Substance Use Disorders Part 2 - How to Make an Effective Change

Transcript

Leah Young: 
The more we experience being in social situations without alcohol, the less anxious we will become over time because I've done this before. "I remember I did this just a week ago." But it takes time and it can be extraordinarily uncomfortable, and sometimes people need to do it in slightly different ways.

Ellie Pike: 
Welcome back to Mental Note's second half of a two-part episode on substance use disorder with Leah Young.

Leah Young: 
Hi, everybody. I'm Leah Young, and I am the Clinical Manager for the Substance-Related and Addictive Disorders at ERC and Pathlight.

Ellie Pike: 
If you missed out on our last episode, you can easily find it in your podcast feed or by clicking the link in this episode's show notes. You don't necessarily need to listen to part one to understand part two. However, you may want to pull it up if you're trying to figure out whether or not you have a substance use issue. Today, on the other hand, is all about what to do once you realize you have a problem with substances or addictive behaviors. This episode answers the question, "How do I make an effective change?" We'll discuss topics like different strategies for ending destructive behaviors, how to develop boundaries to enable healthier behaviors, and easy ways to measure the success of your approach. You are listening to Mental Note Podcast. I'm Ellie Pike.

Today, we are going to pick up where we left off last time, which was really talking about sober curiosity. What if I think I have a problem more? I want to explore this. Maybe I want to change my behaviors to be a little bit more moderate or try a harm reduction approach and then really gather some data and try to figure out from there is this working for me or do I need to explore abstinence. Before we really dive in, I'm wondering if you can even define some of those terms for us, so the key terms being moderation, harm reduction, and abstinence.

Leah Young: 
I think about moderation. That's kind of vague, which might be the reason that you're asking, because what does that mean? Moderation, I don't think that there's a prescription... I'm using air quotes everybody. There's a prescription for it saying, "Well, it's this many drinks per day, per week, per whatever." Certainly, within reason, we can outline that based on how we know the liver operates if I'm talking about alcohol, for example. We're talking about spending, is that going to depend on somebody's wealth? Is it solely about how much money I spend or is it about other aspects of my spending that causes distress? It gets tricky, so I think my answer for moderation is it's probably going to depend on the person within reason. There are certain things that certainly... We know there's some good research that came out of 2022 in terms of daily drinking.

When we get to three, four, more drinks per day, it does start to decrease gray and white matter in the brain, and so really understanding, certainly, there are going to be some benchmarks or guidelines, but unless we're crossing those, I'm not as concerned about them. Moderation could mean reducing how much I'm using when I use, reducing how frequently I use when I use or engage. I'm saying use and I also mean engagement and behaviors, and it might also refer to circumstances under which I will allow myself to use or engage in the behaviors. I have some people who when they use a loan, there is no off switch, but when they use and they're with their friends, they absolutely can control it just fine. I've had some people say, "Well, what I need to do is I need to stop using alone. I need to get it out of the house so it's just not even an option, and I will only use when I'm with my friends," and then they put some parameters around that use.

We'll talk about this quick activity, I think, that could be helpful for folks in a little bit, Ellie. This is part of that. It is determining is that working for me or not? We need to implement the plan and then see how it goes and what are my indicators telling me that that works? Harm reduction, it might be swapping out one substance or behavior for another if one feels like the lesser of two evils. I don't like to put substances and behaviors on a hierarchy, acting like one is better to use than another, because if it's causing a problem, it's a problem. It doesn't matter to me if it's something someone considers a harder drug or a "worse behavior".

In any case, that harm reduction piece, there's also some validity to it, because would I rather somebody use a substance that's less problematic for them, maybe puts less pressure on their organs or doesn't impact the organs that are maybe there's biological issue? If I have a heart disease runs in my family, maybe I swap out from one substance to another because this one is less... It gets tricky. Harm reduction is tricky, because there's this fine line, I think, between the truth of this is better for me than that was, and for lack of a better term, excuse making. I think we have to be really careful with that. It's something, if we're going to engage in harm reduction, we have to continually revisit it and say, "Is this working for me or have I just kind of shifted one problem for another?" In some cases, it does work really well for folks. In others, it doesn't.

Ellie Pike: 
Well, and the other piece of harm reduction that comes to mind is that it really also depends on what someone's definition of harm is, if it's a social harm, a biological, physical harm, an impact on mental health. There's so many types of harm, so when we talk harm reduction, it also, to me, seems like it could feel like whack-a-mole a little bit. You whack one down, something else is going to pop up, so it becomes really hard just to think of it as going from a 10 to an eight is better than a 10 because it's so complex.

Leah Young: 
I want to acknowledge that harm reduction has saved people's lives. I'm not bashing it by any means. It actually took me a while to recognize and understand that. I think something you said before about how it doesn't... Moderation and abstinence for example, they don't need to be fighting each other, and neither does harm reduction or whatever you want to call it. That, again, it's figuring out what's best for that person, and sometimes we have to do things. The harm reduction is almost like a baby step kind of thing for a lot of folks. As long as we're moving in the direction where we're making some changes and we're reducing some of our risk, let's go with that. Hopefully, that helps.

Ellie Pike: 
Yes. How do you define abstinence?

Leah Young: 
I mean, I think that that's a very personal thing. I know of people who call themselves sober and they don't use any substances, and it's because they stopped using all of the other substances but they still use cannabis. You're going to have someone else look at that and say, "That's not sobriety," and it isn't. If we're going to be rigorous about the definition of sobriety or abstinence, it's I'm not using. I'm not using mood-altering substances or I'm not engaging in these behaviors that are potentially problematic for me. However, I also don't want to take away the pride someone might feel for having stopped using other substances or behaviors that were really problematic for them in the future, even if there's been a swap or even if we're using something else in the meantime. Ultimately, if I'm working with them, would I want to move them away from all of that? Yes. There's still something to be said for the effort that they've put in thus far, and I don't ever want to discount that.

I'm not here to fight anybody on their version of sobriety. It's what is personal to you. I respect everybody who walks in the room. I have some people who come in and they say, "I'm so-and-so and I'm an alcoholic," and I have other people who don't like that term. Whatever works for you is all that matters to me, and I don't impose my own beliefs on any one person that I'm working with. If some of you are sitting there, listening, being like, "Leah, you're giving this answer, and this answer, and this answer," it's because I feel like we know the dialectic. We talk about this a lot at ERC, and Pathlight, and then, of course, at other facilities too, and within other modalities, but it's many things. Even though they might feel opposing can be true at the same time, and so as long as somebody is moving towards change, that's all I care about.

Ellie Pike: 
With that said, if someone's trying to approach their next step, if something's been a problem, maybe it's engaging in a behavior or using a substance, and they're like, "Okay, I'm ready for this next step and I'm trying to discern do I go this harm reduction route, go for more of a moderation approach, or should I just quit this behavior or substance all in all?" is there any kind of formula or guidance that you can provide us along the way?

Leah Young: 
The activities that I bring into group and into sessions, none of them are rocket science. They're all very straightforward and oftentimes somewhat methodical, because again, I'm a big fan of data collection. What does the information you have at hand tell you about what your needs are right now? That requires somebody being willing to be honest about how certain things are impacting them, which can be really uncomfortable. But what I do, and this is not mine, obviously, this is something that people probably just do in general in their regular lives, but this is also something that I just apply here and a lot of folks do, essentially, what I have folks do is I have them start four steps for me. I start by having folks get very detailed and explicit about, let's say they want to be able to moderate, what they like their use to look like.

They might say, "I only want to drink Friday or Saturday nights, so one night a week, only on the weekend. I won't drink during the day and I won't drink during the weekdays. I'm going to cap myself at one drink per hour but no more than three drinks over the night," whatever. We've got a quantity and we've got a frequency. I have folks take a look at their intentions. I actually had one patient in particular who intention was one of the most important pieces for her, because if she was in a negative head space, if you will, if she went out with her friends, all bets were off. If she was in a good mood, she could stick to her plan. She would make plans with her friends and get to Friday, for example, have a really tough day emotionally and whatever, and say, "I knew I said I was going to go out and drink with my girlfriends tonight but I can't, because I know where this will lead for me tonight."

Other weeks, she's doing great. It would be a fun social thing for her and she wouldn't overuse, so intention can be a really helpful aspect to take a look at. For some people, it might be about defining specifically time of day or timeframes that we are allowing ourselves to use or engage in. It might also be who we're with. It might be method of use, just getting really specific and detailed with what this needs to look like. The second question that we would ask ourselves is basically the flip side of that coin, and what we already answered is going to inform this second question. What are the things that tell me that I'm not abiding by my plan? These are our red flags and our yellow flags. Our red flags would be bottom line, if I do this, this tells me this is a no-go.

The example of somebody who, "When I drink alone or when I smoke weed alone, I have no off switch. When I'm with my friends, I'm able to be social. I keep it within these certain parameters and nothing bad happens. I don't feel bad about it and it's all acceptable. I'm not feeling sick, whatever." I actually had two separate patients over time have tried this where they, one, "I can't have it in my house, because if it's in my house, I'm going to use it." I had another one who was not willing to get rid of her substances at her house because she said, "Well, what if friends come over? I want to be able to offer them something." The one who had the substances still in her home, she found that, after a couple of weeks, she started to give herself permission to have a glass of wine here or there.

She was like, "Well, I think I just learned that I can't keep it in my house," so she got rid of it out of her house. She didn't choose to stop drinking, she just knew she needed to get out of her house. From there, she actually ended up being successful. My other patient who wasn't keeping it in her home found herself starting to purchase some on the way home from work. But the good news about not keeping it in the home is it did require her prefrontal cortex to kick in and say, "Really? Are you really going to do this? You're really going to stop at the store on the way home and buy some and then take it home with you and sneak it in? Oh, is that really what you're going to do?" It turned out that sometimes the answer was yes. She said, "Well, it looks like I simply can't drink," and she made a decision to stop.

Now, there are a million other responses that we could have to these scenarios, but this is an example. Again, it might be about my red flags, my yellow flags, might be quantity. It might be my intention. I'm noticing that I'm using to numb or to cope. This is not a thing I wanted to do. That might be a yellow flag for someone. Yellow flags just tell us to pump the brakes. Do I need to make a slight adjustment? Red flags are like, if I do this, I'm in trouble. We answer these two questions. The third question is, and I think this is the part that a lot of people leave out, what will my plan be if I start ticking off my red or my yellow flags? When you write out your plan for what I might do to address should I tick off any of my red or yellow flags, throw everything at the wall, write everything down, even the things you think you wouldn't do.

"Check myself into inpatient rehab," write it down anyway. Because in those moments when we're distressed, when we're being faced with the possibility that I might not be able to moderate the way I'd like to, our brain's not going to go to the rehab thing. Writing it down as a reminder of, "Ah, that is an option," can be really helpful. The fourth thing that we do is we get an accountability buddy, somebody we can share this with. I recommend it be a therapist, or someone that we are not related to, or friends with, or in a relationship with. It doesn't mean we can't share with those people, but making them be the person who holds us accountable, sometimes we have to do.

But if it can be avoided, I think that's important because then it can create a hierarchy or a policing thing that can create resentment on both ends. Also, sometimes people who mean well and want to help end up policing us in a way where if we try to change the plan, they go into panic mode and then we can't adjust it according to our needs because they think we're really just trying to get away. It can just get very sloppy, so I think it can be really helpful to make sure that we have an outpatient therapist or someone, a doc that we share it with, and then they can check in with us about it. Now, we can share this plan, let's say, with our partner and say, "Hey, this is a thing that I'm working on with my therapist. I'm not expecting you to police me, but this is what this is going to look like."

It's not about being secretive, it's about choosing who my accountability is going to be. That's it. Those are the four steps. I have had so many people who've wanted to moderate leave treatment in a panic because they're like, "But what if I can't, what do I do? How am I going to know?" When they do this activity, they feel more confident in their ability to be able to be honest with themselves. They feel like, "Well, I have an idea of what this should look like for me." I think it's important also to share with the accountability because they can say, "Are you sure that this shouldn't be a red flag?" They can help us to fine-tune it, so that can be something that's really helpful. Like I said, it's very concrete. I'm a big fan of the concrete stuff.

We can also apply that activity to sobriety. It doesn't just have to be for moderation. It can be what does my sobriety need to look like? I need to go to this many meetings a week. I'm going to get a sponsor. I'm going to engage in fellowship or service worker. I'm using a lot of 12-step language, but whatever, meetings you're going to. It might be about checking in with someone. It might be about medication compliance. It might be about providing drug screens for someone for accountability, whatever that might be. We can do the same thing. What are the red flags? Let's say I'm supposed to be going to three meetings a week and I've only been going to one, that might be a red flag for me. I got rid of my last sponsor and I still haven't gotten one yet, that might be a red or a yellow flag for me. We can apply this to sobriety as well, and I think that that can be really helpful to help us stay on track with an intention.

Ellie Pike: 
I appreciate how you brought in concrete steps. For me, as you were talking, I was taking notes. I was like, "I've never seen this before. I'm going to take notes and try to follow along as if I'm listening to this episode." What I heard was create this plan, what is my intention, and then define for me, "Okay, what are my red flags? I'm really falling off my own plan here," or yellow flags like, "Oh, maybe I should pay more attention," and then the last piece being really what do I do if I notice I'm falling off of my plan and my own bandwagon I created for myself? What's my plan B? Having this accountability buddy, or I love how you say... How do you say it? [inaudible 00:17:38] buddy.

Leah Young: 
Accountability buddy. You should try to spell it.

Ellie Pike: 
It's really fun to try to say. I'm not going to practice right now, everyone would be laughing at me. I love how you make it so concrete for something that can be so nuanced and so complicated. It's not a one size fits all solution for anyone. It's really up to everyone to decipher for themselves, "This is my starting point." When we were talking in our last episode, we talked about mental health issues can drive someone to use behaviors or use substances. Once again, those behaviors or use can impact our mental health. If we were to take away the behaviors, to me, I'm like, "Oh, okay," that could also let out a dam. All of a sudden, these feelings come flooding or memories come flooding, and we have to know how to cope. To me, whether we're exploring harm reduction, moderation, or abstinence, that's the more important piece, is how do we also replace it with something that's actually helpful for our survival?

Leah Young: 
Immediately, I was thinking about my patients who come to residential treatment. Now they don't have access to not only what we would call their maladaptive coping skills, which might be drinking, using, engaging in behaviors in a way that's addictive or problematic, but they're also taken away from some of their adaptive ways of coping, which might be being able to go step outside on their balcony and grab a breath of fresh air when they're feeling overwhelmed, or having their pet snuggle with them, or their favorite blanket to curl up on the couch in, or just being able to pick up the phone and call a good friend who makes them laugh. We can't do that in the middle of the day in residential treatment because you don't just have access to the phone any old time. The coping skills, I think when we're put in a position like that or we choose to stop using, or engaging, or even reduce our use, you're right, a lot of this stuff that we've been suppressing comes. It doesn't go away.

I think a lot of people hope that if I had some experience when I was 12 and I experienced grief around it, I start drinking and using, and we hope that if we stop drinking and using at 40, it's just gone. It's resolved itself. Literally, it's like, "Hey, remember me? I am still here." It's not that friendly. It can all come back, and then in some cases, it's compounded. A lot can happen when we stop or reduce use or engagement. Absolutely, it's imperative that we start to build some of those coping skills, and this is where a lot of people struggle initially when making some of these changes. Because we might be stopping the engagement or the use, but we haven't yet built up the coping skills. We're in this no man's land of feeling all the things and being super aware of all the things and not having a way to manage it.

One of the trickiest parts of coping skills is that they're not intended to make us feel better. I think that this is where folks get... They struggle, because they're just like, "Well, I'm using all my coping skills and I don't feel better." I have to remind them, "What you're looking for is the same feeling you got from the substance or the behavior. You are not going to get that in a million years. Nothing will do for you what a substance or an addictive behavior does for you, nothing. Not all the coping skills piled on top of each other in the world will do for us what a substance or behavior will initially." Initially, when we're learning our coping skills, they're really just intended to allow us to sit with the discomfort that's coming up and not have our head explode.

Many of us are so used to the moment we feel that discomfort, we use something or we engage in some way that alleviates it, so now I'm being forced to sit with it. Coping skills don't make us feel better. I've had so many patients you could practically see the actual light bulb above their head when that happened. They're like, "Well, I'm using them thinking I'm supposed to feel better." I'm like, "Nope. You're just supposed to be able to sit with feeling worse essentially." It's not me trying to deflate them, it's me trying to help them manage their expectations. Because if I feel like coping skills aren't working for me because I'm not feeling better, I'm going to throw them out and I'm not going to bother with them.

But if I recognize that I have to keep working at this coping skill in order for it to actually start to make a difference in my mood, in my ability to remain present, then we can come at it from a place of, "Well, I need to practice this much like I would have to practice playing Rachmaninoff on the piano if I want to be able to play Rachmaninoff." I imagine there are some people who can do that, but I can't just sit down and do it. I have to practice. I talk about building coping skills as this... It's a little bit like drudgery at first. You practice them all the time, even maybe especially when you're not distressed, so that it starts to become... It moves from being a conscious process that I have to think about to being an automatic process that I could do it in my sleep. What I've found a lot of people recognize over time is that, initially, coping skills allow them to continue to feel bad without their head exploding. Over time, coping skills start to make them feel better.

Ellie Pike: 
As you're talking, I'm thinking about a practical example. Let's say I am feeling so anxious, it makes me want to jump out of my skin, my chest feels really tight. I'm like, "You know what? I just need a drink before I go into the social situation," but that doesn't align with my plan I made for myself. I'm really trying not to drink. Instead, let me try this coping mechanism. I'm going to take deep breaths. I'm going to breathe in for four counts, pause, breathe out for four counts. Instead of actually feeling totally better, I'm like, "No, my anxiety is still here and I'm actually feeling my anxiety now," and that doesn't feel good to me. The way that you explained coping mechanisms, in the short term, it doesn't maybe necessarily fix the problem. If anything, I might feel more discomfort because I'm actually allowing myself to feel the anxiety versus drinking and numbing it pretty quickly. What could that potentially turn into? If I were to keep practicing this coping skill or another one, what is the long-term vision?

Leah Young: 
The long-term vision, a lot of times, our brain does a lot of pairing. If I'm used to having a drink when I go into a social situation and I decide to stop doing that, my brain is going to be like, "Where's the thing that's supposed to go with these? Two things go together like peanut butter and jelly." If I'm no longer using the substance, let's say I take those deep breaths, first of all, that can be really helpful. Even though I know it can be hard, it can be helpful in calming us a bit, but we're still aware of that anxiety. If I go in and do the social situation even though I'm feeling anxious, every time I do that, I've just taught my brain. You've just created a new neural pathway and I've taught my brain, "Okay. I can go in a social situation and not drink?"

At first, the brain doesn't quite get it. The more you do it, eventually, the brain will start to pair not drinking with social situations. Honestly, the more we experience being in social situations without alcohol, the less anxious we will become over time, because I've done this before. "I remember I did this just a week ago." It becomes, again, this kind of automatic process where now these two new things are paired together, but we're having to hack our way through. It's almost like I think of neural pathways that we create a path through the woods. It's very, very beaten path and everybody takes that path. It's clear and you don't have to worry about any branches, but occasionally, there's a little off the beaten path, one that someone's taken. You can see a few broken branches, maybe a couple footsteps, but it's not beaten down yet.

Well, if I start taking that one over time, the old one grows over. This doesn't ever totally go away. We might still think before we go into social situation, "Wow, remember when I used to drink before this?" But eventually, that new neural pathway gets created and we've now paired a new experience. We have to develop mastery, and this is essentially what that is. Every time I do the thing without throwing in my old maladaptive coping, I'm retraining my brain and I'm developing mastery over this new way of doing this, but it takes time and it can be extraordinarily uncomfortable. Sometimes people need to do it in slightly different ways. Some people may be able to just pair a bunch of social situations without alcohol, other people might need to take it in what I would say brave baby steps, where it's not like you go to the work party where 50 people are there for your first time not drinking.

That might be way overwhelming for someone, and what's going to happen is we are going to inadvertently potentially prove ourselves right. "You see, I did need alcohol for this because this was unbearable. I couldn't even make it through without having a panic attack." I might have to build and start small. Hanging out with a friend one-on-one without drinking, and then maybe I hang out with a couple of friends without drinking. Eventually, I can work my way up to the bigger situation. We can choose to be brave, but we can't guarantee safety because there are so many things out of our control when it comes to safety, but I can choose to be brave in any instance, in any circumstances. Sometimes bravery means recognizing what is safe for me to do or not, and so I like the idea of something smaller. That sets me up for the potential for greater feelings of victory, and then we can continue to pair those things and move forward.

Ellie Pike: 
I can liken it in a different way. If anyone is familiar with exposure therapy for someone who has a phobia, everyone talks about, "Oh, if you have a phobia of spiders..." You have to warm yourself up to what does that hierarchy look like. You're not going to just jump into a tank full of spiders, the same way that you're not going to drop substances and jump into that giant crowd of people that make you really anxious. You're going to do one step at a time. Despite how "small" it might be, you still have to be really brave to take that step and to also teach your brain to be rewired and to create a new pathway. To me, there's just so much optimism in knowing that our brain can rewire itself. Whether that's the fear of the spider or learning a new social situation without using a substance, that, to me, is where I think our brains are amazing.

We call them neuroplastic because they can move, and they can grow, and they can shift, so the way you explained it to me, I think, makes a lot of sense. I know that, for a lot of our listeners, they might be like, "Okay. Yes, I am curious," or, "Yes, I'm going to find that accountability buddy, and I'm going to tap into some of these resources or maybe Google sober curiosity," so would you add any practical steps to that where there's a plethora of resources and everyone can tap into the ones that they need? We'll be happy to add them to our show notes as well, the wide range of resources people can tap into, but would you want to add anything to that for our listeners who are just curious on next steps?

Leah Young: 
I would also say coping skills are lovely and they're very, very helpful. I know you asked a question about is there research behind it, but actual things we can do in situations to help us feel a little bit more comfortable when we're using less or we're not using it all, we could do a whole episode on that, but creating a plan can be really helpful for how am I going to enter a situation without using, whatever that means. How am I going to address my sleep issues without substance? How am I going to spend time with my sisters now that I realize I can no longer go shopping with them every time we see each other because I have a spending compulsion? I think that having an actual... Planning it ahead, planning ahead for how we're going to decline or say no, or how are we going to manage some of those conversations, some of those events, there's so many actual things we can do to keep ourselves in line with our plan.

I'm a huge fan of that as well. I actually did something, I think was Shannon Copp several years ago, that you can find somewhere on ERC or Pathlight's web pages, or YouTube pages, or something in terms of actual things. I think it had to do with surviving the holidays, the holidays being the winter holidays where a lot of people are celebrating a lot of different actual religious holidays, et cetera, but you can apply them at any time. It doesn't just have to be for somebody who celebrates Christmas or doesn't celebrate Christmas and hates it. There can be work functions and that kind of thing, and so there's a lot of really good concrete tips out there that I think is a really good resource for folks to explore and look for.

Ellie Pike: 
Just for clarity for our listeners, I know that you worked in primary substance use and I'll have you define what that is. At Eating Recovery Center and Pathlight, you do treat substance-related disorders along with eating disorders and mental health issues like anxiety, depression, mood anxiety disorders. Would you just briefly explain the role of what primary substance use is versus secondary and why that might be important?

Leah Young: 
What I find is a lot of patients, actually, the primacy of their substance use versus their eating disorder or their mood and anxiety disorder, they kind of vie. I should say they vie for primacy, these two things, and so sometimes it's really hard to say that a person is definitively primary this diagnosis versus that. We see a little bit of it could be either. I think what we take a look at is what is the most pressing to address in treatment first, and part of what we do here at ERC and Pathlight is we can support that. We can support people who are choosing to be sober, who are choosing to explore their use versus... I might have someone come in where their use isn't... It definitely isn't primary and it's creating some problems. Maybe it's interfering with their medication, compliance or efficacy, so wanting to get them some education and thinking about whether or not continuing to use is helpful for their mental health is very different from primary substance use where the substance is identified or the behavior as the problem.

Yes, there are co-occurring things happening. I rarely see anything that doesn't co-occur. We see that, for sure, with substance use, but I think really understanding that we're there to help people not use and start to create that support system. That's period. That's the primary what we're looking at in terms of primary substance use. We have just a wider range of, I think, intention at ERC and Pathlight, whereas it's a bit more laser-focused at primary substance use.

Ellie Pike: 
Thank you so much, Leah. You really brought so much insight, so much knowledge to the table, and really some amazing self-exploratory questions that we can all ask ourselves and each other. Especially the word accountability buddy, I'm going to take that one with me.

Leah Young: 
Please do.

Ellie Pike: 
Thank you so much for your time. We will certainly link to so many of these resources in our show notes. Once again, if anyone's finishing this episode and is like, "I need more," don't forget, there was a first episode to this, so go back to the last episode as well. Thank you so much and we'll talk to you soon.

Leah Young: 
Thank you.

Ellie Pike: 
Like Leah said, creating new neural pathways can be difficult and will take time, but that doesn't require you to suffer right now. I loved her practical advice of creating a path by asking yourself, "How will I enter a situation without using?" Make it as specific to your situation as you can like, "How will I go to sleep without using? How will I spend time with my friends without shopping? Or how will I decline a drink if I'm trying to stay sober?" You can do so much right now to plan ahead and feel successful when faced with a challenging situation to use a behavior or a substance. As always, we have links to lots of resources in today's show notes, so don't forget to check those out. Thank you so much for listening to Mental Note Podcast. Our show is brought to you by Eating Recovery Center and Pathlight Mood and Anxiety Center.

If you'd like to talk to a trained therapist about the Substance-Related Addictive Disorders Program, please call them at (877) 850-7199. If you need a free support group, check out eatingrecovery.com/support-groups and pathlightbh.com/support-groups. If you like our show, sign up for our e-newsletter and learn more about the people we interview at mentalnotepodcast.com. We'd also love it if you left us a review on iTunes. It helps others find our podcast. Mental Note is produced and hosted by me, Ellie Pike, edited by Carrie Daniels, and directed by Sam Pike. Till next time.

Presented by

Ellie Pike, MA, LPC

Ellie Pike is the director of alumni, family and community outreach at ERC & Pathlight Behavioral Health Centers. Over the years, she creatively combined her passions for clinical work with…

Presented by

Leah Young, LCPC

LEAH YOUNG, LCPC is a Clinical Manager at Eating Recovery Center and Pathlight Mood and Anxiety Centers. Leah has been with ERC Pathlight since 2016. Leah earned her Master’s from The Chicago School…