E.99 How Does Substance Use Treatment Could Look Like With Sarah Cloud

In this episode, my former supervisor Sarah Cloud comes on and discusses her relationship with me, how we worked together, but more importantly, the change that needs to occur in the substance use world so that we can discuss treatment in a different way, navigating the ressources effectively, the stigma that the medical world can also impose on substance use, as well as partnering in the community.  We also discuss her Bulldog Running Club, exercise, and her writing career.

Sarah A. Cloud, MBA, MSW, LICSW, received a Master of Social Work from Boston College School of Social Work in 1996 and Master of Business Administration from Isenberg School of Management in 2018. During her career, Sarah has been recognized for her leadership through awards for improving access to treatment for Latino & Brazilian communities, suicide prevention for elders, opioid epidemic and community justice.  She has specialized in the development of innovative programs, healthcare integration and interagency partnerships, and has lectured on those topics at national conferences.  Sarah serves as a Board Member for the Boston Bulldog Running Club, a wellness community for people in recovery, affected by addiction and treatment providers; and PCO Hope, drop in centers providing a safe gateway to substance use information, resources, support and hope for individuals and their loved ones; Sarah has been the Director of Social Work at Beth Israel Deaconess-Plymouth since 2015 and published author of children books on grief and loss related to the opioid epidemic.

Sarah's book can be purchased here.

The Boston Bulldogs Running Club can be found here.

Transcript

Unknown: 0:02

Hi and welcome to finding your way through therapy. The goal of this podcast is to demystify therapy, what can happen in therapy and the wide array of conversations you can have in and about therapy. Through personal experiences, guests will talk about therapy, their experiences with it, and how psychology and therapy are present in many places in their lives. With lots of authenticity and a touch of humor. Here is your host, Steve Bisson.

Steve Bisson: 0:33

Thank you and welcome to episode 99. There is one single episode left well, actually more than that I'll explain a little later. Before my 100th episode, never thought I'd get there. Just a privilege and very honored. But if you haven't listened to Episode 98, it's Gordon Brewer, we talk about the site craft network, among other things. I am now part of the site graph network. I hope you go listen to Gordon's podcast, among others. Obviously, there's a bunch of them. There's Kim, there's Lisa, and many others that I'm forgetting right now, but guys don't hurt me. I'm just trying to remember him by heart. But episode 99 will be with a former supervisor of mine, not only former supervisors, she actually is the one who hired me for the crisis team in 1999. Yes, I am that old. But her hiring have really changed my career in many good ways. We had a great relationship while we work together. And I am truly happy that she came on we're going to talk about different things. I'm pretty sure we're gonna talk about the Bulldogs. But let me give you a little bit of her biography, which is Sarah cloud, received her master's in social work from Boston College School of Social Work in 1996, and Masters of Business Administration from Isenberg School of Management in 2018 at UMass, during her career, she has been recognized for leadership and received awards to improve treatment for Latino and resilient communities, as well as suicide prevention for the elders the opioid epidemic and community justice. She specializes in the development of innovative programs, and interagency partnerships, which she's really good at Sarah serves as a board member of The Boston Bulldogs I mentioned earlier, a wellness community for people in recovery affected by addiction and treatment and PCO hope. A drop in center provides a safe gateway to substance use information, resources, support and hope for individuals and their loved ones. Sarah has been the Director of Social Work at Beth Israel Deaconess, Plymouth since 2015, and is also a published author of children's books on grief and loss related to the opioid epidemic. We recently reconnected on the writing of a book because we both the dad and just enjoy talking to Sarah hadn't talked to her in a long time. And I hope you enjoyed the interview. Well, hi, everyone, and welcome to episode 99. Yes, this is the episode before the big 100th week. And I can't wait to share that with you. But right now I have someone who has had an influence in my career since 1999, even though I think we were talking and we haven't spoken in a few years now. But we're still close. I consider Sarah, someone who is very important. She brought me into crisis team, she made me do my first valve almost right away. I don't know if she remembers that. But I certainly do. And she really just gave me an opportunity to be the therapist and the counselor and the crisis clinician, and frankly, the person that I am. And Sarah has been there for me on several levels, including when I lost my grandmother. When I had a miscarriage with my ex wife, she was very much a support and a person that I consider. Not only she was my supervisor considered our colleague and today I consider a friend. So I want to say hi to Sara clown. Hi, sir.

Sarah Cloud: 3:50

It's such a pleasure to be here and an honor and it's wonderful to reconnect. You'd have a much better memory than I but we do go way back.

Steve Bisson: 3:58

Well, I made it up. No, I'm kidding. Of course. I even remember when you first started you introduce me to Greg Wileman. And if Greg's listening Hi. And I always remembered how you guys were kind of like you had that instinct thing about a crisis team that had no clue and I felt like I'm overwhelmed. I get this. And I turned out okay, I believe anyway, as a clinician, so And Sarah really helped me with that. Fantastic. So I really appreciate you being on Sarah. And it's interesting. I've known you for a long time, but obviously I know you had my way. But I would love you to introduce yourself to my audience as whatever you want to be you so to speak.

Sarah Cloud: 4:39

Right. Thank you. I really appreciate that. So I have been in the field for a little over 30 years. I think you've met kind of mentioned how far back you and I go. I have a master's in social work from Boston College dates back to 1992. So I'm dating myself and later went on as much as I absolutely love the clinic. work and I continue to be very involved regularly managing and developing clinical programs and supervising clinical team and actually continuing to my love is still emergency room work or crisis intervention. So I still continue to keep my hands involved in it. And I still do some clinical work as well. I also have a great interest in the business aspects. So I went back and graduated with a master's in business administration, from the Isenberg School of Management in 2018. So it's really nice to be able to wear those two hats and have that perspective and the work that I do. And I also very much believe in working with community partners and giving back. And so from that lens, I am involved on a number of steering committees and boards and the ones that I think that are most dear, they are most dear to my heart are the Boston Bulldog running club, there are a wellness community for folks in recovery are considering whether they should be or thinking about recovery, as well as people impacted by addiction. So we have first responders, police officers, family members and other folks involved in this wellness community. So I'm very proud to say that we have 17 Boston Bulldog members running in the marathon 17 Today, right?

Steve Bisson: 6:21

Yes, that's yes. That's awesome. The Boston Marathon is

Sarah Cloud: 6:26

hard, and trained hard and about a mentorship. And so very, very proud of my Boston Bulldog running club. And there's a couple of other ones that are really near and dear to my heart as well as within PCO hope. We do a lot of outreach into the community distribution of Narcan. Treatment scholarships, because Steve is you know, and there's probably a lot of folks that are listening know, insurance tends to only pay for the talks and maybe stepped down after that. But we know that the recovery process needs a lot more support and treatment, well beyond those that short period of time. So getting into sober living situations. So we're housing is such an important step for so many folks. Particularly if they've tried treatment a number of times, they just missed that piece, but a continuation and support and so you know, it's sober living in support. So we do treatment scholarships for them as well. So, yeah, so because some of the things that were involved with,

Steve Bisson: 7:19

and with the community, what community in particular, you're talking about here, just so that the audience knows, because I know, but

Sarah Cloud: 7:26

that is a great question. So a lot of my work has been focused in Plymouth County. Boston, Boulder, county, Massachusetts, in the Boston Bulldogs is we've got chapters throughout the Commonwealth of Massachusetts, and for a period we had a chapter in Chicago. Oh, wow. So we've been largely based here in Massachusetts for that organization.

Steve Bisson: 7:51

And I hope I'm able to link that in the show notes for the Boston Bulldog running club, because I think that's important stuff. I've known you for a long time. I know how passionate you are about that. And I certainly remember even the work we've done. I remember a time when we work together, and you sent me to an opioid overdose prevention program in Western Mass when it was not popular to talk about Narcan when it wasn't popular to talk about treatment. And always remember that you gave me that great opportunity. And I know that that's also very important to you.

Sarah Cloud: 8:21

Yeah, absolutely, I think, carry Narcan. And knowing how to administrative, which is so easy, is the same as knowing how to perform CPR, you probably will never need to use it. But when you do, it's life saving.

Steve Bisson: 8:37

And again, for those of you who don't know, is for every reversal of an opioid or opiate overdose, because those are two different things. And I could go on and on about that. But I'm going to save a little time here, and you can look it up. But I think what happens when you work in this field, especially with the substance use and all that you start looking at your experience, and I know I have my 25 or so years in the field, and you have 30 And there's certainly different settings, different things that happens, but there's also barriers. And what do you think would be the biggest barrier for people seeking treatment at this time?

Sarah Cloud: 9:16

Yeah, I think for behavioral health seeking treatment for behavioral health, which is mental health, as well as substance use disorders. I think it's stigma. It's stigma and misinformation that's out there really stops a lot of us I think from seeking treatment, it causes a great deal of shame, which is so debilitating and keeps us very isolated and alone. And I think also, behavioral health disorders should be compared to and thought of and talked about very much the same way as any other medical disorder or medical diagnosis. So for example, if someone told you, you know, you got stage two cancer, and we know that the use it for things that are effective, they're proven to improving your chances and your prognosis, and putting you into remission if you did it. Very, very people, very few people would say, No, I'm not going to do that. But the number of folks, when we say you've got a substance use disorder, or an alcohol use disorder, we're concerned, here are proven ways. And we have a menu of treatment options that we know could be very effective for you. It's a menu you can choose from, we can mix and match, we can put it together, the majority of the folks, at least the first one or two times around saying, No, I can do this on my own. And we would never say no, I can I can treat cancer on my own. I mean, ya know, so maybe some people might and go to acupuncture and herbal medicines and things like that. But people when I talk with about alcohol use disorder and particulars, such a significant it's far out shadows, the opioid epidemic, which we know is significant, a lot of people say no, I can do this on my own, I can cut back, I don't need treatment, it's really viewed as a character flaw. And it's not a character flaw. But I think like Gnosis that needs medical treatment.

Steve Bisson: 11:18

And I think that that's what happens is that if you tell someone they have cancer, there's no shame into seeking treatment, whether it's stage one to stage four, it doesn't matter. People can go treatment, including, like you said, you know, alternative methods of treatment. When we talk about a substance use, the shame is so heavy on that person, the family and and even, and maybe putting my fellow medical staff on notice here, but sometimes even medical staff kind of shame them, we really need to fight the stigma not only by the community, but I think Do you think that sometimes we also have a medical kind of like view of substance use in general, that's probably also needs to be addressed?

Sarah Cloud: 11:58

Yeah, absolutely. I think one of the best things that I ever think that happened to both the mental health and substance use treatment, world and medical world is people with lived experience, who have succeeded, and they're in remission. And what has worked for them working side by side, with nurses and social workers and medical staff has been an absolute game changer. So you know, working in the emergency room, I, you know, have recovery coaches, recovery navigators that are in long term recovery. And it is a just a tremendous culture shift, and thought process for the medical staff to see that how greatly this disease impacts people, you know, even like, what they would consider normal looking people, they only see people at their absolute worst at their absolute lowest points. They don't get to see the recovery, and the hope, and the healing and the tremendous success stories about how people are able to rebuild their lives and reclaim their lives. And so giving them some of that the medical world some of that through the recovery coaches, has really made a significant shift in how they're think about and how they approach and how they talked to and how they talk about people with that are living with alcohol use disorders or substance use disorders.

Steve Bisson: 13:23

Think lived experience is key, in my opinion. And you know, not that people who haven't had live experience can contribute. I think that's important to remember, too, because I I've said this before, and I learned this when we work together, someone had told me Well, you don't know how to work with someone with kids, because you don't have any kids. And I said, Well, I've never had schizophrenia. Somehow I figured out how to help people who have those diagnosis. I think live experience helps. And it brings to another level what we can do. But if you could tell me more about recovery coaches, because I don't think everyone knows what a recovery coach that is. I think that they imagine someone with a whistle and a hat going, go, go go. So maybe we need to talk about what that means.

Sarah Cloud: 14:04

They do go they do support somebody saying go go go, but in a very different way. So they are people often with lived experience either in recovery themselves. Sometimes I've also seen family members who've been affected by addiction. So they have that personal experience with the disease. And they go through a certification process extensive training process. That includes ethics, as well as you know, many other types of courses and topics and they become certified in the state of Massachusetts. And then they work in a number of different settings. They're out in the community, their detox facilities, they're at other treatment type facilities we have up here and many of the emergency rooms in the state of Massachusetts, up on med surg floors, critical care, helping work engage people with that are living with substance use disorders very often. Know the early stages and when they the throes of the height of their disease process and encouraging them to seek treatment, linking them to treatments, helping them navigate the options that are available all options, whether it be a wellness community, like the Boston Bulldog running club, whether it be a, you know, there's so many different avenues to recovery. And it's not one size fits all, all. There's medications that can help with recovery. So it's really understanding all of those options and helping individuals sort through which ones they think might fit best for, where they're at their life and what their belief system is, and, and then connecting them. And they're really also about offering hope.

Steve Bisson: 15:43

And I think you mentioned another important part is medication. I think that in the past and this is old school a and unfortunately, we still see it sometimes it's a well, if you take medication, you're just chewing your drug, I feel that there's been a significant shift in the a community, but I think we're our medical community has also shifted as a way to help I'll share a personal story here. I had a friend of mine who had seven years sobriety and call me up and had relapsed almost chronically for the last month or so. Not too recently, but recently, and there was even a stigma from that person's part in regards to medication. I think that the change to shifted medication, we need to start using it because it can be effective for individuals with substance use issues.

Sarah Cloud: 16:28

Yeah, I really think nothing should be off the table. What works for one person may not work for the next person. That is not unlike any other disease process. We're always adjusting the treatment plans adjusting, trying different things we should, if anything should be on the table for us to explore. Because the alternative is also so dangerous and damaging. The reoccurrence, this, particularly around the opioid epidemic, one reoccurrence, or relapse could be deadly. And so we really need to be invested in and whatever works. And helping people move up through that process.

Steve Bisson: 17:07

Also say not only Massachusetts, but across the country in the last 10 to 15 years we've shifted. It's a dem problem. People who have substance use issues, to knowing that we all know someone with a substance use issue in some way, shape or form, whether it's a family, a neighbor, a friend, colleague thing that has shifted significantly. Do you think that also working with the families to lift that stigma, because I've seen that many times in my treatment that the families kind of like are either desperate to get home? Or they're shaming them into hell?

Sarah Cloud: 17:42

Yeah, I think families and support systems a really big factor in recovery, because nobody goes through the disease of addiction alone. Or in isolation. That's the family process. I think families often feel like they're to blame, or mental health or substance use disorder that couldn't be further from the truth. So that's, I think, knocking that down and out as the number one thing you are not to blame, you are not at fault. And they need support just as much. And they need to know that they're not alone, just as much as the individual. So yeah, linking families to support is so helpful. And I think we're very fortunate to have in Massachusetts, and I think nationally, some phenomenal family supports. And if there's one silver lining in the COVID pandemic, is that a lot of things went virtual. And so now you can have a virtual meeting, family meeting. I mean, certainly in person, there's absolutely something to be said about it. But to try it out, at least virtually to start this phenomenal support groups for families, a meetings went all sorts of NA meetings, everything went virtual. So there's options, you don't have transportation, you don't have childcare. I mean, those are places to start. So it really helps remove a lot of those barriers.

Steve Bisson: 19:05

I've been doing telehealth for about eight years before it was cool when the pandemic and I can't tell you how that has helped even people who struggle with going face to face whether it's an anxiety issue, whether it's the shame of maybe even using because I know that sometimes we have as providers, we're told if someone is high or under the influence, we're not supposed to see him. In fact, my personal experience is that that's a rich set of data in order to see where the person is at when they are actually using. I don't know if you agree with that and know what your thoughts are, I

Sarah Cloud: 19:39

think any opportunity to engage as opposed to push away or push down. Or you know, no, that's not what you're saying. But there's a sense of rejection, right? If you don't, if you say if you cancel appointment, you don't see somebody so I think the more we have to be with them during this point in their disease process. I think it will only help In the long run,

Steve Bisson: 20:02

I think that that's why for me, I always remember that two of my biggest success stories in my private practice, are people who are actually under the influence while I was talking to them, and I did a lot of the motivational interviewing stuff. And both of them as of this as in the last seven years or so both of them knock on wood, sober doing well, I get messages from them here and there. And that's why I think it's important to just meet a person where they're at versus trying to tell them where they should be. Is that a little bit of what you're talking about, like seeking the treatment a proper way with like, because I think that what we tend to do is we tell them, here's the box, and you got to follow that box. Do you think that there's a better way to seek treatment?

Sarah Cloud: 20:44

Yeah, no, I think that you've outlined it really nicely. I think we're always trying, whether it's mental health challenges or substance use, we're always saying, here's what's available to you. And if you don't, you know, you have to fit into it. If you don't like it, that's too bad. That's kind of what we have to offer. And I think the more we can be flexible and engaging and, and give as much as we can and help folks navigate the resources, I think there's going to just be better outcomes. So I'm certainly not suggesting that we, I hate to use this word, because I think it's a dirty word when able them, you know, to enable them and, you know, an XY and Z. But I think that is not something that we do as professionals. And I don't think it's a word that we should either use the word that she would work on dropping from our vocabulary, it's really about engaging the individual and doing what we can to help them navigate and motivate and like to what they will ultimately be the best treatment for them.

Steve Bisson: 21:45

And I think that I go back to a little bit of our relationship and how much you emphasize the respect of the individual, whether we were working in emergency room, I know that you weren't technically in charge me with outpatient, but technically you were and we had great conversations in regards to that. I also go back to something that people tend to do in the medical field, someone chronically relapses, I still don't like that word, but I'll use it anyway. And then they see him in the ER 789 times and they get the scourge. How do we keep people from being discouraged and getting them the resources?

Sarah Cloud: 22:18

Yeah, so those are the folks that we refer to often here at the hospital and working as familiar faces. So we've got another dirty word, in my opinion, is frequent fliers. Yes, this is the meaning. It's just so anyways, so the folks that are familiar faces, I think it is, can be very challenging as healthcare providers, we went into this field to help people, right, right. And a lot of time when we can't help somebody because we don't know what else to do, or how else to help, as evidenced by them continuing to come back over and over and over again, we start to feel helpless and hopeless and we feel don't feel good about ourselves. And I think some a lot of it, we then put that on to that individual and become frustrated with them. So I think as much as possible, and in those types of situations, I try to change it the team a little bit, who's going in to work with them, maybe a fresh face from our recovery navigator with a clinician recovered, just trade off a little bit, because somebody's going in frustrated, and it's completely understandable. I am human, I get there as well. But that's picked up on and that's not always really super helpful to feel that way. Because I don't think you can make anyone who's in the throes of addiction feel any worse about themselves than they already do. So we don't need to shame or add to that by any means. And I think small wins are even more important than that in the process of recovery. So someone will leave to maybe they and agree to stop drinking hard alcohol and don't really drink beer. I think it's just the small pieces that kind of help us move along the process. I wouldn't take that strategy for you know, the majority of folks in terms of a clinical approach, but I think for some people, that's where it is. That's where we start. And that is, I think, something that that they should feel really good about as well.

Steve Bisson: 24:21

There's so many things that came up to me, the first thing I'm going to say is what I tell my everything I've said on the podcast when people relapse or lapse, I call and that's not necessarily a relapse all the time. To me a lapse can exist also. In when they come in, and they tell me about I say thank you so much. What are we going to do about it? Let's work together. And they usually are surprised because usually the treaters have told him like what's wrong with it, you know, and they kind of like feel shame. And I said, Well, there's nothing I can say that you haven't said 10 times worse in your head. So doesn't matter what I say. So I want to help you instead of just feeding the machines so to speak. And I think that that's very Very important to talk about with people. And the other thing, too is always remember, I want to share this story too, because again, I'm going to show the impact that you've had. And this is the type of person you are. I remember a time where I was frustrated with a particular client who was coming back due to relapse on a regular basis at the emergency room. And one day he like, instead of forcing yourself to go see why don't we send someone else, maybe they need a fresh start. And always remember that this is I want to say this is about 15 years ago, it's not yesterday. But it's also important to have people go in and look at it from fresh eyes, because sometimes that can be the saving grace of human beings,

Sarah Cloud: 25:38

for both the individual and ourselves as treatment providers.

Steve Bisson: 25:42

Well, I also think about trance transference, right? Because we're therapists, but we're humans, and we have some transference. countertransference. And all that brings me to a question I asked everyone I usually ask at the beginning, but here we are now. Have you ever been in therapy?

Sarah Cloud: 25:56

Yes, I think that's a great question. And I'm glad that you asked it. And the answer is, absolutely. I certainly practice what I preach, so to speak, I found myself as many people did, I think, during the height of the pandemic, I was working at a hospital setting I was coming in every day, on site, I was watching some pretty horrible impact from COVID, particularly prior to the vaccinations, you know, and then supporting the staff that are working, heroic, doing heroic things and medical providers and my own team here, and then all the people that are coming in for surfaces without visitors without their loved ones because of the health concerns. And the visitation being paused. And it was just a lot of different layers of really difficult challenging work. And that was a time where I absolutely needed therapy. And I absolutely need to be processing this and taking care of myself. So I can also take care of others. And I wouldn't have been able to do it without telehealth we hadn't shifted to telehealth, I would not avail to leave work on time fitted in physically get to someplace. So to be able to take a lunch break, and be able to have my session with my therapist was was a saving grace. So it's really nice to be able to continue after the pandemic has settled quite significantly, to be able to have the option of oats in Carson and telehealth for so many providers. That was my most recent experience in therapy.

Steve Bisson: 27:30

So you've been in therapy before that even right. Yeah, I think that therapy is such a saving grace for myself. And I'm going to share this because it's important at one point I was like wasn't I'm if I'm a therapist, I don't have to go to therapy, I know how to handle this stuff. And clearly after five after a couple of years, I realized I can't handle this myself. I think that we talk about stigma a lot. And that's what I like about our conversation, Sara, how about we lift a little bit of the stigma even for other professionals to reach out for help, because I think it's hard for people to do that, including other medical professionals, whether it's doctors, whether it's nurses, everyone else, I'm not trying to forget anyone here by any stretch, but how do we lift that stigma for them?

Sarah Cloud: 28:12

Really great question. It's so hard. I don't know what your experience has been like Steve. But looking at or thinking about who I'm going to see for therapy was that was really challenging because I have all the people that I would want to refer myself to I either have or I have a professional relationship with. So I think it puts me in a fortunate position in order to be able to refer loved ones and friends to the great therapist, but it makes us lose me a little floundering for myself a bit. But I don't know what your experience was what that was. But

Steve Bisson: 28:42

I actually see a lot of medical professionals besides first responders, which is my two passions, but they're usually not at all from my region, because they're like, oh, no, I know, Steve or I know of Steve and all that. So it's always nice to have that. But I think that lifting that opportunity for everyone is also important because I don't know about you. Well, maybe you do. But I don't have all the answers. I certainly know I don't. And I think that medical professionals sometimes go in and thinking that we need to know all the answers. And I think I tell people, you know what, I'm a human being. I don't know everything. Yeah.

Sarah Cloud: 29:15

Yeah, I mean, a lot of the work that we do is really focused on knowing what to do and, and having that background and education. But that doesn't mean it gets any less in need of more benefit from from therapy.

Steve Bisson: 29:29

And I think it's hard to tell people to go and get therapy sometimes in the medical profession, not only because they know people, I think there's a stigma associated with that. And it's really finding with telehealth, I see medical professionals from all over the state except where I am. And I think that that's helpful. Now I actually see people from other states as a coaching type of situation. And I think it's we have that opportunity. I think that we need to tell our medical professionals that guess what there's going to be someone if you live in In Springfield, blank state because there's Springfield in what, 30. United States or something, then there's gotta be someone far from that area that you can see and talk to.

Sarah Cloud: 30:10

Yeah, yeah, absolutely. And I especially, you know, not to always keep bringing it back to the pandemic. But it's going to take us a long time to recover from, particularly medical providers, I think and everybody, that's not I shouldn't single that out. It's left quite a bark. And so if now, more than ever, we certainly need taking good care of ourselves, and that includes going to therapy.

Steve Bisson: 30:34

Well, I don't see you excluding anyone, when you said that, I think that we're on the subject of medical professionalism, I think that they saw a lot of hard stuff. You know, I have a lot of medical doctors who told me they like seeing someone pass away, and I'm the last one to hold their hand. And they didn't really know me until about a few hours before that. That's a big burden to carry.

Sarah Cloud: 30:56

It is. And I know that they have a lot of experience with death and dying. And we saw it in particularly in the hospital setting and acute care setting rates of death that were that far exceeded what I think we would have been used to at least in a community hospital, here and south shore of Boston, rates that were that were pretty significant.

Steve Bisson: 31:20

And I would say that I've worked with rural doctors. And I know a few doctors and nurses in particular in the Boston area. And their numbers were also staggering and very hard to comprehend at times. So I don't think it's just like any type of I think it's every site. And I think that we're, I think what we've seen and you know, maybe we can switch a little bit to this. I think what happens in the medical field in particular, we get burned out. And the first person to ever call me out on my burnout in therapy is the person we're talking to right now, Sara, and I really can't tell you how much I appreciate that. Because originally I was angry. No, I can handle this. No, I can handle this. And you said the words. I'm not questioning if you can handle this. But I want you to handle your own life first. And I'll always remember that you said that. And I think that we need to work on that problem, too. Because we the burnout, that we've just got rid of a lot of nurses and doctors who just can't think and frankly therapists and clinicians. How do we address the burnout in this type of field, especially when you see so you know, we talked about COVID and the pandemic, the opiate overdose crisis, in my opinion is still going in across the country. We have other issues, including increased financial stressors, homicide, suicides, how do we help people just get to a point where we're not just like giving they need to not burn out and give them the time they need? How do we know you work in a hospital now? So how do you do that?

Sarah Cloud: 32:54

I wish I had the answers for that. I do have thoughts about directions. I think the demand is so high right now. And it's coming from every angle. It is incredibly difficult work. I think it was incredibly difficult work prior to the pandemic. And now it's feels impossible some days that I know that we have our foundation that we can always go back to that foundation is looking at our lifestyle. It is getting outside in some way shape, or form to reset. It's about connection to others. It is about trying to eat I know I fail on this all the time, because it's about eating well. It's about getting enough sleep. It's about everything in moderation. So if you're not in recovery, or we don't have don't feel like you have a problem with alcohol or other, this gambling, there's all sorts of other challenges, that if you take care of all of that in moderation, and you set that foundation of wellness, it makes it a little bit easier every day to then go into work and be faced with the challenges. And I think when we have things going on in our personal lives that are very demanding or hard, and we all do, we're human. And then you balance that then you add to that with what's going on at work. And then then you take away that foundation of wellness around that it's really hard to sleep when you're stressed or you're maybe trying to deal with the stress, you may have a little too much to drink and you actually think that helps you sleep it actually doesn't it interrupts your sleep pattern. Until all these things can really just very, very quickly get out of control. And leave us feeling like even more stressed. So I think the more we can go back to basics that we know that work for us at reset us and put that foundation and that foundation is we move our bodies we get outside or we go to the gym we meditate like whatever it is for you. That resets yourself for me. I used to be running with the basketball dogs running club and I'm still very much in love often on the board and support of them, but I've shifted to tennis, tennis is getting out in the court is my way to physically reset. So I think having something that helps you physically reset is incredibly important in surviving and thriving and not getting worked out.

Steve Bisson: 35:20

I was at a training recently, and it was the immune system and mental health and how it's related. And I really liked that training. The two things that they mentioned that is consistent throughout most research, we talked about exercise, which is very important, but social interactions, people who have social interactions, they're more likely to survive even a stage four cancer than the ones who isolate. I'm not gonna go into Carlos monkey too long. But that's the study that if you want to go back and looking at it, it's a mother that was made of metal and one made of like, cloth, and the monkey would always go the cloth when even if it was hungry, because it was more comforting than a metal mom. But go look it up. I'm giving you the big points here. But I think that you talked about doing exercise and being with the Bulldogs, I would add that you have that social aspect that comes from that that probably is a great benefit, in my opinion.

Sarah Cloud: 36:14

Yeah, absolutely. That is one of the primary focuses of the Boston Bulldogs running club is to is that social connection, and that alone, we suffer but together, we thrive and being part of a community. So it's really the physical piece of it's super important. I don't want to downplay that. And I don't want to upset any of my Boston Bulldog colleagues and peers and friends. But that connection that community is so important aspect of it. And I think that is one of the reasons why the pandemic has left such a significant mark on our on our lives, and is because we are so isolated. For our survival for our physical health, we are so isolated that really impacted our mental health. And then there's that the mind body connection. So also our physical health. I think we saw rates of dementia skyrocket, we saw rates of alcohol use disorder skyrocket, depression, suicide, at every aspect of our life, we saw a significant increase because the isolation, I mean, we know alcohol use disorder as a progressive disease, progressive just like most cancers, most cancers start at one party body, they start slow, some are slower types of cancer than other types of cancer, some are more aggressive. That's really not unlike alcohol use disorder, a lot of folks isolated home alone, during the pandemic board, what else we're going to do stressed, what else we're going to do was have a couple beers or a couple glasses of wine or whatever it was. And over time, it crept up, like so many people. And it does, it's a sneaky, progressive disease. And before you know it, oh, I've know I've gained a lot of weight, or my spouse is saying I have concerns you need to cut back. You know, so it really, particularly I think the pandemic really fast track a lot of these diseases that we know is progressive. And we need to kind of get back together as a society in support of each other, back to that foundation of wellness, and taking care of ourselves. And I think one of the things that was really surprising to me, even as a health care provider, was the number of folks in the community. And it's not just the community I work with, it's I've spoken to so many other professionals, they were not aware of the impact and the dangers of alcohol withdrawal. So regularly even, let's just say not just but if you know, a bottle of wine a night or half a bottle of wine a night, consistently for a long periods of time, you're going to experience withdrawal symptoms, and it's one of the few substances or that you can actually die from your with through seizure. So when people come in often thinking they're having a heart attack, and I'm glad they came in. They're having a severe panic attack. I'm glad they're coming in to the emergency room. They're actually in alcohol withdrawals and had no idea that that was even possible. Based on the amount they're drinking, their body just wouldn't physically react to that. So I think there's been a lot again, that goes back to the misinformation. You know, what is one of the greatest barriers you said to seeking treatment is misinformation, stigma, so not understanding and being well educated? And how would you be educated on that? Who would know that? And so I think it's just really important to get that information out as well and an address again, still also address the stigma.

Steve Bisson: 39:46

I agree. 100%. I would also add that during pandemic we all turn to social media. And one of my biggest pet peeves during the pandemic is that it was one o'clock or it's five o'clock somewhere and it became such a acceptable thing to drink? And, oh, we're doing meetings online, I don't have to let them know what's in my coffee, right? Because it's not real coffee all the time, too. And I'm like, you know, you're screwing yourself over. Right? And I think that that's part of what happened to I don't know what you think about that. But

Sarah Cloud: 40:18

I agree. And it's, you know, social media. It's right, you know, mainstream media, and mean, everybody, it's so socially acceptable to drink, it's actually a little bit more awkward. What's wrong with you? You know, why? Why? Why you saying no, it's much harder. And I hope we all can do better. If a friend says to us, no, thank you awesome water, that we respect that we don't need to question that we'd never do the opposite. You know, like, why are you having a drink? But we do ask why you're not having a drink. So let it be. I think there's a really cool things movements on your way, though. There's a lot of really great social media pages on recovery now. It's really, really inspiring and successful success stories. The other great thing that's happening right now was people were taking a break, to taking like a two week challenge, taking a break to see what goes for them. And a lot of people are realizing I had no idea how much alcohol use even though I maybe wasn't drinking a lot, maybe just having two glasses of wine with dinner really impacted their lives and how much better they sleep and how much the weight came off, and how much clearer they thought. And so these are folks that you maybe you and I, Steve, as professionals wouldn't have diagnosed with them or even had any concern about an alcohol use disorder. But once they removed what they were using from their lives, for a couple of weeks, just to take a break. They like, Wow, I feel so much better. So I know there's a lot of podcasts and people talking about that, that are really great and educational. So just hitting pause for a couple of weeks to see how it goes for you. Even if you don't think you have a problem, because you probably don't, that's fine. It can be really helpful and eye opening for all of us.

Steve Bisson: 42:02

I agree wholeheartedly. And I think that talked about a few things here that I really want to hit. If you go somewhere and someone says I don't want to drink, or I don't want to go, I'll get a Pepsi, I'll get a water I'll get a soda get whatever they get. I think that we need to learn to be okay. And not really ask why? Because I think that that why question is like, someone's having water and someone's having, you know, fuzzy water. They go why having fuzzy water? No, we don't say that we just let them be. And I think we gotta learn how to let be of people. And you know, I think you're right, we have a lot of colleagues, friends that we would never have suspected of that I certainly have been open with most people not knowing how bad it was for me two years ago. And nowadays, I'm very happy to say that I don't have that problem anymore. But I'm like one situation away from getting back onto it. And I'm not afraid to say that. I think we need to change the perception that it's only blank people who have that. And I don't like to word word people. But that's how we perceive it. And we need to change that.

Sarah Cloud: 43:04

I think that's one reason why I'm so impressed with the recovery movement around recovering gators, recovery coaches, because those are folks that are recovering out loud. And I think the more people it's a personal choice, and I would never push somebody or out somebody that's in recovery. That's their position. And that's their choice to do that. But I think the more people who recover out loud, it will make a significant impact. And I know I see a lot of folks, celebrities, saying that they're in recovery, and they don't drink anymore, being highlighted. And I think that helps really, I think really influence other folks that I like helping somebody that successful. I've had a problem with alcohol use or substance or whatever it is. And I've been continued to be so successful in doing so well in recovery. And I think the more we can really support people in recovering out loud, I think the better it will be for for everybody.

Steve Bisson: 44:04

I think that there's also I don't know which agency I saw it on, but they were talking about sober weddings that have been going on for six months to a year where there's no alcohol served at the reception afterwards. And I think that's a brilliant idea. I think that it's it's something that I really admire personally, and I think it's a good way to start thinking about it differently.

Sarah Cloud: 44:24

Yeah, I think a lot more restaurants are offering mocktails which are kind of fun. And you know, we don't again, you don't necessarily have to be the one to know that. You know what you're drinking, you're not drinking, that's their business. It's never anyone else's. And there's been sober tailgating, just cool to forget about that. Yes. Yeah, there's a lot of really great things on your way in our society. So we're very fortunate to see that happening. And we need a lot more of it.

Steve Bisson: 44:51

Well, you know, Sarah, it's always important for me to also bring up something else that me and you have in common is we're both published. author's. I'm switching gears here because I can go on and on about substance use for hours. And I can thank you for that too, when I decide not to be at the work at a jail anymore, and you're like, I think this substance use thing and the parole officer, really, I don't know, Sarah, and you kind of pushed me into that and talk to, you know, a lot of things. No, I either it's a good thing or a bad thing, but I known you for over 20 years, I really, truly see the influence you've had on my career in a good way. And I say these things, and people are gonna be like, Oh, she forced me and a lot of things. But she never put me in a situation to be clear, for me to fail. If she thought I was going to fail, she would send me some reinforcement, she would give me everything that she can in order for me to succeed. So just want to make sure that people don't think that like Sarah was like this, do this do that she's never was that way. She did push me once in a while. But we all need a little pushing. I saw

Sarah Cloud: 45:55

your potential and where I might be a good fit from a distance. And I was always open to hearing otherwise, that it wasn't a good fit. position. So you did amazing.

Steve Bisson: 46:08

Thank you. I appreciate that. And I remember even when I started, I got, we worked on a contract in Western Massachusetts for parole. And we started getting bigger and bigger in Worcester. And now is, obviously I would make contacts we had a great Vice President, that was really amazing Ken Bates, who also had a lot of contacts in Worcester, and Sarah and I and Ken will always like close these deals in western we became a lot more important when we worked at an agency in Worcester. But I'm digressing here, because I want to ask about your books, because I can say books now. I only have one, so I'm just a human being. But tell me more about your books, because I really, you know, obviously we connected on that subject a few years ago. To hear more about.

Sarah Cloud: 46:51

I am a self published author to children's book series on hope and loss of a parent to the opiate epidemic. And I never saw it set out to be an author, little an author of children's books. But the more I looked, the more I asked them all right networks, looking for elementary school age appropriate materials for children to help them with the loss, the more I realized that there was a huge void. I know it's a difficult topic, a huge void. I wasn't able to find anything that existed. And I was talking to Joanne Peterson. She's the founder of learn to cope. And so we're sitting, getting ready for a taskforce meeting. And I was talking to her and if Joanne Peterson didn't know of a book like that existed, it didn't, it just didn't exist. So at that point, I decided I was going to do my best to try to fill that void. And you know, another piece of this, that was really important for me making this decision is I have been in remission from breast cancer for 14 years. And so I was young I was in my mid to late 30s. At the time of my diagnosis, I had two young children, two young girls. And I that was really hard for them. And one of the things that really helped them get through that was some really great children's books, and literature's on what to expect, you know, and what was going on and reassuring them. And so, books at that age were really helpful to my family, my daughter is getting through a very difficult health crisis. So I thought it was really important meant a lot to me to have some books available to help children get through or try to begin to understand the loss of their parents, whether they may complicated, they may have had a really good relationship, they may have spent a lot of time with them. Or unfortunately, because the disease of addiction, we know that the relationship can be not as consistent as I think the parent would want it to be, or the family would want it to be because the nature of the disease and the progression of the disease. So I felt was really important to to write something so I did. And so the book series is called mama Pakka. So that's Ma Ma P a CA and I have a website, Mama pakka.com that helps introduce the topic of addiction to children how to introduce the books, seems to reinforce throughout the books, and just in general, when talking about this disease process to young children. And also as I learned and connected and found more books for children, I link them in there. So no one else has to kind of be struggling and looking for these books. So there's books linked there for children that are living with their in their childhood and as so they've had been born exposed or addicted to substances that will be it's in particular and what that's like and how that impacts their lives. There's children's books on that. There are Our children's books about a parent who hasn't passed away that are struggling or living with addiction. And then also for teenagers and young adults, there's a really great book a graphic novel, what it was like to grow up having, I think, in this particular case, a mom that was living with the disease of addiction, and that one's a very well known author that other people are probably well aware of called pay, kiddo. But anytime I find a book, I link it to that website to have it all available in one location. And then very briefly, after that, I after the first book, Mama Paco, my, my heart won't want to go. So a little girl who loses his her mom to addiction. I wrote a book about a boy who loses his dad. And that book is particularly near to my heart because a Boston Bulldog running club leader, Sean Stockton had been in recovery I think for almost four years, doing phenomenal running marathons. And very much again, a leader and somebody we absolutely looked up to in the Boston Bulldogs. He had a reoccurrence. And the reoccurrence was deadly when he passed away, and it's going to be two years in June. So I teamed up with his brother and his sister, as well as his parents say, What do you want the world to know about Shawn and how his disease progressed and started, and how he what avenues and outlets he had for recovery. I mean, four years is such a tremendous success. And wellness was a really big avenue for him, he tried so many different things. And wellness, and particularly the basketball running club was very significant piece. And so in those four years, and in recovery, he was able to heal many things, including relationships with his family, including her relationship with his son, his young son. So a lot of wonderful things happened in recovery for him in connection with the wellness path. So we wanted to tell his story as well.

Steve Bisson: 52:05

You know, my daughter's read the first book, we haven't read the second book, and they really enjoyed it. And they gave high praise, I read it high praise also. And I'll link your website to the show notes. So that way people can go and visit it. The other thing too, is I truly appreciate you sharing about surviving breast cancer. As you said earlier, you know what out people, I was hoping you'd bring that up, because it's an important thing to talk about. But I wasn't going to out you because I have way too much respect for you.

Sarah Cloud: 52:33

Thank you. Yeah, no, very much. I think it was a very important influential crisis in my life that led to really wonderful, so many wonderful things, and they maybe don't really talk about on your podcast, but it really significant changes both in my personal life as well as my professional life and, and my focus. So thank you.

Steve Bisson: 52:53

So yeah, I just, I remember being there, when you're going through that and just realizing how much you know, and not that there's anything wrong with where Sarah was prior. It has definitely changed her even better. So it's not like it was bad before. It's just got even better. And like you said, we might not share a whole lot here. And that's maybe a private conversation for me and Sarah, no one no one else. No. But I truly saw it in you and having that. I tell people I lived vicariously through you. And a couple of other people we know from our agency we used to work at who had that. And I realized that it's so important to support people. And it's not about supporting this is something I say constantly to people, it's not the first week, it's not the second week, it's the fourth week, it's the seventh week, because this is not a battle of a day or two. It's a battle that is consistent. I know my friend who recently and hopefully at this point is done with his surgery says no survive colorectal cancer. And he was like you were the only one consistently checking in with me. And I'm like, Yes, because I live vicariously through a few people.

Sarah Cloud: 54:05

Yeah, it's a it's a long haul. It's it's, it's a marathon. We're not it's not a it's not a quick and easy done. And it's something that we always continue. And again, it brings me back to I don't want to belabor the point. But my recovery and in remission for breast cancer is a lifelong, you know, I'm not I'm done with chemo, I'm done with radiation. It doesn't mean that I don't need to pay attention to it doesn't mean that I need to to not pay attention to that foundation of health and wellness and movement and, and whatnot. It's a forever thing. It will always be in my life and something that I need to focus on in terms of my health and disease process. And again, it's not unlike the experience that people have with with addiction. It's something that's a continuous everyday forever thing that's paid attention to

Steve Bisson: 55:01

And I think that looking at it from an experience perspective, I think that that's what most people tend to forget is that call it positive call a negative, I'm not a big fan of positive or negative experience, experiences or experiences. And we can only grow from there. And you can have a bad experience with a person or a situation or what have you. It's what you do with that experience that really pays off or not in the long term. So I again, I appreciate your openness. And thank you for that.

Sarah Cloud: 55:28

Yeah. I mean, it's one of my favorite sayings, right? You know, very well, crisis is opportunity.

Steve Bisson: 55:33

Yes. Very much. So. Like I said, that was experienced I had sometimes it was received in a different way. Nowadays, I absolutely get it and it's sometimes got to age a little bit in order to really understand it. Well, Sarah, as we wrap up, we've been about an hour already. I'm gonna link the Bulldogs. I'm gonna link your website. Anything else that you want to share with people or?

Sarah Cloud: 56:00

No, I appreciate the opportunity to connect with you on this. We connect with you on this level as well, Steve, I think it's really awesome. The work that you're doing in the podcasts, I always catch someone I'm driving in the car and love that you're getting this out to our community to our to the public.

Steve Bisson: 56:18

I can't thank you enough, Sara. And, you know, I was in Plymouth not too long ago. And it was like, seems weird to call Sarah and say I'm, I'm in Plymouth and no lo and behold, they text you for restaurants. And you had some advice from me. So thank you for that.

Sarah Cloud: 56:32

Next time, let me know that you're going to be in the area we'd love to meet up

Steve Bisson: 56:36

that I would love to meet meet up with you too. So thank you, Sarah. And I can't tell you how much this is going to help people I hope listening to this. I hope so. Well, that includes episode 99 of finding your way through therapy. Sarah cloud, thank you not only as a person who was my supervisor, who I consider also appear at this point. I also really appreciate our conversation. I thought it was AMAZING talking about substance use talking about how to make things a little easier for those who are seeking treatment, particularly substance use. And I love the analogy to cancer treatment. But next episodes will be to celebrate my 100th episode. This is there's going to be 100 episodes, obviously that I release every week, but there's going to be at least three more special episodes that week. And these are guests that have been on before they re invited and they kind of mashed it up with other people. So I do hope that you come back and listen to that. And don't forget to go listen to the site craft network. I will link it in my show notes.

Unknown: 57:42

Please Like Subscribe and follow this podcast on your favorite platform. A glowing review is always helpful. And as a reminder, this podcast is for informational, educational and entertainment purposes only. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor for consultation. If you are in a mental health crisis, call 988 for assistance. This number is available in the United States.