Systemic Barriers, Generational Trauma, and Culturally Affirming Care; a Conversation About Race And Substance Use With Dr. Ayana Jordan

Hopestream for parenting kids through drug use and addiction
Hopestream for parenting kids through drug use and addiction
Systemic Barriers, Generational Trauma, and Culturally Affirming Care; a Conversation About Race And Substance Use With Dr. Ayana Jordan
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ABOUT THE EPISODE:
Dr. Ayana Jordan is a passionate advocate for racial and ethnic minority groups dealing with substance use. She's an MD/Ph.D. addiction medicine practitioner and associate professor at the Yale School of Medicine, but more importantly, she's someone who works tirelessly to bring culturally informed, gold-standard addiction treatment to racial and ethnic minority populations.

In this episode Dr. Jordan speaks about important topics that impact communities of color like;

  • system barriers to highly effective treatments like buprenorphine for those in Black and Brown communities
  • generational trauma stemming from the War on Drugs and its impact on minority populations today
  • the new definition of MAT and why language is important in reducing stigma
  • what culturally affirming care can and should look like
  •  the negative cloud that surrounds methadone even though it's just as effective as other medications that treat addiction
  • why she wants people to focus more on structural policies than the addicted population when it comes to improving treatment
  • the role COVID-19 has played in expanding access to medication for addiction treatment 
  • substance use and treatment disparities among Black and Latinx youth compared to white youth
  • her research around integrating spirituality into evidence-based treatment modalities
  • how current racial tensions are impacting minority individuals who want to seek care
  • and her plea to the Black and Brown community to follow their dreams and join her in the field of addiction medicine

I learned so much from this conversation and I'm positive you will too. You'll come away with a greater understanding of what it means to experience substance use and to seek addiction treatment as a racial or ethnic minority, and learn what Dr. Jordan is doing to bring more equality and culturally relevant services to those in need.

EPISODE RESOURCES:

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SPEAKERS: Brenda Zane, Dr. Ayana Jordan
Brenda  01:47
I want you to get ready for a very important and very real conversation around the idea of race and addiction. My guest today is basically a rock star. She has both an MD and a Ph.D.. She completed a general adult psychiatry residency at Yale University where she became interested in treating patients with substance use disorders, and then completed specialized addiction training at Yale with an interest in using her research background to address clinical questions in the Black community. She’s currently an assistant professor at Yale and a physician attending at Connecticut Mental Health Center. She has done research in Sierra Leone, West Africa, examining the link between mental illness, substance use and stigma and has served as an expert witness discussing those issues. In Connecticut, she’s working with Black churches to offer an evidence based therapeutic modality shown to be effective in decreasing a substance use. Today friends, I am talking with one of the smartest and most dedicated physicians working in the field of addiction, Dr. Ayana Jordan. 
Brenda  03:04
Welcome, Dr. Jordan to hopestream, I’m so thrilled to have you! It took a long time to get an hour of your time, actually, we’re going to have 50 minutes of your time so that you have a minute to breathe. But thank you so very much for being with us today and sharing your perspective and your expertise with my listeners.
Dr. Jordan  03:22
No Brenda, really I am so happy to be here. And I’m finally glad that we’re able to have a conversation together. It’s so important. And I’m sorry, it took so long. But I I think that speaks to a larger issue of the demand to really talk in an informed way about you know, racial and ethnic minorities who are really dealing with addiction. There’s not a lot of us doing this work. 
Brenda  03:48
Exactly, we need to clone you by like 1,000, if that’s possible. If that would only be possible that would be amazing. Well, I’d love to start out with just a kind of a fun question to let people get to know you as a person before we dive into everything professionally. And that is what did you want to be when you were growing up?
Dr. Jordan  04:09
Oh, wow, that’s awesome. You know, I always wanted to be a doctor. I did, Brenda, and it’s so funny because I I didn’t have any representation of what that even meant in terms of being a doctor. And I didn’t come from like a very impoverished background or anything like that. Both of my parents were educated and went to school and went to college so it was definitely within the realm of possibility, but it’s not like I had any doctors in my family or anything like that. But I knew from my surroundings, that there was a lot of nobility related to being a doctor and that really came from watching The Cosby Show growing up and being like, wow, they live a pretty good life and kind of the character of Bill Cosby being a doctor and had so much esteem but also was very down to earth. So I think that definitely infiltrated my consciousness very early on. And I just also really had the privilege of growing up with many Black doctors. And so they were always helpers. And I said, oh, that is definitely something that I want to do. Now, I didn’t have the foresight to know that doctor could be like, not just medical doctor, but PhD, and I found that out later. But when I was younger, I definitely wanted to be a doctor. So I’m grateful to be here many years later.
Brenda  05:50
Yeah, that’s really unusual. But I find that in the medical profession more that there’s some people that just know, it’s kind of in their DNA. Like, I know this is where I’m gonna go. And maybe talk about that, because I know that you are a medical doctor, and a PhD, and I’m just freaking out, because, like, were you in school for 100 years?

Dr. Jordan  06:14
Brenda help me! I was a professional student for so long. And it’s so funny cuz it’s like, you know, I think about all of the years I was in school over, I don’t know, maybe 20 years, being in school between college and, you know, medical school, PhD, residency, fellowship, it’s a long, long process, but it’s a worthwhile process. And I’m so grateful, I just didn’t know what I didn’t know, because I don’t know if I would have completed it. The value of being young and naive, you know, and having big dreams, but because you haven’t afforded to to do that, so I’m grateful. But it was a long road. And I, I didn’t start off knowing that I was going to do a combined MD/PhD. And I actually didn’t start off knowing that I was going to end up in psychiatry, and definitely not addiction. But I am a big believer of the universe in the spirit really guiding your path. And so I don’t think it’s any happenstance that I’m doing the work that I do. Because all along my life, I’ve been informed personally by people who have struggled with addiction, and have been deeply impacted. figuring out a way how I can help people who look like me just live better lives. So I think that really led me to, to do the double degree, for sure.
Brenda  07:42
Well, I just can’t even imagine what a marathon that must have been. I only have an undergraduate degree. And I feel like it was a long road. So I just, I’m in awe of people who who do that and go the long haul for what you do. So that’s incredible. So you said that you had good representation of you know, physicians in your life, physicians of color, and that’s so special. And I think that that’s something that I would love to explore a little bit and in what you’re seeing also because I know you’re in an advisory role and what you’re seeing with medical students coming up? And is the field of addiction looking more attractive or less attractive and kind of what’s going on in that area?
Dr. Jordan  08:26
That’s a great question. So, it’s complicated, there’s not really a direct answer. I am always an optimist, in order to do this work, because it can be extremely painful. But there are some silver linings and bright spots. I will say though, that there are just not enough addiction specialists and definitely not addiction specialists from racial and ethnic minority communities. But there are programs that exist to recruit and develop more. So one of the programs that I do, I’m so proud, of I’m the medical director, and it’s funded by SAMHSA through the American Academy of Addiction Psychiatrists, and what we’re able to do is work specifically with people who are interested in having careers in addiction from racial ethnic minority communities, we help them gain the knowledge that they need to work with people who have substance use disorders. And so I’m very grateful because one of the main, main barriers to people being in school forever, Brenda, is debt and not being able to pay their bills, right, and really wanting to take care of themselves and live full lives. 
09:45
And so through our program its called REACH – Recognizing and Eliminating Disparities in Addiction Through Culturally Informed Healthcare – one of the things that we do is we make it easy, we say we’re going to give you money to really obtain this training because your presence in the space is so, so important. So we definitely need more addiction docs. We definitely need more addiction physician assistants and all types of professionals. And this is one of the ways that we’re doing it. And also there was another program that just came out where they’re expanding addiction Doc’s again, a government program. So there’s some good news, people are starting to get this training that they need. So we increase the amount of addiction specialists, we still have a long way to go. But it’s a lot better even within the past five years to where I started back in 2011. So there has been tremendous progress. And so I’m grateful. And I’m optimistic because people are starting to understand that it’s not a moral failure. It’s not an inherently bad, that person is dirty, or, you know, you have no value. If you use drugs, people are starting to understand that compassion and education and medical wisdom and training is the way in which we can help folks. And so I am feeling very optimistic, Brenda, to tell you the truth, and I am seeing actual programs in place to increase the human workforce to deal with folks with addiction.

Brenda 09:55
Wow, that’s incredible. What a barrier. I mean, when you talk about just the years and years and years of schooling, and then additional, you know, specialized training in Addiction Medicine, I can’t imagine what a burden that would be. So if you were young, you know, physician looking at your options, that that could be a big barrier to say, well, I don’t know, that looks like a lot more debt piled on top of what I’ve already got.
Dr. Jordan  11:50
Exactly.
Brenda  11:53
And then in in talking about that, and I know, that’s been one of the things that I’ve been looking at, as far as this view of compassion now that seems to be emerging. And I think in some communities it’s caught on more than others, that addiction really is not a moral failing, and, and looking back, you know, even to when the War on Drugs started and that debacle – and all of that I think can be its own podcast episode.
Dr. Jordan  12:26
It really can
Brenda  12:28
And it is now I think, a message of hope for people and that the medical profession is recognizing that and not shunning people who, come in with that. And I know, medication assisted treatment is a big part of that, I have never had anybody on who’s a professional in this area so I’m so excited to have you. When you talk about medicated assisted treatment, maybe you could just tell us what that is. And then how is that perceived in communities of color. And I know that there was also a history of Suboxone versus Methadone and that’s, again, probably a whole other podcast, but maybe you can give us the cliff notes version of that, because I think that’s just really interesting. And people need to understand what’s happening in that space.
Dr. Jordan  13:21
Yeah, no, I’m happy to do so. So one of the things that like to do is just take a step back for a little bit and just talk about language. And just be very clear that even our the language that we use, has evolved over time as we learn more. And so some of the language that we use in the past was appropriate for that time. But then as we get more information and did studies, we updated our language. So in that context, as we think about MAT, and a lot of medical professionals don’t know this but I like to share it with your listeners, is really thinking about what MAT stands for. So it used to be that we would say medication assisted treatment, but now their term that is a lot less stigmatized and kind of appropriate is really thinking medication for addiction treatment. 
So using that – MAT – medication for addiction treatment, and the reason why that’s important to talk about just in the beginning, is because if you are dealing with say opiate use disorder, which is very hot right now thinking about things like you know, prescription opiate pills like Oxycontin, oxycodone, heroin, fentanyl, carfentanyl, all these things. It used to be the thought that it would be mandatory for people to not only take medication but also have to be in counseling in order to be deemed as having treatment. So we said okay, the medication is assisting your treatment right? But what we know from more recent studies is that the medicine alone, although for certain communities, these other things can be helpful, but just being on methadone or buprenorphine, which is the generic name for Suboxone, that actually decreases your chances of death at one year by 80%. So one of the things I want to make sure people understand is that you don’t have to be required to do anything else. Right? So we wanted to change our language to say, no, it shouldn’t be mandatory for you to sit in groups, if you don’t want to, if you want to, that’s different. But it shouldn’t be mandated by treatment centers and doctors for you to have to do that in order to stay in care. So we want it to be very clear – medication for addiction treatment in the same way that we wouldn’t make somebody who has, who needs insulin to actually have to go to groups, right? It’s just we just do we don’t have to call it assisted. It is what it is. 
Brenda  15:58
that’s awesome. I love that. Thank you. Thank you for sharing that.
Dr. Jordan  16:01
Yeah, no, I think it’s important. Okay. So then in thinking about, you know, the question in terms of what is our understanding? So it used to be, you know, that people didn’t want to be on methadone, because there were a lot of negative associations with methadone. A lot of times the opioid treatment programs where methadone was dispersed for opioid use disorders were in areas of high crime, also can be in lower impoverished areas. And so understandably, people didn’t want to be associated with those areas in terms of getting their treatment. But also, to be totally honest, you might not want to put your recovery in jeopardy if you have to go to this place in order to get your medication. But you know, you’re going to meet some drug dealers along the way, right. So methadone itself is a wonderful medication and has been used for so many years, right. It was our gold standard. But what happened is the negative association of how methadone was dispersed and where it was dispersed, really cause and still does have a negative cloud on how effective this medication can be. 
One of the things that has happened over time is that buprenorphine came onto the scene. And it works, its just as effective as methadone, right, so there have been studies to show that there is no difference in effectiveness between methadone and buprenorphine – both are effective in treating opiate use disorder and preventing death. Now, it just depends about access. So that’s the thing we’re know we have to talk about is, why is it that Suboxone is able to be at accessed through your office based care, right, so it just makes it much easier for people to get it because you don’t have to worry about going to one program, one place, multiple times a week, you can get it, have a prescription for your doctor, and then only come in about once a month, which is really, really nice. 
And so this is important to think about how there’s two systems of care for majority white populations and racial and ethnic minority populations. Because when there was this uptick in the amount of white people that were dying, there was a huge push to make sure that buprenorphine was offered an office based care when we know that methadone is just as effective. So why wouldn’t methadone be offered in the same way so that all people can have access to it. And what we’re seeing is that even to this day, the most people who get buprenorphine, which is much less stigmatized, it’s not in necessarily bad areas, benefit white people. And it’s really upsetting because we want to be able to offer both treatments, which we know are effective equally to all people. 
And it wasn’t until we really transitioned from the war on drugs, right? That really affected negatively Black and Latinx population. It wasn’t really until more white people became effective with the opiate crisis that there was a kinder approach to dealing with people who had opiate use and that really followed what we’re seeing in terms of allowing something like buprenorphine to be offered in the less restrictive way. And so part of my work is really understanding that kind of negative history associated with methadone and also pushing so that methadone can be offered in office based centers just like buprenorphine to make sure that everyone can have access to it. 
The other thing that I think is important to know is that we’re not doing well for anybody in terms of making sure that people have are actually using these medications. Can you imagine like, this medication works so well methadone and buprenorphine, but less than 20% of people actually use it. So we’re not doing well for anybody, to be totally honest, Brenda, but we’re definitely doing worse in terms of Black and Latinx populations, and engaging with care. So part of it is, yes, the views that these minority populations might have. But even when they’re willing to use it, they can’t access it, because it is really reserved to more affluent areas where people are offering the buprenorphine in the office based treatment, you know. So that makes it really tough. And people don’t want to have to go to an opioid treatment program where you get methadone six days out of the week. I mean, can you imagine that? 
Brenda  21:10
No, that’s crazy. And it’s always in a sketchy part of town that you wouldn’t want to go to,
Dr. Jordan  21:14
Exactly, that you don’t want to go to, and so that is just what I’m saying. Like, these are the things that we have to look at not necessarily the population. But why are the structures put in place that really make it very difficult for people to get the help that they need?
Brenda  21:33
Has that, I think I’ve read some that that’s changed a little bit with COVID, that COVID has given a push a little bit to easing some of the restrictions on some take home prescriptions and hopefully, I don’t know, will that continue? What do you think is gonna happen there?
Dr. Jordan  21:55
Brenda, I am just loving you so much, because I am so impressed about how much knowledge you have. My colleagues, probably they don’t even have this much knowledge.
Brenda  22:08
I read a lot.
Dr. Jordan  22:11
Absolutely. Oh, gosh, I’m so grateful to be in community with you. So let me just say yes and no. So to answer your question directly, that yes, SAMHSA, the Substance Abuse and Mental Health Services Administration has these exemptions because of COVID. When they realize how ridiculous the policies were, how can we allow people to physical distance, and we’re asking them to come in to get their medication every day, it doesn’t make sense. So under that COVID exemption, what happens is you’re able to get 14 or 28 days of take home, so that you can keep your methadone with you, you don’t have to come in. The issue is that that is not enforced in the same way across different regions. So we need to understand, for instance, where there is a majority racial, ethnic population, minority population, are they able to get the 14 and 28 day take homes in the same way that more white serving opiate treatment programs are? We don’t know the answer to that. So this is why I’m involved right now in the study to actually see, number one, what are the experiences of people who have opiate use disorder that have been getting methadone before the pandemic? How do they feel now that they’re getting these increased take home? Are they able to keep themselves safe? Are they not using it in a way that’s harmful? We believe that people, for the most part, want to take their medications and do well. So we think that they’re going to be okay. And that’s what we’re studying, because we want to advocate that even after COVID. 
This is the way it should be, people should be able to have their take home, way longer than having to come in, right, every day, we want to collect the data to advocate for that on a policy level. But I think another point that you bring up as a very good one is will this continue after COVID? I don’t know. I hope so. Which is why we’re doing research in this area. But also, another important point is that is everyone following the same rules? And I can tell you the answer is no already. Even with this exemption. There are opiate treatment programs that are still not allowing people to get the take homes that they need. So, again, people don’t know this. And so this is why your podcast is so important to get the education and knowledge out there so people can start to advocate for their loved one and advocate for themselves to say, hey, this exemption is happening. Why is it my loved one, why aren’t I benefiting from getting 14 or 28 day take home doses? Why is it so much harder for me to get the medication I need to keep myself safe? These are the artificial barriers that I say upset me so much when we’re thinking about people with addiction, why are we treating them in a way that is totally different than we would treat anybody else with the illness? Right? It’s ridiculous. And then when we’re dealing with racial and ethnic minorities with addiction, it’s another way of people being other, or treated less-than without humanity. 
Why would we not offer in majority urban communities where there are racial ethnic minorities, why wouldn’t we offer the same opportunities to engage in treatment with buprenorphine, in the same way that we do with more affluent communities, it doesn’t make sense, we are really creating, I say, structural racist barriers, right, where we know that it could be much easier, and we’re not doing it. And so that’s why I do a lot of my scholarship, a lot of my research is really understanding that it’s not necessarily the racial and ethnic minority communities that don’t want to use the medicine. That’s just a small part of it. But more than that, is that there are really policies in place that make it much harder for them to engage in treatment. And so that’s what I want people to know, is let’s focus more on the structural policies, as opposed to the population, because I really do think if people can get easier access to care, of course, you want to live better lives, of coures you want to make decisions, you know, but if you make it much harder for them to get it, or their only decision is to go to a place that has a high infestation of crime, or they might meet their drug dealer, no, nobody would want to do that. You know, if there’s a waiting list for two months, how are you supposed to survive? You know, come on, it doesn’t make any sense.
Brenda  27:03
It doesn’t. It doesn’t. And it would be so horrible if after, I’m hoping that there is going to be an after-COVID, I keep saying that. I’m wondering if that’s even a thing. But it would be so tragic if things got rolled back. You know, when conditions do improve, so I’m so happy to hear that you’re studying that to be able to say, yes, people are getting their medication taken at home, and they’re taking it it’s not getting diverted, or it’s not, you know, being used inappropriately. So that’s, that’s huge. Because, yeah, you know, it’s so stigmatized, all ready to be in this situation, but then to make it even worse, to just go get the medicine that’s going to make you better. It’s just ludicrous to think about how that, how that works. So that’s great to hear, is there,  my world is fairly white, I have a two boys who are mixed race, Filipino and so they, they bring a lot of fun and wonderful culture into my life. But I’m just wondering, what is kind of from a cultural perspective, the view of addiction and treatment, you know, my son went through, I don’t know how many treatment programs, wilderness therapy, and you know, you name it, and I, and I think he was the most diverse person I saw, right, and he’s half Filipino. So I just am wondering what that looks like, for young people in particular, you know, from a cultural standpoint. Are there differences there?
Dr. Jordan  28:39
Yeah, I mean, one of the things that I’ll say is like culture, to your point, it just, it means so much. So it goes beyond just, just race. And it goes even beyond just ethnicity, because a lot of times we mixed up race and ethnicity and we, we substitute those things as being a proxies for cultures, but we know that it’s multifaceted it like you can be someone who is identifies as black and grows up in a predominantly affluent community and your culture is going to be very different than same person who grows up in a different area, right. So all of that definitely influences the way in which people think about addiction, the way in which people think about treatment, and actually who has access to getting help. I will say that one of the most important things that I tried it, let people know is that this whole system of race is really a social construct meaning that is man made. It’s something that’s made up. But at the same time, I don’t want to minimize how important race can affect the way in which people think about addiction because there are real consequences to be identified with a certain race versus others and If you’re not associated with the majority kind of white race that has a lot of positive attributes compared to other races, then it can be really, really hard for you to get the treatment that you need. So that’s important to say, even though races race is made up, and it’s a social construct, that it really is a system that preferentially advantages some people and disadvantages others. I say that because one of the things that I’ve seen in working with people from who identify as Black, who identify as Afro-Latino, so they’re Black and Latinx, or who just identify as being of the Hispanic origin, or Latinx origin, is that they feel like a lot of times their experiences with addiction is left out of the mainstream media. 
So you mentioned the War on Drugs. And what really happened, starting with the Nixon Administration, in ’71 is that it really identify and called out Black and Latinx population who use drugs. And instead of providing care and treatment, what happened is those people were sent to jail. Right. And that was really the policy. And I think that this is important to understand and answering your question about how culture plays into this, because there are many people whose parents have been in jail and been affected, and it has really shaped their ability to be able to get help now, generations later, right? So we know that that led to over representation of black, black and brown people in the carceral system who use drugs, and that affects the experiences that their children will have. So thinking about, what does that mean? What is the trauma that’s involved to grow up with a parent that is involved in the carceral system because of their medical illness? How does that make you feel? How do you experience that trauma? Do you try and use drugs as a way to deal with the pain of not having someone care about you? These are the issues that come up more often in racial and ethnic minority communities, not because there’s something about them genetically that predisposes them to this, but it’s because of how they have been affected by the systems and the policies, right, that have led to being treated differently. 
So then when we’re thinking about youth, when we look at Black and Latinx youth, they actually are using substances much less, at lower rates than their white colleagues. But the issue is that they’re not engaging in treatment at the same rate. So there are a lot of protective factors that happen culturally, that actually minimize it. The use of Black and Latinx youth compared to their white colleagues. So what is happening there? Is that a stronger sense of community? Is it having a connection with the higher power? These are all things that people are studying, but the bottom line is that overall, there is less use. So then the bigger question is, well, why is there so much more morbidity or bad things that happen as a result of use, or as a result of their use? And one of the things that I say is it has a lot to do with access to treatment. So there is really huge disparity amongst racial, ethnic minority youth and white youth in terms of what is even available to them. And then when you’re thinking about finances, so we know that in this country, people from racial ethnic minorities are don’t have the same opportunities. And even if they do, it’s much they don’t have the overall wealth, okay, that white communities do. So then when you’re starting to think about who pays for these treatment facilities? Brenda, I’m sure you know, these things are not cheap. 
Brenda  34:18
Oh, yeah, I’m painfully aware. 
Dr. Jordan  34:22
Yeah. And so if your family, they don’t have access to the wealth that they need to be able to pay for these, and the insurance won’t pay for it, then of course, you’re going to have problems. So then that’s where we start to see the beginning of this disparity blooming out of control, because the racial, minority youth are not able to get the treatment they need at the same rate. Then, if you go into the policies that allow for Black and Brown people to be more targeted for their use, as opposed to getting care, then you have to think of the downstream effects of that. If you are involved in the carceral system, it’s harder for you to get a job, there’s actually places that you can’t even live, if you have been involved in the carceral system, much more likely that you’re not going to be able to work as a result of your history of incarceration. So then all of these compound, your ability to stay on recovery, because if you can’t find a job, you can’t find a safe place to live. And in some places, you can’t vote, how are you supposed to start to put together the tools you need to establish recovery. So these are all of the things that really do make it much much harder for racial ethnic minority, minority youth and adults to really engage in the system in the same way. So that’s really difficult. 
But I do want to spend some time to just think about, well, what are the strengths that are happening? And what are the ways in which we might draw upon kind of these cultural values and common themes amongst racial and ethnic minorities. And one of those things is, the work that we do is really, really, really having a strong sense of faith as a tool to escape the reality of what is happening. And so for so many racial ethnic minority communities, it’s important for that to be integrated into their treatment, you know, the treatment planning and their systems of care. And so many traditional addiction models shy away from that. So one of the things that we try to do and our our research Imani Breakthrough, and another project that we’re doing that’s funded, is see if we’re able to integrate spirituality into evidence based treatment, things that we know that works, are people more likely to engage in treatment? And what we’re seeing Brenda, is they are, so it’s not this myth that they don’t want to get treatment that they don’t want to use medication. No, it’s not that at all. If the information is provided to them in a culturally informed way, if they know that, if they’re able to be on methadone or buprenorphine that decreases their chances of death by 80%, people absolutely choose that, 
Brenda  37:20
Right, who’s gonna say no to that,
Dr. Jordan  37:21
Right, but they it’s never been presented it in a way that allows them to really understand right? And so one of the things with working with majority Black populations that I found is, Brenda, so much of the opiate crisis has been focused on prescription pills and a large focus on white communities that a lot of Black people don’t even know, Brenda, that heroin is an opioid. So they don’t even realize that this is something that could help them because they don’t even know that they’re part of the opioid crisis.
How upsetting this that, you know, mainstream media, and you know, in the New Yorker, and this and that New York Times, all these places, they’re like, oh, you know, this crisis, but what about the people in the late 60s and 70s, that are Black and Brown, and have been dealing with heroin for years, right. And they’ve never been offered these kinds of treatments. They’ve been offered the War on Drugs, you know, from Nixon, that was really doubled down by the Reagan administration. I think it’s important for people to understand like, if people are presented with information, the way that they can get and understand, along with the risks and benefits, of course, they will make informed decisions because people want to live healthy lives. But also you have to incorporate cultural affirming values like spirituality, and be able to help and things like expunging carceral legal histories, right? Because that can get in the way of really being able to take care of yourself in your family. 
Brenda  37:55
Right.
Dr. Jordan  39:01
I’m really thinking about the importance of physical wellness, right? If somebody is doing something illegally, right, and there’s someone from a racial, ethnic minority background, and you see everything that’s happening in our in our society right now with police murders, do you think that they are going to feel safe to engage with a treatment program that has police there? No, because they’re thinking about not just their addiction, but their physical safety, that I might not come out of this alive and even if I come out of this alive, that is very traumatic to have to be in a facility of just supposed to be quote unquote, treatment when there are police there that just the presence can allow me to have a physiologic response. So one of the things that we talk about when thinking about culturally affirming care is, is there a way to eliminate police presence from addiction clinics, not because we don’t like the police. That’s not it at all. But because there are real reasons to understand why people wouldn’t feel safe in those traditional settings of care. 
When you turn on the news, and you see people who look like you being shot in the street like an animal, we have so many examples, right, Brionna Taylor, and George Floyd, most recently, we heard about Daniel Prude, you know, he was a Black man who was using PCP, and his brother called the police to help them. And Brenda, he ended up dead. So these are the reasons why people don’t want to engage in quote, unquote, treatment, not because they don’t want to help themselves. Of course, they do. Not because they don’t believe in medication, they do, but they don’t feel safe in the existing treatment paradigm. So that’s why we do a lot of work and saying, can we involve natural communities that have trust, faith communities, nonprofit communities, peer recovery coaches, get police out of treatment facilities, so that people will be more inclined to feel respected, to feel safe. And then can we also be able to address what we call the social determinants of health, so that we can have a holistic approach to recovery. So that’s things like emotional wellness. And I know, you know a lot about this, right? Psychological wellness, making sure that you have access to green spaces, that can promote a sense of calm, to be able to even think about the decisions that you need to make to stay in recovery. And this is what a lot of my work centers on to really help racial, ethnic minority communities to have the same access and resources that a lot of majority communities have.
Brenda  41:56
Wow, I feel like we could talk for about 18 more hours about that. Yeah, you know, just yesterday, I was talking to some gals that run a foundation that funds wilderness therapy for young people who can’t afford it. And, you know, one of the key things is really just getting outside just being outside. And if you don’t feel safe to be outside, you’re not going to go there. And that’s just, you know, it’s so basic. It’s just so basic that I think it’s easy to overlook that, if you’re not in that situation to say, well, I’m not going to go sit in the middle of a park, because I don’t know if I’m going to be safe there.
Dr. Jordan  42:36
Exactly. Like I don’t want to be profiled, and we know, again, our policies that Black and Brown communities are over policed. So that’s a very real fear.
Brenda  42:49
Yeah, absolutely. Well, I want to get you out of here on time, and I honestly could talk forever. But I would love to know, you’re in a high stress, career and life and you have so much going on. Is there a self care tip that you would give to someone who is also – maybe it’s one of the moms who’s listening to this, or, you know, a young medical student who admires you? Is there something that you do that you found really helps you deal with all the crazy that’s in your life?
Dr. Jordan  43:24
No, Brenda, thank you so much. Because I’ve always struggled with self care. And the more and more that I am involved in this work, and also what’s happening in our nation, quite honestly. And being a member of the Black community, I have deeply come to understand that self care is really about self preservation, and that I can’t be useful to anyone, not my patients, not even thinking about engaging in podcasts such as yours, not to my families of the people that I treat, if I am not well, physically, spiritually, emotionally, right. And so one of the things I think about is the quote from Audre Lorde, like, “self preservation, in and of itself, is an act of political warfare.” And that helps me to have very hard boundaries, and to spend time with the ones that I love. So I’m an auntie, I’m not a mom, but I’m so blessed to be an auntie, and I have nieces and nephews that filled me with so much love. And so I always make sure to stay in contact with them. Stay connected to them, make sure that I have time in my schedule, where I literally will FaceTime with them stay socially connected, even during COVID while we’re physically distancing, because that brings me joy. Also being able to connect with my community and for me, that means my religious faith so I identify as a Christian, so being able to go to church on Sundays, even if it’s virtually. And pray, and center that because I don’t ever want my work to get so overwhelming that I’m not fulfilling my spiritual self. So I’d like to say to the moms and I, I can’t intimately understand because I’ve never had a child suffer from addiction. But having a father who has alcohol use disorder, having a cousin who has a cocaine use disorder, I can intimately see how chaotic and painful it is to have a loved one and to care for that loved one, really, on a very visceral level that you care for them more than you care for yourself. 
But what I can offer is that you are no good to them if you’re not well, you can’t make decisions in their best interest if you’re not preserving yourself. So that might be something as simple as not answering the phone, because it’s all too much, identifying people in your community that can take those loads away from you. I had to really call upon my sisters on one to three to say, it’s so difficult right now for me, I need you to help with daddy’s care so that I can get a break. Right. So really, really figuring out who in your life brings you joy, who in your life can help the emotional labor that’s involved in bearing witness to someone a loved one that is going through addiction. And also I just offered the the hope of when you’re in a much better place that allows you to make better decisions for yourself and your loved one, but also to be available and present when people do come out on the other side. 
And one of the things I will say, and Brenda you know this intimately, is people can recover. And so that brings me hope, that allows me to stay connected to this work. Because when people know better, they do better. And so if we’re able to, you know, advocate for safe consumption sites and ways in which people can get access to Naloxone to save lives in ways that it can be much easier for people to engage in the treatment that they need, they can be alive. And so that’s why I have to stay well, right. That’s why I have to make the time because I want to be around for people to recover because that is an amazing thing. 
And finally, I’ll just say to young people who want to have a career in Addiction Medicine, it’s an awesome career. I don’t know the racial makeup of your podcast, but I will just say, for all my Black and Brown folks who have been beat down, made to feel less than, especially now what what’s happened in our nation, I need you, I really need you to join me to do this work because there are so many people who value you, who love you, and who will support you in this work. So please follow your dreams. please reach out for help the community need you and and that really is going to allow a path for people to get well. And so I’m grateful. And I I’m feeling very optimistic about our future with it. And we have a lot of work to do. So we need people to take care of themselves to engage in this work.
Brenda  48:23
Exactly, exactly. Well, I can’t thank you enough. I wish I could give you a hug but I’ll give you a virtual hug. And thank you so so much and you know, get get on with the rest of your day. And I will get this out to all the world to listen to. So Blessings to you.
Dr. Jordan  48:45
Amazing. Thank you so much, Brenda, take care.
Brenda  48:50
If you’re a mom listening to this and thinking, there must be other moms out there listening to, I can tell you that there are thousands of other moms that are searching for this same information. And for a more personal connection. You can find me and a bunch of these moms by going to my website, BrendaZane.com. And there you will get lots of information about a really special online community of moms called The Stream. We have regular calls and chat sessions. We do a monthly yoga class for stress and anxiety. And it’s all positively focused. It is not on Facebook, and it’s completely confidential. Membership is on a pay what you can model, so if you want to join this community, and you need the support, you are in. 
You might also want to download my free ebook called HINDSIGHT: Three Things I Wish I Knew When My Son Was Addicted To Drugs. It is packed with information that I truly wish I had known back in the darker years with my son. And so I share it now in case it might be helpful to you in your journey. You can get that at Brendazane.com/hindsight, and I will put a link to both of these resources in the show notes as well. Thank you so much for listening. I’ll meet you right back here next week.

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