One aspect of addiction treatment that is sometimes misunderstood by family members, patients and the general public is the relationship between substance abuse disorder and mental illness and the importance of co-occurring disorder treatment. In this episode, we’ll explore the different opinions that the general public has about the relationship between mental illness and substance abuse disorder, as well as the role that co-occurring disorder treatment plays in the addiction treatment industry.

Transcript

Richie Hession:

Hello, and welcome to The Other Side. I always felt it was a little bit corny in the opening, but I just do what I do. It’s the official podcast of BlueCrest Recovery Center. I’m Richie Hession, I’m the CEO here at BlueCrest. Actually, we’re not here at BlueCrest, we’re remote. And I might as well say that right now in the opening. The reason we’re remote is that we wanted to be able to do it outside, because having a podcast with masks on would make it very difficult, if not impossible. And so, for my guests and for myself, and for everyone’s safety, we decided the best thing would be to have it outside. So, here we are doing a nice outdoor podcast. That’s why we don’t have masks on. We’re maintaining a distance. We used tape measures before we started to make sure we’re all perfectly distanced from one another. And here we go.

So, anybody who is watching, thank you for joining us today as we discuss, definitely I think we’d all agree, one of the more misunderstood aspects of addiction treatment, which is the relationship between substance abuse disorder and mental illness. The role that co-occurring disorder treatment plays in the addiction treatment industry.

I’m joined today by my guests, my own clinical director at BlueCrest Recovery Center, James Chitty. And we’re also joined by one of our good friends from Pennsylvania from Brookdale Recovery Center. We’ve got Joe Mattioli. He’s the COO and executive director of Brookdale. Welcome to you both.

Joe Mattiolli:

Thanks for this.

James Chitty:

Thanks for having us, Richie, it’s good to be here.

Richie Hession:

Of course. Jim, thank you for coming. Jim is moving this week, and so he’s on vacation. And he actually left his house. And I know that must’ve been very hard.

James Chitty:

It’s great to be here, Richie.

Richie Hession:

Very hard to leave your house with all the insanity and packing, “Oh honey, I got to go to work. What could I do?”

James Chitty:

I’ll be home soon.

Richie Hession:

So, all right. Remember, to anybody that you can listen to this podcast on our website at bluecrestrc.com, www.bluecrestrc.com or subscribe in the major streaming platforms, iTunes, Spotify, SoundCloud and YouTube. We add a YouTube, that’s right. Anybody live on YouTube, please sign into your YouTube accounts to leave us a comment or a question. And then, we take listener questions throughout the show. Nick, is going to scream out to us for anybody who does have questions. For all the rest of the platforms, those questions can just, they can type them in, in normal fashion. Only YouTube, you have to actually be signed in.

Nick:
Just the Instagram. Yeah.

Richie Hession:

Instagram, you have to be signed in as well. So, anybody who happens to be on Instagram, sign into your Instagram, if you want to ask a question.

Nick:
I think YouTube, you have to sign through a Gmail account.

Richie Hession:

Yeah. Gmail account with YouTube. So, okay. And here we go. So, the first topic, we have it broken down. So, it’s called the show sheet. We break it down into topics, but the reality is we discussed this just for the 10 minutes we were chatting before we went on, is that we’re going to discuss everything. And it’s going to be very hodgepodge stream of consciousness. Although they made me promise to try and keep it to a little more structured things. So, I’m going to give it a shot, do the best I can with it.

So, the first topic to discuss is misunderstanding of substance abuse disorder and mental illness. So, I’m going to actually start it by reading the first intro that we had set up for it. And then we’ll go and I’ll start asking these characters a bunch of different questions. And we’ll talk. I’m going to read what it says, and then I’m just going to throw out my own thing before we dive in.

But so it’s the number of cases with patients that have mental illness and substance abuse disorder have become more and more frequent in addiction treatment. There is a lot of misunderstanding that occurs between the patient, loved ones, family, and even sometimes the medical community when it comes to these specific cases. But why is there misunderstanding? We’re joined today, as I told you already who it is, to learn more about substance abuse disorder and mental illness in the addiction treatment industry.

So, there’s 80 ways we can address this topic with you guys. Because when people come into our care, and we have different levels of care, let’s frame out the conversation to everybody who’s listening, right? Joe comes from a detox residential facility. That’s the first place you go. Mom, dad, addict looking for help and recovery, the very first stop you’re going to make is detox. It’s a medical procedure. You’ve got to get the poison taken out of your system. Afterwards, some people go from detox straight to a much lower level of care to PHP. Oftentimes they find they can benefit from that next notch down, which is the residential care. And so, Brookdale does both. Both of them have much more of a medical component to it. It all takes place in one building, one setting, 24/7 nursing care, right? You have 24/7 medical care for everybody who’s there?

Joe Mattiolli:

Round the clock, two full time physicians there.

Richie Hession:

There it is.

Joe Mattiolli:

Absolutely.

Richie Hession:

And it’s important. And so, that part can be rough and to get it all removed. And a lot of people have other medical conditions, not just their addiction and some potential co-occurring disorder, some mental illness, but a lot of people also have other physical problems, right? That come out of the use and abuse, whether it be liver problems or… That’s not the nature of this podcast today, but it’s a lot for you guys to manage right at your level of care when people first come in.

Joe Mattiolli:

No, absolutely. When they first come in, I mean, in addition to both substance abuse disorder and mental health, which we’re going to talk a little bit about, it’s great to make sure that that is your first stop. Because you may have other biomedical complications going on by virtue of how much you’ve been using and of which substance, whether it’s liver stuff or other internal issues, by virtue of coming into a fully medically managed level of care, we have the ability to assess, make sure none of that’s going to be problematic and complicate your ability to continue on your recovery journey, be it with us or stepping down to the next level of care and transitioning into a life of recovery.

Richie Hession:

Okay, so now, if we’re going to focus in on people who come into our care, and this is, it’s an age-old conversation, actually with us right in the treatment field. And we’ve seen much of this. And there’s so many aspects of how this affects and who it affects and what we have to do to be sometimes creative. Sometimes there’s more art than science. Sometimes there’s more science than art. But we have to ascertain when people come into our care, what comes first? The chicken or the egg, right? I mean, is this mental illness that they’re using substance abuse and it feeds the mental illness or does the mental illness feed the substance abuse, right? Which is primary? That’s a big question for us. Is this a primary mental health case that happens to do a lot of drugs as a result of their mental health issues? Or is this a primary substance abuse where they also have co-occurring disorder, but really their primary is the drug abuse or alcoholism? And that’s a big question for us to find the answer for, because that’s our main goal, right? That first differential diagnosis, right?

Jim, when they first come in, they see it first, when they go to detox and res first. We don’t take a lot of people into our place that don’t do detox first at the very least. But you do have cases sometimes that do qualify to come into our level of care when they’ve home detoxed, which we don’t recommend. But sometimes people call us after that’s already been accomplished. But anyway, we won’t get into those because those are outside cases. But typically speaking, they’re going to go to these guys first.

Now, that’s something that we’ve talked about. And I’ll put it over to you first, Joe. Do you guys find it difficult when you come? And if you could speak a little bit to the fact that when clients come into your care and they’re going through detox and you may only have them from anywhere from seven to 30 days, right? Depending, right? I mean, it could be depending on insurance companies, what they allow for, for residential stay before they’re being told they have to go to a lower level of care, right? It could be anywhere within that range of time. What’s an average, do you think for you guys?

Joe Mattiolli:

Our average length of stay with folks that are joining us for detox and res, that’s usually about 23, 24 days, because of a lot of these complicated issues. We fight and push very hard to make sure we have enough time to do as much as we can. And so, that we’ve got the best, I guess you can say blueprint of where a person’s at, what do they need and how do we best make sure when they get to you guys, you guys are armed with the facts to continue that care.

Richie Hession:

Right.

Joe Mattiolli:

And sometimes yet insurance companies push back on us and try to reduce some of those length of stays. But we’re always very committed to making sure everybody gets what they need in spite of that.

Richie Hession:

Now, for the families, this is where the first medicine, it’s not a problem. It’s just a challenge, right? Because we deal with this all the time. But let’s talk to the mom and the dad, or even the addict that sometimes can be confused about the chicken and the egg part of this conversation. But so they come into your care and Jim says this all the time, sometimes we’ll get people that get referred to us from a detox res. They’ve already been separated from alcohol or drugs or whatever their drug of choice is for X amount of 21 days or whatever the timeframe is. That’s right around the time where Jim says, right, Jim? Where you can probably start to see the real what’s actually going on emerge after that’s cleared. They’ve cleared up a little bit from the detox portion of it.

James Chitty:

I think one of the big misconceptions is people think like, “Okay, recovery is going to begin, his or her anxiety and depression will get better in a linear way.” So, there’s this expectation, and it’s a reasonable expectation, but really what you’re looking at, a lot of people will begin their recoveries, and sometimes that depression and anxiety or any other mental illness can start to take off with recovery proceeding forward. It’s not necessarily always going to get better in that sense. The recovery from substances will. That you can consolidate. But the actual mood stuff, that doesn’t necessarily get better. Sometimes it does. Sometimes it doesn’t. I think having an open mind with that knowledge is really important. No matter what the level of care is, you just have to have that open mind.

Richie Hession:

And I think Jim is being polite when he says sometimes it does, sometimes it doesn’t, because it’s the nature of him to play both sides and to be… But for me, I’ll just tell you, you took my alcohol and drugs from personal experience and the chatter of a thousand monkey started in my head, right? The committee in the head. They call it in the recovery community, they call it a lot of things. I always loved chatter of a thousand monkeys.

Now, imagine if you have mental illness, imagine if you have a co-occurring disorder. What is a co-occurring disorder, right? There’s all sorts of, we can name a bunch of different… Matter of fact, I’ll just pass that one over to you, Jim. Give everybody what’s we were bandying about terms here, right? We’re having an entire podcast about co-occurring disorders. Let’s name it. It’s funny, even this show sheet that we created, second topic questions, what exactly is a co-occurring disorder? You think that that’s a second topic question. Let’s talk about what it is first, and then go into the conversation, instead of having a conversation about it and then naming its definition. So, what’s a co-occurring disorder?

James Chitty:

If you want to keep it simple-

Richie Hession:

As simple as you can, please, for the laymen like me.

James Chitty:

I’ll try to keep it simple, which he knows I can go on-

Richie Hession:

He can go on.

James Chitty:

…. with the technical jargon.

Richie Hession:

He’s very, very smart.

James Chitty:

So they say. When the symptomology of addiction and mental illness competes, when you see one side is equally as loud as the other side, then you have a co-occurring. When your anxiety and depression isn’t, so to speak, so loud, then you just have a substance abuse disorder. You have other things that can go on, positive psychiatric symptoms, schizophrenia, that type of thing, that becomes very prominent. And it’s easy to see that starts to supersede addiction itself. It’s observable. It’s prominent in the patient. Suicidality, you’ll see. Homicidality, that people really struggle with some of these symptoms.

Joe Mattiolli:

And other times when you talk about that, it also brings us to that the chicken and the egg statement that Richie made earlier, which is the stuff we all battle with, where you’ll see when it’s less present that substance abuse disorder really being the true presentation of it. But oftentimes, the withdrawal symptoms and coming off of alcohol and other drugs create symptoms in that window of time during detox and early residential treatment, where it’s going to look like some mental health symptomology. And so, somebody might think, “Oh my God, I’ve got this, I’ve got this, I’ve got this. And I’ve got this.” When in fact, in some cases like you were talking about there in parallel and an equal noise level, so to speak.

And then in other cases, we have to wean that through and say, “Hey, look, before we start treating things, should we see if it’s actually present?” Because I’ll tell you what, a guy in long-term recovery, much like Richard was just talking about, you took away my best friend. You took away my drugs and my alcohol. Yeah. I was anxious. And I was depressed. I had no idea how to cope with life without this stuff. Yet, that was my whole tool. That was my solution and everything. And now it’s gone. So, of course we’ll have this wash of feelings come over me.

Richie Hession:

Problem number one, right? He named this problem number one. And a lot of times it starts before they come into his care or our care. A lot of times this happens before they even find themselves into a rehab, right? Because you have people who are using alcohol, using drugs, they try and stop or moderate on their own. They recognize it’s becoming problematic. If you’re younger, mom and dad are putting their foot down, and so maybe you do stop or moderate for a period of time and you get anxious. You get depressed, especially if you stop or moderate on your own. Maybe you’re a husband or a wife and you’re home, and your partner is telling you, “This is ridiculous. Enough is enough.” Whatever the case is, what happens when people typically come off of it is they get anxiety. They get depression. It makes perfect sense. And you should.

Now, and again, keep in mind everything that we put in here, everything is case by case. Let’s just put that out there.

Joe Mattiolli:

Right, 100%.

Richie Hession:

If anybody is listening to a podcast like this, we’re talking about generalities, specific generalities. It may or may not apply to your case. And so, if there’s any confusion around any of it, no matter what happened, you should always go see a medical professional, always go see a doctor, always seek the kind of help that you need to find out what your own answers from the medical community, right? In the psychiatric community. I’ll just put that out there right now. So, no one thinks like, “Oh, well, Richie said that I didn’t have…” But that’s the first question for us. That’s the first issue in problem. They come into our care. They go to your detox. How often do you have, and let’s talk about that for a second. And you can ask me.

Joe Mattiolli:

Absolutely.

Richie Hession:

And then when we get to our side, it’s a little bit, it’s the same issue that we deal with. Except it looks a little different when it gets downstream a little further or lower level of care than yours. But what happens when someone comes into your care and this guy that I’m talking about, the first time he had gone and dealt with this. Just we’re envisioning, right? Patient X, right? Citizen X, and this person tried to get sober. Or they tried to do whatever, they took away their alcohol and drugs. They got anxious and depressed, which happens. Right?

And we tell everybody in early recovery, in the 12-step fellowships, of course you’re anxious and depressed. We just took away your best friend, right? You just took the thing that every time you got excited, you used or you drank. Every time you were depressed, you used or you drank. Every time you were worried about something, you used, you drank. It’s a panacea. There’s a time when alcohol and drug works miracles, it works wonders in your life. People wouldn’t do it as hard and as much as they do, if it didn’t solve a problem for them.

The problem is eventually it stopped solving your problems and it becomes the problem. And then that fuel of insanity. And when you get into that addictive lifestyle and you lose power of choice, and you’ve crossed over into that murky dark land, then something has to be done about it, because you can’t get out of it yourself. And now it’s no longer a solution and it becomes that negative cycle. And so, now you’ve already tried to do that. And you went to a family doctor or you went and saw a psychiatrist and that person they’re going by self, for everything that we do, all decisions we make is based on self-reporting. You’re going to them, a lot of times, the doc, the psychiatrist, how often do people not bother to share the fact that they just stopped doing cocaine? Or they just stopped drinking a bottle of Jack Daniel’s a day.

They go and they just see the doctor and they say, “Yeah, I have anxiety and I’m depressed. And they ask them a few questions. They talk about their anxiety and their depression. And it seems reasonable to give them, oh, I don’t know, say a benzo, right? A benzodiazepine. Right? He did nothing, those little Xanax couldn’t help with.

Joe Mattiolli:

Funny history. Hey, you’re looking at a symptom, the guy’s presented with this. This is meant to help this.

Richie Hession:

And it can.

Joe Mattiolli:

And it does.

Richie Hession:

.25 for normal people that don’t abuse medications of a particular type of substance, actually not long-term. There’s better things to do that are long-term. Benzos are very long-term addictive. That’s something I’ll throw out there. And that’s true for everyone. Benzodiazepines, your Xanax, your Klonopin, your whatever, the other.

James Chitty:

Valium.

Richie Hession:

Valium. These are all long-term, very addictive, right? These are extremely addictive substances. I don’t care who you are. But I know people who’ve taken them on the appropriate dosage over longer periods of time. And they don’t seem to really struggle with it.

Joe Mattiolli:

They’re just not people like us.

Richie Hession:

They ain’t like me, that’s for sure. And they probably will never see the inside of my rehab. Right?

Joe Mattiolli:

Appropriate dosage is not a word I know about.

Richie Hession:

Exactly, what is appropriate dosage mean? Having said that, well, the guy we’re talking about is the guy who now, he’s on these medications, right? So, this guy who went and he saw this person, now they diagnose them with depression and anxiety. And they put them on this medication and this medication. Now, they go and the drug addiction gets worse. Their alcoholism gets worse. Over the years, those things get worse. Now, each time they try and stop it. Now, they’re starting to go to rehabs. They show up in a place like yours. They walk in, they have a history, right? Is not the first question you ask, “Well, have you ever been diagnosed?” Right? Is that?

Joe Mattiolli:

Absolutely.

Richie Hession:

So, talk about that. Now, they come into your care and this is what we have to deal with now. As a treatment facility, you’ve got to ask the questions of the client, “Do you have any history of mental illness? Do you have any diagnosis?” And then everything you do from that point forward is based on whatever diagnosis they’ve received in the past. And unfortunately, if they’ve received inappropriate or incorrect diagnosis, sometimes at inappropriate ages, right? How many times have you heard a kid that’s told you that was diagnosed with bipolar when he was 12, right?

James Chitty:

Yeah. It’s tough early on, but I tell you, it could be helpful early on when you can find out what the kid was about prior to using drugs and alcohol. So, if you really, what’s a big piece of information is, little Johnny or little Jane started at age 15. What were they like from age 12 to 15 or from age five to 15? You can find out a whole lot of mental health history by that period of time. And then once you add drugs and alcohol to it, then it becomes super convoluted.

Richie Hession:

But it’s convoluted anyway, because how do we find out that history, right? We don’t get to this, this isn’t some futuristic where you can get to go to a computer and watch their life in fast forward. It’s all by self-reporting. So, you’re asking them questions and they’re giving you self-reporting. And so, this is the imperfect system in which we have to operate.

And so, here they are. This guy comes, let’s say, first detox stay, right? I’m hopefully, God willing the last prayer we always say, but a lot of times, typical for us, it’s multiple treatment episodes. Usually people need three. I don’t know why. But if they survive at all to make the second and third. But they come into your care. Now, what do you guys have to deal with? You’re the first differential diagnosis. Is it real? Is it not? How do you manage it?

Joe Mattiolli:

Well, the first thing I want anybody to know coming in, right? This guy we’re talking about, that comes in, the very first thing we want to do is get you comfortable. Get your triage. Get you stabilized. And that first time you come in the door, you got to feel cared about before you’re going to open up, especially with a self report. How comfortable am I going to be to disclose what’s been going on, what I’ve been using, what I should have been doing that I haven’t been doing and vice versa across the board. Once we’ve got that done, the most important thing that our medical team does, it’s the history. That history I talk about, that Jim talks about, going back a little bit, where you can.

And if we’ve got diagnosis and somebody comes in with, of course, as part of a pre-assessment. Before you even get in the door, we’re checking with you to see, “Hey, are you on medications? What do you want?” We want to make sure that we’re going to be appropriate to help you. And that we can identify what’s going on. See if it’s necessary. See if it should be continued. See if it should be looked at, in conjunction with your addiction.

So, from the moment you hit the door, we’re going and gathering all that information about, all right, so maybe you’ve been on this medication, so you said. All right, who prescribed it? Can we talk to that doctor? Can we find out what he saw when he put you on this? Were you sober when you went to see this doctor or were you actively using? Did he or she know that? Because all of those things can convolute this, whether or not the diagnosis was accurate, whether or not this medication was appropriate, or whether or not you were just medicating insanity and alcoholism and drug addiction, or true presentation of mental health co-occurring symptomology.

So, by gathering this history, going back and looking through prescription stuff with patients, I mean, it’s a forensic investigation to a degree to deliver really good care. You talk about how we’re talking about this in generalized terms, that’s a hundred percent right. Something I really love about what we do and what you guys do is the individualized nature of our care, each patient, individual case by case basis. How are we going to meet this person where they’re at? How are we going to get the information we need to treat appropriately? And how do we determine what appropriate treatment is and deliver it and make sure they get what they need.

So, when you first come in, if you’ve got somebody that’s on meds, we may not say, “All right, you’ve been on them and you’re relatively stable.” We’re going to leave that be for a minute. We’re going to get you through a detox protocol first. You’re coming in saying you’ve been using benzodiazepines, heroin and cocaine. Okay, let’s get that off board first. You’ve been on these meds. Now, there are places where I’ve, God bless, there’s an idea about you take everything away and see what happens. Well, there’s a diagnostic value to doing that, but it’s terrible for a patient.

James Chitty:

Hold on.

Joe Mattiolli:

And hold on for the ride, right? Because nothing good is going to come in terms of a patient experience from that. But after you take the illicit substances out of somebody’s system and you have a chance to speak with them, get more of a profound history when their mind isn’t so maybe altered or adult and see how they present, where you have your own firsthand objective, subjective view of a patient and an environment. And all of a sudden you can see what’s presenting or what isn’t. And you can say, “Hey, maybe you don’t need this as much as you did.”

Or maybe somebody that is presenting like Jim was talking about before, maybe they thought it was just because they were drinking and using, but we’ve taken that away. And we’re still seeing an acceleration of some of these presenting symptoms. Well, we’re going to set this guy up for failure if we don’t address that a little bit now. Because if you’ve got this noise and then the screaming thousand monkeys going on in your head, which I know full well about, I have no idea how I can, if that noise is still present, when the drugs are removed, how I’m going to grasp ahold of anything, 12-step fellowship, recovery related, and have it be meaningful, is going to be very challenging without, maybe some pharmacological interventions to help with that presentation of the mental illness.

James Chitty:

Now, it’s a delicate balance because you do want to coach up clients who are coming into recovery, especially for the first time. There’s going to be some anxiety, depression, just naturally speaking. So, clients come in med seeking and alcohol seeking in certain ways. So, we have to take that into consideration. It’s like, is this person truly med seeking? And it’s part of our job as a staff to say, “Look, there’s going to be some natural anxiety and depression associated to your recovery.” Because especially early recovery, that’s a big part of it. So, learning how to work through that and helping a client psychotherapeutically, along with the medical, that’s super important, that combination. Because if you do just one or just the other, typically you’re going to run into trouble.

Joe Mattiolli:

Absolutely.

James Chitty:

So, you want the person medically taken care of, but you also want them getting ready. It’s like, “Hold on, this is going to get a little tough.”

Richie Hession:

Yeah, sure.

James Chitty:

And then dynamically, how do you work with that and get that client prepared like, “Look, part of what you’re going to go through is going to be very, very difficult.”

Richie Hession:

Well, I want to throw this out there too. And this is important for families. It’s important for people looking to go someplace, not so much the addict themselves, because I think they like the places that are happy to load you up on meds for the time you’re there. No, I’m serious, right?

James Chitty:

Yeah, so true.

Richie Hession:

It is what it is. I heard that there’s a new rehab that opened up and… A lot of times I’ll do a caveat and I’ll say, listen, God bless you, who might’ve say, but I’m not saying that in this case. Apparently, there’s a new rehab that opened up that’s doing the marijuana, doing the-

James Chitty:

Marijuana maintenance.

Richie Hession:

THC, I couldn’t think of the… You get THC and you’re able to smoke pot the whole time you are in rehab. And apparently, that people are addicts are lining up around the corner and they’ve got like three week waits. Of course, they want to do that.

Joe Mattiolli:

Are they presently accepting?

Richie Hession:

No, but it’s true. I Think about that. That’s insanity to me. I know too much about addiction to believe that lie.

Joe Mattiolli:

Well, I don’t want to deviate too much, but I got to say one thing about that, because I’m in lockstep with you on this. I’m not opposed to that substance being used for certain things. In the same way I’m not opposed to non-alcoholics being able to have a glass of wine.

Richie Hession:

Right, right.

Joe Mattiolli:

They have the ability to do that the same way that somebody doesn’t suffer from addiction, might have the ability for some other disorder to use that substance and have it be effective for them. A guy like me, absolutely not, can’t go anywhere near it.

Richie Hession:

Come on. You know what? No, I got to stop. Because if I go this way down, this is a rabbit hole. This is the rabbit hole.

Joe Mattiolli:

How long is the podcast? We have enough time for this.

Richie Hession:

You got me going on this, forget it.

James Chitty:

It could be 6:00 AM, tomorrow morning, man.

Richie Hession:

Actually, we’ll do another podcast just on this topic. Right. And we can broaden it out and not just about these soulless people. But no, I’m talking about like the marijuana maintenance itself. Is it a good idea? Can it work for real addicts and blah, blah, blah. We can totally go down a rabbit hole. And as a matter of fact, I just did, because now I’m like, “Okay, wait, where was I?”

James Chitty:

If you’re going to talk about co-occurring just briefly, and I’m not here to trash other parts of this industry, but there’s a business end. There’s the big pharma. And that pushes.

Richie Hession:

Absolutely.

James Chitty:

And we have to be careful. Look, they do a lot of good. They really do. And you have to be careful with those pressures because where is that pressure coming from? And when medications are delivered correctly, okay, that’s all good. But just let it be known, pressure is out there. And that’s all we need to say.

Richie Hession:

That’s why I went down that rabbit hole, and that’s where I was gone with it in the places that are happy to load you up with medications.

Joe Mattiolli:

And in defense of that, just real quick, because it’s important. Because like you, I don’t want to have anybody feel attacked by it. Up until about eight years ago, I think it was most medical schools were providing doctors in training eight to 12 hours of study on addiction.

James Chitty:

Most psychiatrists use and go the same thing.

Joe Mattiolli:

They’re going to see most of us in their entire lifetime. And they got the least amount of education. They were poorly armed.

Richie Hession:

You’re absolutely right.

Joe Mattiolli:

And now they get big pharma pushing in, and it’s, “Well, this treats this.” Well, my oath is to do no harm. This fixes the harm they are in.

James Chitty:

They’re well-intended. Most of them are well-intended.

Richie Hession:

And let’s also not forget fear of litigation, that’s changed massively in the last x amount of years. And so, a lot of these people are scared they’re going to get sued if they do the wrong thing, which is why. And again, we’ll get onto this topic. And of course, this it’s totally relevant and germane to our conversation.

But when this guy comes in and he’s diagnosed early on with depression, anxiety, then he sees indifferent guy, because of course, he jumps around. And that guy goes, “Oh, I think you’re bipolar.” And now he gets that prescription. And before you know it, the guy’s been diagnosed with three different mental co-occurring disorders plus addiction. He’s on seven different medications. And now he’s been doing that for the last four years. And no new doctor wants to see a guy and say, “All right, well, I’m taking you off all that, because I don’t believe any of those diagnosis.” God forbid you’re wrong. And some suicidal ideation comes up. This is the big fear that they have. And so, everyone’s scared to make that kind of a change or that kind of a decision in that world. And I totally get it right. I mean, it’s what happens.

And again, I want to touch on this because of the kind of facility, because we’re talking to the parents. We’re talking to the addicts. And I know the addicts would love to go to a place where they just keep you loaded up on meds. Detox, totally different story.

You know what I tell people when I talk to them? When we first opened, I used to get the calls all the time. People calling like, “Oh, I need detox.” And so, “Okay. I know a good place that you can go.” “I don’t really want to go. I don’t want to do detox.” They know they need it, but they don’t want to go. Of course, they want to go. They don’t want to be sick, especially the heroin addicts. But any of them, none of them want to go. I always tell them all the same thing.

And I’ll tell you, if anybody’s watching this and you’re thinking of going on a detox, man, they’re going to load you up with meds on the front end. And then they’re going to bring you down smooth and easy. That’s what I love to tell people, because that’s what’s going to happen. We’re going to give you plenty of meds on the front end. We’re going to bring you down smooth and easy.

James Chitty:

Which makes your job difficult.

Richie Hession:

Earl Hightower told me that. And he’s an interventionist in the West Coast. He’s a rock star. Earl, you can’t complain I’m using your name, because you’re getting free advertising, right? Rock star. And that’s what he uses with all his interventions. And it’s true.

But eventually when you come to our place, we don’t tell them that, that’s for detox. When they come to our place, we tell unapologetically. And again, maybe we’re not for you. Parents love us because they know my goal is to get them off of any non-essential drugs, anything they don’t need to be on to address a specific understood, underlying mental illness co-occurring illness, they should not be on comfort meds. Comfort meds are the blight, right? Because comfort meds just keeps them sick. When they’re on high doses of Gabapentin, and they’re on reasonable doses of Seroquel and they’re on…. what’s the other stuff? That the Clonidine. And what else do they give them? I mean, there’s so many places.

James Chitty:

Trazodone.

Joe Mattiolli:

Trazodone.

Richie Hession:

Can have its place depending.

Joe Mattiolli:

Seroquel, depends on where it is.

Richie Hession:

And again, some of the stuff, like I said, some of it is legit. That’s the goal for us. And this is the nature of this topic and this kind of a panel discussion is. What’s real, what’s not, how do you figure it out and decide it? Harder for you guys, because in the beginning, what do you guys have to deal with? Someone first comes into detox and res. They’re not even themselves yet.

By the time they come downstream, like Jim says, we’re starting to see you guys will make a referral to us, and you guys will be like BlueCrest would be perfect for them, 12-step, blah, blah, blah. The whole thing. We love them. This guy, it’d be a good fit. I think it works. Okay. Here’s the referral, BlueCrest. Person comes to us first day, we’re like, “Okay, this could, blah, blah, blah.” And we introduce him. This seem a little off. Right? But you probably didn’t see any of that. And your thing, they probably-

Joe Mattiolli:

He was going and looked perfect then.

Richie Hession:

Looked perfect. Right? But then they come into us and we notice when we do… We have amazing, our new client assessments, our assessment people are astounding. Mitchell, is an absolute rock star, Mark. So, they’ll meet with them and they’ll be like, “Huh.” they’ll make a mental, a little, an actual note. And they’ll say like, “Hey, just be mindful of this. I noticed a couple of things that were a little, but just this we’ll keep our eye on early days.” And then after the third day, we’re like, “Oh my gosh.” You know what I mean? This was presenting itself, it’s clearly primary psych, and this person definitely needs a different level of care.

James Chitty:

Well, if we get them straight out of detox, much like you, that third, because detox appropriately is going to taper down. And the timing is the day they leave. Right? And again, this is all good. The detoxes do a good job with it. But the timing is the day they leave, they either end up knocking on your door first or knocking on our door. And then two, three, five days after that, the detox, so to speak, is complete. And then you have a different ball game when those comfort meds, and then you have decisions to make medically, what do we do with this medically, do we not do it? Do we comfort them out? And this becomes an art and a true profession on doing that correctly. And that’s where you guys have a little bit more of a harder time than we do.

Joe Mattiolli:

Works with the awkward signs.

James Chitty:

Because by the time they come through you through your facility, you’ve weeded through that difficulty. Whereas I think we have a little bit of an easier time with that because you’ve done some hard work for us.

Richie Hession:

Sure.

Joe Mattiolli:

Well, and you know what? It’s certainly a lot of work on both sides. Detox and residence, you guys get to actually dive in and do more in-depth clinical work, which I really, I love. It’s why I encourage everybody to go beyond the residential level of care, work with some guys that do really great PHP, transitional levels of care like you guys. Because that’s where you’re going to start to really figure out, a, who you are, and b, figure out how are you going to live life in a way that allows you not to have to go to drugs and alcohol to pick back up. And what’s necessary, what work do I need to do on myself to be ready to do that?

And they are at the perfect position by 21, 25, 28 days where the brain is restarted to reset just enough where you can really create those new habits and make them be lasting routines and behaviors to override the old stuff. But when you’re with us, I mean, that’s why, sometimes I get people that they call in and they want to do, just want to do a detox only.

James Chitty:

Three days, right?

Joe Mattiolli:

Yeah. Three, maybe five. I can do five.

James Chitty:

Yeah. I got to get back to work.

Joe Mattiolli:

Exactly. Because I’m a rock star right now. I’m showing up drunk, but they still love me. Whatever the case, the story is you’re telling yourself, “I can only take this much time.” And it’s, while I want to help everybody at some point, that’s almost a little bit of a waste because you’re going to get yourself cleaned up, but with no new solution as to why you got drunk and high in the first place. Or with a tool set, that’s going to allow you to not to. And sometimes that’s just a recipe for disaster.

Richie Hession:

At some point you got to say, “Come on, man.”

James Chitty:

But naturally speaking-

Richie Hession:

How many times will you take somebody in and do a detox? How many times will you take somebody in like an individual person, Joe Q, citizen from Skokie, Illinois. You had a question? Hold on one sec. How many times do you guys have a rule? We always try and do things case by case. I try not to be, for me in our place, like our place is apparently weirdo world that Jim says all the time. Because me, I’m the CEO. I’m one of the owners of the place. And I’m like, “No, he can’t come. We’ve already…” At some point, let him try something different. I’m not going to let him just keep coming back here doing the same bullshit. I got to stand up for his recovery, if he wants.

At some point we’ve got to say no, because I don’t want front seats to the death show. I’m not going to let you come into this place on med management for us for co-occurring. If they won’t be on med management and they won’t go on and stay on the proper meds to the people who do have legitimate diagnoses, we’re done. They can’t stay in our place at all. Being on med management goes without saying.

But even the guy who keeps coming in over and over, we don’t do it over and over and over and over again, guys. They have to talk us into it after the third time. Because I know sometimes it takes several treatment episodes. But if we see the jokers that come in and these guys are not serious and they’re not able to sell me on why I should take them back, we turn them away. I don’t care what their insurance is. Doesn’t mean anything to me. Right?

We don’t have a good reputation by accident. We have a good reputation because we look out for clients and family, is what it’s supposed to be. And that’s why we don’t load people up on meds. We’re not looking to make people docile and manageable while they’re in. We want to take them off that stuff. That’s the hard work. It sucks to have to deal with clients who are coming off Seroquel. And they’ve been on that comfort bed for three years, but they clearly don’t need it. They hate us, man. They don’t want it. You know what I mean? But they know inside, they know they shouldn’t be on this, because in the end they never get to connect with actual recovery. When you’re on this other stuff that you don’t need, you’re taking an outside substance to fix an inside problem, to make yourself feel different, to make yourself feel better.

So, before I ask you the question to you guys is, and it’s an interesting question, right? In the treatment field, now how many times is inappropriate? I get detox is totally different. I would imagine it’s a higher number because it’s a medical procedure. You don’t get to do a lot of clinical work with them. They have poison in their system and you guys have a responsibility to get it out. But to me, I always ask myself, if I opened the detox, I would want to say that I would tell my people, if this person comes six times and they refuse any aftercare each time, the seventh time they look to come, the only way I take them is if they agree to do some type of aftercare, whatever that number is.

Joe Mattiolli:

Absolutely.

Richie Hession:

And if they don’t agree to after, if they do agree to aftercare and then they don’t follow through, next time they come, we don’t allow them in, you’re out. We’re not taking you. I don’t want front seats to the death show. Do you guys do that?

Joe Mattiolli:

We don’t have a set number. Everything else we do-

Richie Hession:

Case by case.

Joe Mattiolli:

… it’s going to be case by case. Now, here’s what I’ll tell you, I’ve had a patient come in and it was the third admission, not the sixth, not the seventh, but on the third admission, we saw very close together limited willingness to do anything different, to the point where my admissions director called me and I get on the phone myself. Look, I want to help as many people as I can. But at the same time, I also know the value of somebody being willing to get help, even if it hasn’t worked before. That’s an opportunity that has to be maximized.

So, if I know you’re a little too comfortable coming to me, and you’re not going to really push through or do something different, then I’m essentially participating in robbing you of that opportunity to get well, just to put you into treatment with us versus saying, “Hey, look, here’s what you’ve got going on. We love you. We’re going to help you. We’re going to place you with one of our partners that we know who also delivers amazing and excellent care.” But it’s going to give you an opportunity to have a new experience, a new environment, maybe a new counseling staff, something that may allow you to walk through this a little bit different and have to walk through some uncomfortability, versus coming back into a place where you high-five the techs as you’re walking through the hall.

Richie Hession:

Yeah, exactly.

Joe Mattiolli:

And you’re, “Hey, how’s your mom.” That is not helping anybody when that stuff starts to go on. Now, there’s other patients, I may take back in. Maybe I’ve seen them for a fourth or fifth time, but each time maybe they were, as some of us are, sicker than others. I was a guy that took eight treatments to get well. So, I’m grateful some people kept taking me in a certain way. Now, the difference is this young man or woman in that situation, we will have seen progress along the way, with a slip or a difficulty or an outside external issue. Somebody doing very, very well, and all of a sudden, God forbid, mom died. And while that happened, maybe their meeting attendance was a little bit lax. Maybe they weren’t doing all the right things. And they were overwhelmed with that emotion.

And you know what? Yeah, we’ve seen them three or four times before, but they progressed to a different point. And the willingness is there. That’s a person I can take back and say, “How can we reset you? And by the way, you may need a little bit more runway time to take off into real recovery based on the fact that a life event like this took you out. How about we get you set up where maybe between partial and intensive outpatient and some good sober living. We can get you 90 days of good structured care on a step-down deal. So, that when you reenter back into the world, again, you’re a little bit better armed maybe, and prepared for stuff like that to happen without it crushing your recovery.”

Richie Hession:

Hold on, let’s go to Nick because he’s been trying to get a question.

James Chitty:

Yeah, Nick.

Joe Mattiolli:

He’s been flagging over here.

Richie Hession:

Yeah. Yeah. What’s the question.

Nick:
What’s the difference between manic depressive disorder and bipolar?

James Chitty:

It’s an old term, manic depressive disorder and bipolar, but manic depressive was just an old diagnostic term. And bipolar is the new term.

Richie Hession:

Basically the same thing?

James Chitty:

Yeah, it’s the same thing. The DSM has changed. The DSM always changes through the years. And then that was just one change. The verbiage changes.

Richie Hession:

I’m going to just put the fact that I didn’t actually know that, to the fact that I’m not as old as Jim. That’s what I’m going to tell myself.

James Chitty:

Now, it’s the truth, being 60 has its benefits.

Richie Hession:

It makes me feel bad about it.

James Chitty:

So, you have to respect your elders here. That’s all.

Richie Hession:

But is that right, that so it’s basically the same.

James Chitty:

A lot of stuff changes in the DSM statistical manual.

Joe Mattiolli:

You’ve got two to three to four to five now, I think we’re up to. Are we not?

James Chitty:

Yeah. TR, time-release, that’s what’s is called.

Joe Mattiolli:

Time-release DSM, I like that.

Richie Hession:

it’s actually a good, we never know where these things are going to go. We can have a general outline and we could talk to this. The potential and the direction this kind of a conversation can go is literally infinite. That’s why it’s nice to have questions sometimes because people might have questions say, “Hey, talk about this aspect of co-occurring versus addiction.” Because it could go anywhere, right? I mean, there’s so many different ways we can take the topic. But one thing I’m going to do before we continue on, I’m going to do what they said to do because I’m responsible in that way.

Joe Mattiolli:

Following direction.

Richie Hession:

A little, a little. And I can tell you a story about following direction. Matter of fact, maybe I will just for the fun. Actually, you know what? From now on, every time we do a podcast, I’m going to tell a Richie Hession story. And I’m going to tell a story right after I do this whole thing.

James Chitty:

Richie tells good stories, man. I’ve heard a lot of Richie’s stories.

Richie Hession:

Well, this one is good, it’s about following direction. It’s an interesting one, right?

Joe Mattiolli:

I have tons about not following directions.

James Chitty:

I got a few of those too. I don’t want to say them though.

Richie Hession:

So, if you’re watching us live… No, I did that already. Isn’t there some kind of a break. For those of you are just joining us, you’re listening to The Other Side, the official podcast of BlueCrest Recovery Center. I’m Richie Hession, CEO here at BlueCrest. Today, we’re discussing an important aspect of addiction treatment, co-occurring disorder care. I’m here with our guest, Joe Mattioli and James Chitty. James is the clinical director at BlueCrest Recovery Center. Joe is the COO and executive director at Brookdale Recovery, that’s in Pennsylvania. So, I promised I would do the thing.

So now, following directions, this is going to be off topic, but then again not, how many of us have a hard time following directions. And so, when you first come in and you’re first going to get recovery in treatment, outside of treatment, in a 12-step verse with a sponsor, you’re going to be given directions. You come into our care or your guys’ care, you’re going to be given directions on personal care. You’re going to be given some dietary suggestions. You’re going to be given some medications that you’re going to need to stay on. You’re going to have to engage in group. You’re going to have to change around some of your sleeping habits. There’s a lot of things that you’re going to have to do.

When I came in and I came into recovery, I know I’m not a big direction guy. I don’t like authority. And I don’t, quite frankly, maybe some on the lists, is I’m not a big authority guy. And I didn’t really like to be given direction very much, probably because from my childhood, with my dad or whatever. And maybe Jim being a psychoanalyst by training, could sit with me for an hour and a half and we could really get into it.

James Chitty:

Or me screaming at Richie or Richie screams at me.

Richie Hession:

But I’m not a big director, I don’t like following directions. But it’s an integral part of what I need to do in early recovery, especially when you do in 12-step work. So, okay, fine. So, here I am and I go through and I come into this thing and I was absolutely out of my mind. And I had one hell of a 12-step experience. Now, it could have been that I might’ve been able to be diagnosed with certain things when I was a little bit younger. I wasn’t. My family didn’t believe in therapy, psychiatry. I had, did go see a therapist for a period of time, but I was never actually diagnosed to the point where I was required to take medications. Who knows, right? How my story would be different, had that been the case.

Anyway, so I go on, I get sober and I have this unbelievable 12-step experience in recovery, unbelievable. And I go from this unemployable wreck of a human being to my story. And if you’ve ever heard my story and maybe over the course of the podcasts, in different these little segments, I would tell more of my… My story is like a movie, it’s crazy. I shouldn’t be anywhere where I am. I should be dead. I should not be where I’m at. I should not have seen what I’ve seen in the world. But I was able to go to Africa, so which is crazy. A kid like me from Staten Island wanted to go on safari in Africa.

James Chitty:

Richie, I didn’t know you went to Africa.

Richie Hession:

Yeah. I went to Africa.

Joe Mattiolli:

Sounds almost as good as my India story.

Richie Hession:

Dude, crazy, I go to this place called Singita Reserve, right? It’s in Kruger National Park, right? Singita Reserve. Unbelievable.

Joe Mattiolli:

Sure. That’s South Africa.

Richie Hession:

South Africa. We ended up going to Cape Town after. But anyway, we go on this reserve. Now, I’m going on a safari. Now, for a kid like me, and I’m only sober for three and a half years or whatever. And I find myself in a safari in Africa, which is, I was rolling pennies for cigarettes. And now all of a sudden I’m in an African safari. Life, sobriety is amazing. And listen, we don’t do it for the cash and prizes, but sometimes it delivers some pretty cool-

James Chitty:

Sometimes cash and prizes is good, man.

Richie Hession:

Yeah, it does come, right? So, I ended up going to this, I go to Africa. So, I go on the safari. And if you’ve ever been on safari in Africa, I had never been, you get in this truck. And the truck is an open, it’s like a Jeep with a stadium, like bleachers built onto the back of it, like gym bleachers almost. It looks a little bit ridiculous, right? It’s a Jeep and these bleachers. And you step on and you climb up on the bleachers. And that’s it. It’s wide open. So, you’re sitting in these bleachers, driving around. There’s no fences, this isn’t a zoo. You’re in Africa, right? So, you’re driving around and all these wild animals, including lions and all that, they’re all out there. And you’re out to look for lions. And I find that to be unbelievable. Right?

So, when we get into the thing, the African guide is there, and this guy is a monster, right? And he’s got his drivers with him and these guys are clearly pros. And he’s got this big elephant gun with them. Right? And the elephant gun is monstrous. He said, “I’ve been doing this for x many years, I’ve never used this before, but we have three very simple, basic rules. And that’s all we ask of you guys while you’re here.” He said, “And if you do them, I’ll never have to touch this gun.” And he puts the elephant gun away in the front of the Jeep in this clip.

And so, we’re like, “All right, what’s the rules?” And he’s like, “While you’re in this truck, these animals are all used to us not being a food source and not being a competitor. So, they’ll leave us alone. They ignore us. And you’ll see, they basically have learned to ignore our truck. And the reason that happens is for three simple things. And if you guys follow this, we’re going to have a fun time today. And we’re not going to have any issues. I’m not going to have to yell at you.” And right away when he said that, I’m like, “No, I don’t like people yelling at me.” You know what I mean? And especially all these rules, but whatever.

So, the guy is like, “The first thing is no yelling. You can’t yell out loud. It can be dangerous in here. You got to keep on a monotone.” And I’m like, “Okay.” I mean, that makes common sense, right? No pointing. It can be a sign of aggression. You don’t put your hand ever outside of the truck. You don’t point at anything. He’s like, “It’s a basic common sense rule, no pointing.” And I’m like, well, so far this is like no brainer, right? I mean, you wouldn’t do either one of those things, it would make sense to be quiet, especially if you see lions. No pointing, I can do that. Easy enough, I mean, these ridiculous rules.

And he said, “Final rule, no standing up.” And so I’m like, “Duh.” Right? I mean, imagine if you fell off and you fell off the truck, you no longer in the neutral zone.

James Chitty:

Food for thought, then.

Richie Hession:

Yeah, food for thought.

James Chitty:

Yes, you are.

Richie Hession:

I’d get dragged into the-

James Chitty:

Lion thought.

Richie Hession:

So, I listened to the guy’s rules and I’m like, “All right, well, this is just, that’s ridiculous, but okay. So, fair enough, that’s it?” He’s like, “That’s it. Those are the only rules.” I’m like, “All right. So, I don’t even consider those real rules.” So, now I’m psyched. And now we’re going to drive into the jungle, right? So in hill, we’re going to go up. And it’s soon as you get up over the hill, you’re now out into the reserve and you could see, God knows what.

So he goes, and he drives up over the hill and we start going down this windy road. And we go, and we’re going to pass to get into where we’re going, the airstrip, where we landed. We pull into the airstrip, and what is at the end of the airstrip? But a rhinoceros with a… a huge rhinoceros. So, I jumped up and said, “Rhino.” And the guy was like, “What are you…” I broke all three rules as soon as we climbed the hill.

James Chitty:

At once, yelling, pointing and standing up.

Richie Hession:

I pointed, I screamed and I stood up. I’ve never been very good at following directions, dude.

James Chitty:

Well, if you’re going to break the rules, you might as well do it all at once.

Richie Hession:

I did it all at once.

Joe Mattiolli:

And you might as well see a rhino while it’s happening.

Richie Hession:

Exactly.

Joe Mattiolli:

I mean, if ever there was a good reason to get excited, I’d say a rhino qualifies.

Richie Hession:

Yeah. I think that qualifies. But it’s a crazy, and I’ve told that story before, during my qualification, just to, for the newcomer to know that, sometimes even with best intentions, please follow directions.

Joe Mattiolli:

Well, and by the way, you can tell there’s two alcoholics sitting here. He told a story about doing something he shouldn’t have done, I justified and qualified it for him.

Richie Hession:

I don’t want to say that there’s three here, but there is. All right.

Joe Mattiolli:

Always going to break us in there.

James Chitty:

There’s three here.

Richie Hession:

So, we’ll go back into our topic, right? So Jim, why is it, and I’m going to use a baseline question just because sometimes it’s fun to go to the… because we can break the conversations however we want. We don’t have that much longer to go for the nature of the podcast. People who are listening, I mean, anybody who does listen to the whole thing, it drags on when you go for too long. And nobody wants to listen for too long. But let’s do this. What should someone looking for co-occurring disorder care look for in a treatment program, detox, res, this level of care, after care. I love the aftercare part of it.

James Chitty:

Yeah. I was going to go there. I was also going to say, you have to have talented clinicians, in no matter what the level of care that can identify. More so the aftercare is prognosis, meaning what’s going to happen in the future. Prognosis is everything.

Richie Hession:

Would you agree that there’s a treatment facilities out there that call themselves co-occurring but they’re not really co-occurring per se.

James Chitty:

Yes. I’m sure most of them, yes. It’s tough work to begin with. But there are some that whatever they get the license, they say they’re co-occurring. But most people who are co-occurring tend to-

Richie Hession:

But if you’re a mom and dad, and if you’re looking for it, what do you do? Do you go on the website and look for the levels of the clinicians you have?

James Chitty:

Exactly.

Richie Hession:

Do you have two L’s and 15 CADC interns? Or do you have mostly right L-level licensed clinicians? What do you look?

James Chitty:

It’s pretty straight, the more training that you have, if you have master’s level clinicians on your staff, a lot of them they’re going to be better off in terms of diagnosis, prognosis and dealing with co-occurring. That’s the basic. That’s what it comes down to. The more trained you are, the better off you are in handling co-occurring. It’s not magic. You either have those abilities through training. You can gather that through experience, but really you want a staff that’s trained well, that can handle these situations, and they have experience at the same time.

Richie Hession:

And I’ve found it that it was helpful, again for us at BlueCrest. And this is just what we do. And it doesn’t mean you have to or whatever, but for me, I take that stuff serious, client care, the dealing with the families. But especially client care, that’s our number one priority, right? It should be everyone’s number one priority. And because we call ourselves a co-occurring facility for us, we hired, we don’t just, and there’s nothing wrong with having outside people that you have that come in, a psych APN. You really need to have a psych APN who has addiction experience, because otherwise the clients bullshit them and they lie to them to get them to write prescriptions. But whatever, you should have be rules-based anyway.

And there’s certain things that you shouldn’t be allowed to provide and to induce medications for clients, but whatever. But you need an addiction savvy psychiatrist and an addiction savvy psych APN. For us, we hired them both. So, we have full-time. Our people aren’t outside guys that come in, not that there’s anything wrong with having that, but we hired them both full-time. We wanted them to be BlueCrest focused.

James Chitty:

And even that you’ll watch them, we’ll see our staff try to tease stuff out. So, we have these two guys medically trained, they’re wonderful. And they still have to tease out information about where do we go with this client? That’s what you want to see. You want to see a staff going back and forth, kicking ideas around, rarely, is it a linear decision. And then that comes to the conclusion of what are we going to do with this client moving forward. And when you have a good team, well-trained and they’re cohesive, those decisions are wonderful. They are easier to make.

Joe Mattiolli:

Oh, no, absolutely. That collaboration between medical and clinical is essential to be able to have that back and forth in that collaborative approach to how are we approaching this patient? What are you seeing? What am I seeing? Because they may tell a different story based on where they’re at in a given day, and also based on whether or not maybe we’re not ready to be fully honest, and maybe we are med seeking a little bit. Maybe it’s out of desire to be altered, or out of pure fear of feeling anything. Because sometimes that’s also very common.

We believe in the same thing. Brookdale has two full-time physicians. Our medical director was a neuropsychiatrist by training. So, you couple that with an addiction specialty, and he’s got the ability to look at people and address things from multiple angles and multiple sites. We have a mix of master’s level, licensed clinicians along with some folks that are also very experienced.

I’m a big believer that school can teach you so many things, but OJT, on the job training, sometimes is the best. And when you have seen cases, time and time again for 15 years, in some cases, I’ll tell you what, I’ll take a 15-year experienced clinician over this guy with two years of just got his master’s degree, because this guy seen everything and he knows how to approach it.

Richie Hession:

Absolutely.

Joe Mattiolli:

And we have a combination of that in our staff that I love. Because you get guys that come in that have that slightly elevated educational standpoint, but they can transmit, give that to people when they come in and say, “Hey, have you read about this? Have you seen this?” And then that same guy is going to be talking to a guy who’s the 18-year veteran, he’s going to go, “Did they write about this in your book?” And he’s going to go, “Sit down, let me tell you a little something about what actually is going to happen while you’re here.” And when you bring all that together with that level of staff and professionals, you can really achieve this.

So, mom and dad at home, those are the things you want to look for and things like that, that you’ve got those resources available, especially when they’re first coming in detox, res, and going on to care. So, it can be managed into the next place. It can be handed off appropriately. That’s why we love working with you guys so much.

James Chitty:

And one thing you want to look for too is staff turnover. And that’s hard to get at, how does a parent know about staff turn? If you have a staff that’s been stable and working together, or if you have a staff that’s been turning over on itself, those are two very different animals. When you have a team that’s been together for a chunk of time, you really start to know each other. Richie and I have been working together since the beginning of BlueCrest. He knows me, I know him.

Richie Hession:

See, that’s something more noble within the industry, within the field.

James Chitty:

Correct.

Richie Hession:

We know each of those places and who has high turnover and was doesn’t at families.

James Chitty:

They’re not going to know that.

Richie Hession:

Well, the nature of that question, what do you look for? They wouldn’t necessarily know that. Although, it’s a good question for them to ask these characters when they go, or people in that private care.

James Chitty:

That is correct.

Richie Hession:

When you’re in detox and you are in res and they say, “Well, we have a suggestion for aftercare for you. Why don’t you go to these people?” A good question for the family guests, “Well, let me ask you about them. Do they have a lot of staff turnover or is that a place that has staff that’s been together for a long time?” And it is a good question to ask. I agree.

The question is kind of a softball question and we can end it with this. This podcast has never been, it’s never going to be, I mean, we have to have the BlueCrest stuff in the background. You’ve got to look at something, right? If you’re going to be watching it. Most people probably just listen to it for 20 minutes when they’re in their car. But what the hell was I just going to say? This is the nature of my addiction is that I go completely blind sometimes when I’m in the middle of… Yeah.

James Chitty:

Is not about BlueCrest, you were saying?

Joe Mattiolli:

The stuff is in the background because-

Richie Hession:

Yeah, it’s not an infomercial, right?

Joe Mattiolli:

There it is.

Richie Hession:

Not much infomercial BlueCrest. But this question served up a softball for me, and the softball for me is, and it goes to what this whole topic and everything we’ve been talking about. And you alluded to it because one of your answer before you discussed it, to me, it’s everything to me and everything we do in this and everything I do personally in recovery is about where the rubber meets the road. That’s what everything is about for me.

And so for me, we set up BlueCrest specifically, we’re not just a co-occurring disorder facility that treats co-occurring disorders because it says so in our pamphlet, we’re literally set up that way. Our very philosophy and our core mission is set up to speak to that because in the end of the day we are, and we’ve created a program, it’s where clinical meets big book, clinical work, psychiatric work, medications, whatever that entails, depending on the nature of the person that comes into our care, meets 12-step recovery, which is the best aftercare program in the world for your addiction.

It also can help with a lot of co-occurring issues, but by itself, doesn’t carry the day. That’s been my experience. Just doing 12-step work when you ignore, if you try and ignore the fact, and this goes to, I had written this down to say it and to speak to it. And I talked to the parents. It’s wild. And and maybe we’re not going to close in one second, but see if you guys have had this experience. I know you have.

But some parents prefer mental illness over drug addiction. When I say prefer it, what I mean is what do you call their kid? Right? Like, “Oh, well we can’t listen. We’re going to have to refer them out.” We’ve had that quote like, “Look, she’s a lovely girl. We would love to keep her here. We like her. You guys have great insurance. As a company, we would love to keep her in our care. It’s just not appropriate, mom. She’s not appropriate for here. She clearly has primary mental illness. We’ve made that decision. We recognize it. We know what it is. We’re good at what we do. I understand you want her to be here. We want her to be here. It’s just not appropriate for her to be here because she needs to have a different aspect of what’s going on addressed. “My daughter doesn’t have mental illness. She’s a drug addict.”

And the mom doesn’t want to hear that her daughter has mental illness. She wants to believe that it’s just drug addiction. That happens sometimes. Families don’t like that stigma that comes with a particular, if you put that on them. But we’re not, I can’t worry about the stigma or what that’s going to look like. My concern is and should be that the person get the care they need.

Or we see it the other way as crazy as it is. We have parents who come in where they’re like, “Well, my child just has depression and anxiety and that’s it. They’re not drug addicts.” And they want it to be the mental illness, but they want it to be a low-grade mental illness that can be managed with some basic medication.

James Chitty:

You can get over it.

Joe Mattiolli:

Socially acceptable mental illness.

Richie Hession:

Socially mental illness, right? God, you know that doesn’t have too bad a stigma attached to it because it’s become a little more acceptable nowadays to have depression and anxiety. You can actually admit that. And it’s not such a bad thing. I mean, it is what it is, right? It’s just this is reality. But I don’t know. I mean, I think we see both sides of it, right? We see, and when we have to manage that and we have to deal with it either way, we have to recognize what the truth is. We have to make that differential diagnosis is where it all begins, so you can figure out what’s actually going on. And then you act accordingly. We proceed.

For us, sometimes that looks like a refer out to a more appropriate level of care. Other times it means diving in. If it means that there’s a co-occurring illness and there’s an appropriate medication to get them on, that starts out as science. And that becomes art. How many milligrams? They have to adjust. And there is no one set rule that you weigh 180 pounds and you’re going to get this. It doesn’t work that way because of the chemistry, right? Jim, it’s just different for everybody when they have to write those prescriptions and they have to see and find that comfort point. If you need to be on meds, you need to be on meds. You have to get on the right medications that bring you even with everyone else. And then you’ll be able to actually engage in 12-step lifestyle. If you don’t have co-occurring, you’re rock star, the 12-step best after care program in the world, it’ll change every aspect of the way you are, how you look at life, and you can be taken beyond where you are in relation to your-

James Chitty:

In a great way, though, the 12 steps also will instigate co-occurring if it needs to be in a very good way.

Richie Hession:

In a good way.

James Chitty:

So, the 12 steps, and this is coming from a psychoanalyst. So, my collision of training is an interesting place. The 12 steps itself will instigate co-occurring that maybe isn’t quite seen in the beginning. So, it’s a fascinating process. And if you have both sides covered well in a facility, there you go. It’s fabulous.

Joe Mattiolli:

Where the rubber meets the road.

James Chitty:

That’s correct.

Joe Mattiolli:

I will say this-

Richie Hession:

Final comment from you.

Joe Mattiolli:

I got one, because it’s an important one. And this is my hope for anybody watching. And it really speaks to the core of what we’re talking about. I’ve seen both sides, whether it’s, “Hey, I’m a mom, I’m a dad. I’d rather my son be, if they’re going to have some label with various stigma, well, if they’re an alcoholic, it’s okay. I can’t handle it, if they have this. Or you know what? All right, so they’re anxious and depressed, but there’s no way that they’re a drug addict, right?” What I really want everyone to know, listening and watching right now, there’s no difference between either one of those things and heart disease, diabetes, cancer.

Richie Hession:

There it is.

Joe Mattiolli:

Nobody that has them has chosen to have them. It’s a reality of life. It’s the cards we got dealt. It’s the cosmic force at work for whatever reason. How it happened is almost irrelevant. The reality of it is it wasn’t something anybody chose, all that’s left to do is how do we manage it? How do we change and go about living life in a way that allows us not to just manage it, but to live with it, to flourish through it, and to still be able to be the best version of ourselves that we were intended to be without letting any nonsense in our head about what we may think about it or what somebody may say about it, stop us from being able to achieve that.

Richie Hession:

Well put, phenomenal. And I’ll go one more, and I’ll tell the families that we also recognize that it sucks, and that it’s either one, it’s hard to deal with. It’s just life draining for the moms, dads, husbands, wives, brothers, sisters, to deal with active addiction and mental illness can be unbelievably difficult for the families. There is help there for you as well. It’s not just about treating the addict. It’s about treating the family. Our family night that we have, anybody watching or listening, we’re open, it’s free. It’s free and it’s open.

And we would welcome any family who’s struggling with any addiction issues at all, mom, dad, brother, sister, aunt, uncle, anybody who struggles with this, on their receiving end of the insanity that we deliver to family, you’re welcome to come to our family night. And you can find people who know what you’re going through, and that you can get the love and support that you need to give you that extra—to see it through to the end, whatever that’s going to look like, because we recognize how hard it is for the families.

Joe Mattiolli:

They have it worse than some of those…

James Chitty:

It’s hard to watch it go down. And I’ll say for the three, we are blessed actually, to be able to work with families and for clients coming through. We really feel that way. So, for people to come to us, we know that’s an exposed difficult position. So, we truly are blessed in this field to have people come to us and trust us with that type of dilemma. And we really respect that. So, we just want to thank you.

Richie Hession:

And remember this isn’t an infomercial for BlueCrest. This is a general message to families out there.

James Chitty:

For addiction.

Richie Hession:

Anybody listening, is a mom or dad or whoever it is, and you hear us, there’s help beyond just BlueCrest. Just the fact that you recognize that you yourself probably need help. You may have codependency issues with that loved one in that addiction. There’s a lot involved. But you yourself need as much help as they do. And in some ways more because how the toll that it takes mentally, emotionally, and spiritually on the loved ones. There is help available to you. And you should definitely consider that and look for it. It’ll go a long way with helping you to get free because you’re in some ways in much bondage from addiction as the addicts themselves.

Joe Mattiolli:

Couldn’t agree more, said it better.

Richie Hession:

There you go.

Joe Mattiolli:

Well done.

Richie Hession:

All right.

James Chitty:

Bye, guys.

Richie Hession:

So, thank you for sharing time with us. And this is a wrap on the other side and we’ll see you next time.

James Chitty:

Thank you very much.

Joe Mattiolli:

Thanks for having us.

Richie Hession:

And we’ll close with this song.

James Chitty:

What do we got, Richie? Let me guess, Queen.

Richie Hession:

I’m going to do Queen.

Joe Mattiolli:

We’ve got Freddie Mercury.

Richie Hession:

Freddie.

Joe Mattiolli:

Hey.

Richie Hession:

How could you go wrong?

Joe Mattiolli:

Perfect.

Richie Hession:

If this wasn’t COVID, we’d all stand up and start hugging each other now. That’s something I would envision the podcast ending.

Joe Mattiolli:

And it’s a little bit of a sway and a kumbaya.

Richie Hession:

Yeah, and Nick comes in.

James Chitty:

So, this is like a virtual hug, a virtual sway that will be virtual recovery.

Joe Mattiolli:

I like this. We’ll join in it right now.

Richie Hession:

Yeah. Come on virtual.

James Chitty:

There we go, guys.

Richie Hession:

Wouldn’t it be a cool way to end the podcast, tunes going-

Joe Mattiolli:

Oh absolutely.

Richie Hession:

… hugging on each other, shaking hands.

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