Okay, well, that’s a great tip on the APN. I love that because I think we can get really stuck in like, I have to find this kind of person. And, you know, between that there’s amazing, I think naturopathic doctors, there’s, there’s just so many different kinds of people that depending on your family could be really helpful. But like you said, you have to sort of be in a brainspace self care so important so that you can make those decisions. And you can make those phone calls and listen to what the people are telling you and speak up and ask the questions. Don’t feel intimidated by you know, being on the phone with a doctor’s office or a doctor or treatment program? If you feel like they’re rushing you to get off the phone? Or to answer your questions, probably not your place would be my recommendation. Mm hmm. Is there anything that you hear or that you think there are myths out there or misconceptions maybe that parents have are just people in general about mental health disorders and or substance use that you would just like to clear up like, this is your megaphone to say, people, this is what I want you to know. Is there anything that comes to mind,
Mary Ann  47:21
I think when I hear that, when the parents finally get to, you know, the partnership, for help, they’ve already been through the thinking, this is just a phase, you know, they’ll grow out of this, or it’s a rite of passage, or this is just typical teen moodiness. And I think that one of the things that’s really important is if you’re noticing that your child is struggling, and they’re starting to use substances as well, and you know them well enough to know that this may not that this struggle may have been happening, before the substances started, you know, is to really not attribute any kind of change of your child to a passing phase, I think the most important thing is to really be checking in with your child, as you’re seeing things changing. And identifying that and talking about it, talking about what you’re noticing, and not just hoping it’s a phase that will they’ll be passing through. Because at the end of the day, they really do count on their parents to recognize when they’re struggling if they’re not talking about it.
Brenda  48:31
Right? Absolutely. Yeah, it is, it’s important to have that those conversations, and I like what you said about even using the phrase, I’m noticing, instead of saying, you know, you’re doing this, and you’re doing that, and you’re sneaking out or you’re coming home drunk is to flip that a little bit and just say, you know, I’m noticing a few things that are kind of concerning me, can we talk about it, I think is such a more inviting conversation.
Mary Ann  49:02
It’s such a hard thing to do, though, because you really literally have to put on, and I’m a parent of two grown children now. And, of course, they would always say to me, Oh, you’re, you know, playing therapist with his mom. But that may have been true a little bit, but the idea, it’s hard to put on that neutral, non emotional hat when you’re a parent. So it’s almost like you have to really literally pretend you’re putting this hat on and you’re the counselor, now you’re the coach, or you’re the concerned neighbor, you know, and you’re having that talk with them and kind of trick yourself into adopting a tone. I could have a neutral tone. I’m wondering or it seems like or it sounds like you know, lots of soft approach but it what you notice if you’re willing to do that, and you come from a calmer place, when you’re ready to have that conversation is that they tend to be more receptive to you. So it works and it tends to work better?
Brenda  50:01
It does. It does. And it is hard. So if it’s not working for you just take your time actus it does happen. Well, I know I need to let you go. But I would just be curious, what do you love the most about what you do?
Mary Ann  50:15
I think what I love is why I love helping people overcome something that they think is so shameful, or that stigma. And I love when I see them finding other people that they can relate to and talk with and connect with, about what’s going on. And then then I see them becoming empowered to really accept and embrace what’s going on for their child. And, and then you know, when you’re working with somebody over a period of time, to kind of see those healthier relationships start developing in their family and, and seeing how they’re connecting with their child again, and, and how everything’s just getting more kind of genuine and honest in the relationship. That just brings me a lot of joy. Yeah, it really
Brenda  51:01
does. It’s so true. And I love to hear that, because when you’re in it, it can just seem so bleak, and so hopeless, and like this is never gonna end, this is never going to change. And you have seen 1000s of people change by this point in your career. And so I think if you’re in that place where you’re listening, and you’re like, This is just not going anywhere good. Know that it can know that people do change, and it can take time. And it takes the right help, which is not easy to find. So I just thank you so much for giving us these resources. And just the basic information that we need. It’s so hard to find some time. So I really appreciate you coming on and just helping us really understand in a simple way, this kind of confusing topic.
Mary Ann  51:53
Well, Brenda, thank you so much for having me. And just I appreciate so much what you do for Hope stream and, and for the hosting community as well. You bring them a lot of good information and support and a beautiful oasis to get some support and nurturing with each other to you do a beautiful job.

Brenda  52:13
Thank you, thank you, it’s great to be able to just come together. It’s so funny on these podcasts because I do feel like I’m actually sitting in a room talking with people, which is kind of weird, because I’m not, but it feels very much like a community. And then the stream obviously is a is a community where people can hang out together and do this. Well, I will be listing all of these great resources in the show notes. If you’re listening, you’ll want to just go to Brenda zane.com forward slash podcast, and then look for this episode. And you’ll get all the links to everything. And I will also be posting their fantastic PowerPoint presentation or all the PDF that Maryann gave me on this that you can go and download. So that will be there. And thank you for joining me.
Mary Ann  52:59
Thanks for having me. Appreciate it.
Brenda  
Thank you so much for listening. If you’d like to go to the show notes, you can always find those at At Brendazane.com/podcast, each episode is listed there with a full transcript, all of the resources that we mentioned, as well as a place to leave comments if you’d like to do that. You might also want to download a free ebook I wrote called hindsight. Three things I wish I knew when my son was addicted to drugs. It’s full of the information I wish I would have known when my son was struggling with his addiction. You can grab that at Brendazane.com/hindsight. Thanks again for listening and I will meet you right back here next week.

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