Fostering Compassion in Addiction Treatment
Speaker Series featuring Dr. Karen Flannery. Interviewed by Ryan Soave, MA, CTT - Clinical Director for Telehealth at All Points North Lodge:
My name is Dr. Karen Flannery. I am a physician - board-certified in Internal Medicine, Hospital Medicine, and Addiction Medicine. I've been practicing for nearly 20 years in West Palm Beach, South Florida, and I have developed a team of providers that focuses on concierge recovery and wellness services.
We developed this out of necessity. I started out in this area working in sort of a high-end concierge hospital-based detox unit in West Palm Beach. I realized that patients sometimes self-selected. They came into this unit because it was detox only, because it's a high level of discretion, and they would come in under an alias. Mostly they self-selected because they only intended to kind of hit the pause button, seek out detox, feel better, clear their head for a few days, and really had no intention of going on for further treatment.
So I realized a couple years into this that it takes a village. I developed a team to meet them where they are (literally and figuratively) - that when they're in the detox unit, everybody on the team comes to meet them from the recovery coaches to the psychotherapists, lots of wellness endeavors, guided meditation, mindfulness training, functional training and physical activity, nature exposure, and re-exposure for people really isolated. We began bringing this to them even while they're still in the early detox phase.
Then we found that after they go home, if we follow them and bring that continuity into their home again by meeting them in their actual home environment rather than having them travel back and forth to a treatment center, I think this accomplishes several things. One is that we get to see how they behave in their environment, what is activating or triggering for them in their home environment, the relationships and support (or lack thereof) that they have in their own environment, and also really understand the challenges that they have in a social or group environment.
This may not be the last stop for them. Many folks that probably would benefit from going to an intensive residential treatment center will get there at some point. But we get to have them at least start the process by working with them closely in their own home environment.
And we’ve recently been able to work a case together. So, I’ve seen how comprehensive it is and what care you deliver, and I'm really grateful to have been able to be a part of that. I would imagine that most of these clients are of higher net worth. But I think this is something that's not often addressed when we're in counseling education. We often talk about cultural diversity, and often, we are dividing that up by race and sex and religion. I definitely believe that this is another population that has some specific issues. I think generally in the world, nobody wants to feel bad for someone who has a lot of money. But they have their own set of issues. What are some of the challenges around this type of treatment that you see with this group of people? And do you agree with what I'm saying there?
Thank you for asking that question. I absolutely agree, and I think I've seen it on two ends of the spectrum with the same population. You know it's funny that you say that we don't want to feel sorry for someone who has a lot of money. But money, I've learned, is not happiness. However, with wealth seems to come a sense of power or a perception of power - whether it comes from within or from other people perceiving them as sort of being at this higher level.
One thing I’ve seen is those who are really feeling kind of like the “president of the universe,” I like to say. “I control everything. Everyone reports to me. I'm ultimately responsible.” So, they feel the weight of the world on their shoulders. Or they're always in the limelight and so everything has to be in order to their expectations. They hold themselves to extremely high standards. Anything less than top notch is perceived as failure to them and to those who hold them in that regard. So that's one end of the spectrum.
The other end I see are those who at least perceive that they have slid or fallen down from that. They may still enjoy or retain the wealth they had, but they feel powerless at this point. Not so much when we are talking about substance abuse, being powerless over their addiction. It’s rather that they’ve lost their position and their comfort level.
So, being able to find their new approach to life is important. Maybe they don't need to run the company anymore. I work with a bit of an older population too, and a lot of these people are able to retire at an earlier age. They thrived on being able to work 60, 75, or 80 hours per week. Then they were so great at what they did that they built their empire, and it runs itself or they’ve done well in getting the people under them to run it. Then they feel a little displaced.
There's a dissonance, cognitive dissonance, because the profits keep rolling in but suddenly they're not as needed. They lose the tendency to take out all of their energy in their work environment. Then maybe they turn to other things or perhaps even start to isolate which then opens the door to all kinds of other emotional and substance abuse disorders.
Well that's really great, thank you for sharing that. From what I understand, you had your medical training and practiced in a certain way for a period of time and then went into addiction medicine. What, if any, were some of the bigger awarenesses or thoughts you had that were challenged or changed when you moved into addiction medicine? Maybe what you thought about addiction before or as you learned about it and then also started working with that population? Is that a fair question?
Yes, I’ll give that some thought. Well, a huge thing is (and I'm grateful that it’s talked about now) the stigma associated with addiction and the compassion even among healthcare providers.
I was in a high acuity and high-volume environment, and so there's a certain level of burnout for people that work in that environment of healthcare. You see the people around you start to become a little callous, a little jaded, and a little judgmental. I said, “Wow, you know the people who are suffering the most, who are really hurting may seem that they're coming in for an emergency.” As a hospital medicine physician for many years, we had people coming in for emergency medical services with various chest pains or GI illnesses or things that someone who looks at them might say, “We ran all the tests, you're fine. There's nothing wrong with you. You're anxious or depressed. You’re med seeking. It's related to substance abuse disorders.”
It’s easy to be somewhat dismissive. Not to necessarily fault the healthcare providers, but it really highlights the need for education for everyone on the healthcare team, not just those that are working in the addictions and/or mental health field. There needs to be a sensitivity and awareness.
This might be one of your future questions, but I’ll just tell you now about one of the things that I’ve found most gratifying. I guess I was surprised to find this. The work that I'm doing now is a very low-volume, high-touch practice. As a concierge level physician, I get intimately involved with each patient. The patient that we were working on together recently, he heard what I do, and he told the referent he was afraid I was going to come in and label him right off the bat as an addict and judge him.
I know he's been told multiple times, “All of your medical conditions or complaints are psychosomatic.” He worried I might judge him and that I too would say he's crazy or that this is all made up in his head. I was glad that he gave me that opportunity to realize that is the fear that a lot of folks live under. They’re afraid that they’re being judged or being accused of either overutilizing healthcare services. They're really just stuck in a healthcare system that sometimes doesn't have the capacity, the education, the training, and the services to show them the compassion that they absolutely need.
If there's one thing that I try to do and that brings me the most joy in my line of work is to just be compassionate, to try to empathize, and right off the bat to say, “Yeah, there probably is a component of this that is psychological or emotional, but that is a chronic ongoing health condition the same way as something that's medical and in your organ systems would be. The brain is just one more organ, so how about we talk about the interplay between the brain and the body and how those things come to play.”
I'm so glad you said this. There are a lot of things that we see especially when we're dealing with things like post-traumatic stress disorder or other stress disorders or anxieties that are psychosomatic. I think the feeling is or the belief is often that if it’s psychosomatic, it's not real. It's still real. It doesn't matter if it was caused by my environment or breathing some air that was polluted or the system that I grew up in that created a belief that’s formed this experience in my body. It's still real, and we have to treat it.
And to validate it first.
Validate it first, and then not just say that it’s something that we can push away. I mean it's obvious to me in just the short time that we've had dealings together how compassionate and connected you are with them. I saw that person we were working with really develop that trust. It probably was, in some ways, looking like med seeking, but that's relief seeking too.
Where would you like to see the medical community as a whole in early training, when they're entering medical school? What would you like to see change? I know some of it has changed, but what would you most like to see change related to addiction services or mental health services or education about them?
I would like to see it starting far earlier than those who choose to go into health professions - starting at an elementary or at least a high school level to work at educating, informing, and creating safety around talking about mental illness and substance abuse.
My daughter is a sophomore in high school, and they've implemented a mental health training into the curriculum now. It became mandatory this semester, and it has evoked a whole range of responses. Right off the bat what I've noticed is that it creates a culture of safety and gives everyone permission to talk about how they feel when they're exposed to let’s say a peer who is faced with mental illness challenges.
The other thing I wanted to point out is something that for a long time was kind of embarrassing for me. It was very early on when I was in medical school my first year. We were talking about something in psychology, just introductory stuff. I remember raising my hand. I said, “I really think that there's a lot of subclinical psychological conditions out there.” For those who don't necessarily understand “subclinical,” it is the things that don't rise to meet the diagnostic criteria of depression or anxiety or PTSD but have features of them. It’s when people have those feelings even though their behavior may not fully be that.
When I said that, I don't know if I asked for a show of hands, but I guess I just almost expected everyone in my med school class to say,”Yeah, you're right. We're all a little challenged in our own ways.”
Nobody had my back. I was like, “Okay, maybe I won't talk about that again for a while.” It took me a long time to say, “You know what? No.” There is a lot of subclinical emotional dysregulation and a lot of psychological early-stage conditions. If that's when we can assess, show compassion, empathize, and potentially intervene, I think we would have a whole lot less substance abuse disorders, fulminant mental health disorders, opioid epidemic struggles, gun violence, road rage, you name it. That’s when we could really support each other and create a culture of safety where we're all free to talk about that and heal together.
Ryan Soave: Thank you so much. It’s been so great to talk to you today. We're really grateful you are here.