Taking the Shame out of Anxiety and Addiction (With Tori Lynn Panzarella) | Ep. 396

Managing anxiety and addiction can be a very painful process.  It involves high levels of shame, guilt, and distress. In this episode of Your Anxiety Toolkit, Tori Lynn Panzarella discussed anxiety and addiction, highlighting the importance of compassionate care. 

 

There are many key components of anxiety and addiction treatment.  It is not a matter of “just stop doing it” or “going cold turkey”. In fact, we have evidence that this approach is very unhelpful.  Here are the most important approaches to anxiety and addiction treatment. 

The Power of Compassionate Care

Compassionate care is at the heart of effective addiction and anxiety treatment. Treating individuals with dignity and respect is crucial, and understanding the power of words is a key part of this. Terms like “addict” can stigmatize and hinder recovery. Instead, recognizing individuals as human beings struggling with substance use can significantly reduce shame and promote healing.

Overlapping Symptoms and Treatments

Anxiety and addiction often share similar symptoms and treatment approaches. Exposure therapy, commonly used for anxiety and OCD, can also be applied to addiction. For those recovering from addiction, daily exposure to withdrawal symptoms, cravings, and triggers is akin to the exposures faced by individuals dealing with anxiety or OCD.

The Role of Medication

Medication-assisted treatment can be a lifeline for those experiencing severe withdrawal symptoms. Medications like methadone or suboxone help manage these symptoms, allowing individuals to focus on their recovery. This approach should be viewed with the same respect as any other medical treatment, reducing the stigma associated with using medications in addiction recovery.

Breaking the Stigma

Stigmatizing language and attitudes towards addiction can keep people stuck in their struggles. Educating ourselves and others about addiction, using non-stigmatizing language, and offering support can help break this cycle. Viewing relapse as a recurrence of symptoms rather than a failure is essential in fostering a supportive environment for recovery.

The Importance of Support Networks

A team approach to treatment, involving medical professionals, therapists, and support groups, is often the most effective way to support individuals with addiction and anxiety. Building a strong support network can make a significant difference in recovery, providing the community and validation needed to overcome these challenges.

Realistic Goals and Person-Centered Care

Treatment plans should be tailored to individual needs and values. Whether the goal is complete abstinence or moderated use, it’s important to support individuals in their unique recovery journeys. Motivational interviewing can help navigate ambivalence, helping clients make informed decisions about their treatment.

Understanding the Biology of Addiction

Addiction alters brain chemistry, making it difficult for individuals to cope with distress without substances. This biological aspect underscores the importance of compassionate care and the need for medications to manage withdrawal symptoms effectively.

Addressing Alcohol and Marijuana Use

Alcohol and marijuana are common substances used to cope with anxiety, but they come with their own risks. Alcohol, a depressant, can exacerbate anxiety and depression in the long run, while marijuana’s effects vary from person to person. Understanding these substances’ impact on mental health is crucial for effective treatment.

Educating ourselves about addiction and anxiety, treating individuals with compassion, and breaking down stigmas are vital steps in supporting those on their recovery journeys. Building a strong support network and setting realistic, person-centered goals can help individuals navigate their path to recovery more effectively.

By incorporating these principles into our approach to treatment, we can create a more supportive and understanding environment for those struggling with anxiety and addiction.

Transcript: 

Kimberley: Welcome back. Today we have Tori Lynn Panzarella. She is bringing us such a beautiful conversation, and I’m actually so deeply grateful for us having this conversation. Welcome, Tori Lynn.

Tori Lynn: I appreciate it so much. I’m so excited to have this conversation with you.

Why is Anxiety and Addiction so Important to You?

Kimberley: Tell us about why this topic of anxiety and addiction is so important to you. Tell me a little bit about the background of how you became an advocate and a clinical provider in this area.

Tori Lynn: Yeah, totally. I’m going to try to keep this concise, but I think that the context is important here—my journey and how I came through my own experiences with education and how it led me to where I am practicing now in my private practice. I feel like the backstory is useful information to have, so I’ll try to be concise with that. But basically, starting out in my undergrad program at Rhode Island College, I ended up working through a double bachelor’s degree, one in Psychology and one in Chemical Dependency and Addiction Studies. I came upon the Chemical Dependency Program. You might hear me refer to that as CDAS for short. But I came across it through a friend who was like, “I’m in this program, and it’s really great.” And so, I joined that program where I could get two bachelor’s degrees and learn about addiction and recovery. 

It was at that point where I was able to learn under Dr. Beth Lewis, who I credit a lot of my professional growth and development to her. I think she made compassionate care for addiction cool before it was cool. I think she was the one who was like, we have to treat our patients, our clients with dignity and respect, and we have to respect how much control addiction can have over an individual and how it overlaps with so many other mental health concerns like anxiety, depression, OCD. We see that comorbidity often with substance use. It’s usually comorbid with something. She really led me to this place of understanding that addiction treatment needs to be focused with a compassionate lens. We need to see our clients as people who are struggling with a disease. We know that there’s a lot of controversy about disease model and a lot of controversy about, is this a disease? Genetic? Is it choice? Are they just making the decision to use substances? There’s so many opinions about it. There’s a lot of research about it, how 40 to 60% of individuals who are struggling with addiction, 40 to 60% of that is genetic. On top of that, we have the predisposition, the environment that people were raised in, the environments that they had access to certain substances. Once that substance takes hold of someone, it turns into that disease model of the brain, where the brain now thinks it needs that substance to survive. 

When I was in this program, the CDAS program with Dr. Lewis, she talked about the power of words. We don’t call people addicts. We don’t talk about people as failing at recovery or not being in recovery if they’re taking certain medications or not being in recovery if they’re having lapses. A lapse is a symptom of addiction. This is just how it is. Just like any other mental health concern, if you have anxiety, and there are moments where you’re doing really well with anxiety and moments where anxiety’s really loud, that’s a symptom of anxiety. Same thing with addiction, when you have cravings and withdrawal symptoms and triggers to use, and even those moments where you do end up using a substance, that’s a symptom of the diagnosis. And so, I was really inspired by her and learned so much about just being compassionate in this recovery. 

Moving forward, after I completed that program, I worked for nearly eight years in a medication-assisted treatment program. And that’s where I was a substance use counselor. Our focus there was treating individuals with opioid use disorder. We treated them with methadone. They took a daily medication to help mitigate withdrawal symptoms and cravings to use. Again, I was so honored to have the experience to work under a supervisor who was so dedicated to her clients. Her patients, when you talk to them, you knew they believed she was on their side. First and foremost, she had their back. It didn’t matter what state of their recovery they were in. It didn’t matter if they were actively using, if they were in recovery and not using at the time. She had their back. She was just there for them. I get to watch this. First, I have Dr. Lewis, then I have the supervisor. Meanwhile, all these things are like taking seed. They’re just planting in my head about here’s how we need to look at addiction. 

And then as I’m doing the work of a counselor in that field, I notice there’s a lot of overlap here with shame, and there’s a lot of overlap with regret and guilt and anxiety. I’m like, “Wow, there’s just a lot of connection here.” 

I think that’s where, fast forward, I go into the Rhode Island College. Clearly, I love Rhode Island College, and I shout out to them. But I went into the master’s program for clinical mental health counseling. Again, the professors there, they’re dedicated to their students, and they’re, I think, even more so dedicated to the people that those students will end up serving someday and teaching us about here’s the science, here’s what we know about shame and how it doesn’t propel or motivate or build momentum, and how it just keeps people stuck.

In 2020, I believe it was, is when I got my LMHC and I opened up my practice. Working in private practice, I’ve been working with a lot of individuals who struggle with anxiety, OCD. Either they struggle with substance use or a family member struggles with substance use. Listening to your podcast and hearing about the themes of compassion and not perpetuating shame, and being mindful of the words that we use with people, I’m like, “Wow, there’s a lot of overlap in how we want to treat people here.” And so, I end up in this spot where I’m seeing how treatment plans overlap and how we’re using similar things. We’re using similar concepts. I mean, I could apply ERP to OCD into anxiety, but also in a sense to addiction and recovery. We do a lot of urge surfing. We do a lot of tolerating distress. For someone with addiction, we do a lot of sitting with the discomfort. The exposure is there every day. Their exposure is from the moment they wake up to the moment they go to sleep, if they can sleep, and their exposures are withdrawal symptoms and triggers and cravings to use, and peer pressure, and all the things. On top of it, long-term use of any sort of substance dulls our senses in a way. We end up having lower distress tolerance. We’re not really able to tolerate the anxiety that comes up. Now we’re fighting that in addition. 

Really, that’s where I’ve come to this place of saying, “Okay, there’s just this whole thing where these diagnoses, they overlap in terms of treatment. They overlap in terms of symptoms. They just look a little different.” I guess that’s where the passion of mine of being mindful of my words, being mindful of how I treat people, being mindful of demonstrating how we can show compassion to other people. It’s been a passion of mine for just so long, as you can probably hear as I talk about it. But it’s something that just runs so deep. I credit my experience in education and with working with individuals, where not a lot of counselors get access to working with individuals with substance use concerns. I feel like it’s almost like this in the off-to-the-side category, but if we stood back and really looked at how much it overlaps, I think it would be pretty shocking for a lot of therapists to see.

Why Words Matter in Anxiety and Addiction Treatment

Kimberley: Yeah. I feel like we could just end the episode there and be like, “Wow, I feel so inspired. I just want to go to work.” I have so many questions for you. You talk about this compassionate care, and I think, as you were talking, I was thinking about messages I was given as a child from society around addiction. I think that — I mean, maybe not, but I think that we all have those, like it’s weak. It’s similar to anxiety, like you’re weak if you use, or you are weak if you’re doing compulsions. Or we get fed these messages of you don’t have a lot of control of your body. Tell me some of the ways in which you do talk. You said words matter. How can we improve the way we talk about these really painful conditions?

Tori Lynn: I mean, obviously, this is opinion-based, but similar to the way that we talk about anything else. We have a lot more compassion, I think, and we still have a long way to go. But with anxiety and depression, we have a lot of compassion for that. But with addiction, we tend to lean into this idea that this is a choice. You chose to use that drug. You chose to pick up. Knowing that you’re working on your recovery, you chose to engage in that behavior. I think what happens is we forget that the consequences sometimes of using the substance of the addiction, the consequence of engaging in the compulsion of use, can be much more profound than maybe our more covert anxiety compulsions. We can do a lot of those under the radar, but we can’t really do these other compulsions when we talk about addiction or substance use. It’s not really under the radar because there’s law enforcement. There’s behavior that you would not normally engage in that you’re engaging in. There’s things that are associated that are much more noticeable to other people and therefore much more stigmatized. 

When I talk to people about their own journey with recovery, I talk to them about, let’s talk about the messages that we’ve all received. We’ve received that we’re weak if we use substances. We’re weak if we can’t control our anxiety. If we have a lapse or recurrence of symptoms, which again, Dr. Beth Lewis was always really good at saying like, when somebody uses or has a relapse, it’s just a recurrence of their symptoms. Their symptoms are just happening. That’s what’s going on. The same thing with anxiety. When we’re engaging in those compulsive behaviors or ruminating, the symptoms are just showing up. And so, trying to educate people, especially people who are struggling with substance use, educating them on like, let’s be kind about the process. It’s not linear. It’s going to be ups and downs. We’re going to have moments where we use, saying, you have 90 days under your belt does not mean you’re never going to use a substance again. You very well might use a substance again. And that doesn’t take away from all the work that you’ve put in. That doesn’t mean you’ve automatically never been in recovery. And that’s a stigma and something that I think is really bought into in the way that we treat recovery. It’s like you’re either abstinent or you’re not. If you’re not abstinent, you’re not in recovery. But that’s not true. We know that about all sorts of diagnoses, like anxiety. We know that, no, you can still feel anxious, you can still engage in a compulsion, and you can still be on your recovery journey. That’s part of the process. So really educating people on how they talk to themselves. 

If somebody tells me, I identify as an addict. The word itself makes me cringe, but that’s a privilege of mine to know that I have the ability to say it makes me cringe. But for someone, that could be an identifying factor for them. They’re like, “No, I’m empowered to say I’m an addict and I am in recovery.” If that’s their label for themselves, a hundred percent in support. I just like to pull it apart a little bit and say, “Okay, is there any part of that statement that hinders you from working towards where you’re trying to go?” And if there is, then maybe we can use something different. Like, I struggle with substance use, or my symptoms are flaring up, or whatever it is. I’m not going to tell a client what language to use for themselves, but I will educate on the language that can cause a barrier to their recovery, or at least have the conversation with them. This could cause you to feel less than or inadequate. Can we just adjust it a little bit? I want it to feel authentic, but I don’t want you to get in your own way by calling yourself something that feels degrading or like you’re less than. 

Kimberley: Yeah. Again, as you were talking, I’m thinking about conversations I’ve had about OCD or anxiety, depression, eating disorders. These same sorts of words matter. We do get to choose what’s right for one client. Some clients might say, “I’m proud that I might say I have OCD or I have an eating disorder.” Not that they’re proud of the disorder, but they’re proud they can take it as a part of their identity, whereas other people don’t. They say, “No, I’m a person who suffers from anxiety or an eating disorder.” So interesting. 

Anxiety and Addiction Treatment Statistics

From my experience clinically—but I want you to share if you have other experiences—I often see clients who’ve had anxiety disorder or an OCD-related disorder, struggled for years, haven’t had a good recovery or good access to care, and find that substances is a way to cope. They’re often the clients I see. Is that often similar to you, or what does it look like in your population that you see?

Tori Lynn: Yeah. I think there’s such a wide range of factors that play into if somebody develops substance use disorder. Like I mentioned, 40 to 60% can be accounted for by genetics. But we also know that an environment where maybe talking about emotions wasn’t supported or we don’t talk about mental health. I stand by this. I realize this is again opinion-based that I had heard from — I can’t remember which professor, but one professor had mentioned, if you didn’t have trauma before your addiction, you definitely had trauma after your addiction or during your addiction because addiction in and of itself can be traumatic. I think that there is absolutely a quality that is numbing when we talk about substances, when we talk about opioids or benzos or even—there’s a lot of controversy—marijuana. Everyone has their own experience with that, but there’s a numbing quality to any substance that we put in our body. The more that we use that substance, the less we feel like we’re able to cope with the discomfort of other emotions. Not the bad emotions, because there’s no bad emotions, but just the uncomfortable ones—grief, loss, anxiety, anger, all the things. I mean, you take the substance, and all of a sudden, you’re like, “Okay, I’m okay. This is okay.” 

A lot of people who do struggle with anxiety may turn to substances, but I feel like often it’s not the only factor. It’s a factor, but it’s like this perfect storm of like, I don’t have a lot of support from family, or we didn’t talk a lot about substance use and mental health. I’m having feelings that I’m uncomfortable with, whether it’s anxiety, depression, and I tried this thing recreationally one time, and it was mind-blowing. I felt great. I felt like I didn’t have any anxiety. I felt like I was able to just enjoy a moment where every other moment outside of that substance use felt like I’m white-knuckling it. I’m just trying to get through my day. 

Yes and no, to answer that question. Yes, I absolutely see people going towards substances for relief from certain emotions or certain experiences. I don’t think it’s the only factor, but I definitely think it perpetuates it once that happens. Once we take that substance and we feel the relief, of course, we’re going to want to keep engaging in that. It’s the aftermath of that where it becomes problematic.

Anxiety and Addiction Treatment

Kimberley: Right. I want to talk to you about anxiety and addiction treatment, but I want to make sure I understand, because I want to be transparent. This is not an area I was trained in at all. I think I got some credits in it in some three- or five-hour course that I took. I think it’s important that clinicians really aren’t trained very well in this, and it’s affecting a large population, even since COVID. I know substance use was through the roof. I want to just zoom in just real quick so that everyone understands and make sure I understand this. When you use a substance, you say—and please correct me on my words here—there’s like this quietening down of everything that they might be feeling so that next time they have that emotion, shame, guilt, grief, whatever it might be, anxiety, that feels more intolerable now. Is that what you mean? It feels louder? What’s the way that this plays out for people once they are using?

Tori Lynn: Right. How I’ve seen it play out is, if someone uses a substance, and it depends on the type of substance, because we obviously have substances that are depressants, and then we have other ones that are more stimulating, so you’re going to have different effects. I’m going to talk about this through the lens of opioid use and benzo use, and those are medications. Those are drugs that whether synthetic and illegal or prescription, they have an effect on the respiratory system, calming everything down. It brings everything down. Your heart rate goes down, your breathing slows down, literally the opposite of anxiety. It brings everything quieter. I’m going to speak to that first. 

OCD and Addiction

I’m going to say that what I’ve seen happen is an individual who may or may not be predisposed to substance use disorders through family history, environment, et cetera, they use a substance and they notice the change in their anxiety, or they notice the change in OCD symptoms and they say, “Whoa, I just went from like a nine where my baseline is a nine all the time to like a four, and that felt really good.” And so, what we tend to see happen is that person will chase that. Not always. Some people can use once and be done or use a couple of times and be done and never develop into an addiction. That’s just based on that person’s genetic makeup and support system and everything that they have. But often what I see happen is someone will notice the relief and they’ll want that relief again. Just from their day to day. And so, they’re like, “Yeah, I’m going to do that again.”

The problem is, more often than not, you never catch that first high, we call it. You’re always chasing the high. You’re always chasing the relief that comes from using that substance, but you never quite get to it because your brain chemistry changes with the longer-term use of that substance. If you’re at a nine and you use this substance, you come down to a four, you’re like, “I want to use that again when I’m at a nine because that felt great.” But you use it again, and maybe you’re at an eight or even a seven, but you never quite get up to that nine. Every time that person use, like, “I know I can get to that four. I know I can come down from that nine and get to that four,” and just alleviate some of the symptoms that they’re feeling. But as this happens, the longer time we’re using, your brain becomes adapted to that substance. Now what we’re doing is we’re not feeling things on any higher level because we’re constantly using that substance. And now our distress tolerance is going to change. Our ability to cope with the nine that we were at before, that lessens because we haven’t felt it in a while. So our tolerance just shifts over a long period of time of use. 

But we’re still never getting the same relief. We’re still never getting quite as much relief as we did the first or second time that we used that substance. So now it’s like your brain is morphing, just like it does with OCD or anxiety. When we engage in compulsions, we get that temporary relief. Usually, it’s not as strong of a relief as it was in the beginning, but it still gives some relief. And so, that’s where the motivation to continue using comes in. But then when we’re left at the end of it, we’re saying, “Oh, I can’t cope with those things when I get that heightened. I’m not able to cope with that,” which we know is like a fallacy in thinking. I guess we technically can cope, but it feels like we cannot cope with that higher level of distress. Does that make sense? 

Anxiety with Alchohol vs Marijuana

Kimberley: Totally. What’s the case similar to, let’s say, alcohol and marijuana? Is it the same process? 

Tori Lynn: Alcohol, again, is a depressant. There’s some caveats there. With alcohol, we know that it’s a depressant. We know that the way that it metabolizes in the body, it actually causes the depressant part to come first. And then it actually spikes our anxiety later. We know that when we’re drinking alcohol, the effect of that lasts longer than just that period of time where we’re intoxicated. You’re going to notice, like based on your own mental health and patterns, you may be depressed for days after. You may be really anxious for days after or both. And that is something that some people say, “Oh, I can avoid that if I’m just only drinking when I’m in a good mood.” But this is biology. This is the way our bodies function and process alcohol. 

With alcohol, there’s a much higher risk of dependency with consistent use, and it’s one of the very few substances that, if we become physically dependent, meaning we drink so often that our body depends on it. If we were to stop cold turkey, we’re at risk for seizures and death. It’s one of the few substances that we can actually die from if we don’t decrease use gradually with the support of a medical team. 

Marijuana, as far as I’m aware, doesn’t have the same risks as that. You’re still altering the way that you feel about certain things. You’re still altering your response to anxiety-provoking situations. But some people get anxious when they smoke or have edibles, or whatever it is. I mean, everyone is a little different in how it plays out and just based on their body. But I would say with alcohol, that one is really important to know because it’s legal. It’s something we have access to all the time. 

Kimberley: It’s celebrated. 

Tori Lynn: Yeah. It’s celebrated. It’s promoted. We see it on TV. We see it all over the place, and it’s going to be more deadlier addiction to have because it’s so sneaky and because of the way that our bodies react to it when we are dependent.

Kimberley: Interesting. Thank you for sharing that. I think it helps me to understand the biology. Tell us about treatment, particularly when it’s co-occurring with anxiety disorders. I mean, maybe tell me both. What does it look like? What does effective compassionate care and treatment planning look like for addiction?

Treatment Planning for Addiction and Anxiety

Tori Lynn: When we’re talking about treatment planning for addiction, we’re talking about realistic goals. We’re talking about getting rid of the stigma of it’s either abstinence or nothing. That doesn’t have to be someone’s recovery. It can be if that’s their choice, but it’s a really person-centered approach. It’s like, what do you want to see happen here? How do you want this to turn out? Do you want to be the person who is absent forever? Do you want to be the person who feels like they can get to a place where they can moderate what it is they consume and feel good about how they live their life, even if they are consuming some alcohol? 

I find that most people try that latter approach first and get to a point where they’re like, “You know what? I just would prefer not to even put myself in a situation where I’m drinking at all or using anything.” It depends on the person and what their values are because we got to take into consideration that some substance use, like drinking with family, can feel like a value. It can feel like, oh, we have a glass of wine with dinner, and that’s a way for us to connect. Who are we to say, “No, you can’t have that”? We have to be mindful of their own personal values. 

It’s a person-centered approach. We use things like motivational interviewing where again, we’re helping the client navigate the ambivalence. They’re wanting to and they’re not wanting to, and that’s okay. What are we more wanting to do? Are we wanting to continue the path that we’re on? Do we want to make some changes to it?

Motivational interviewing is really important for OCD and anxiety work, too. We do that all the time. I get it. To do this work is really hard, so why do we want to do it? Do we want to do it? Is it easier for us to just keep going the way we are and not do this really hard work of exposures or with substance use? Is it easier for us to just try to moderate how much we’re using instead of stopping use? 

We work a lot with motivational interviewing. Urge surfing, like I mentioned before, is a skill that we use a lot with all of it—with OCD, with anxiety, with substance use. I think it’s just looking at it through a different lens. It’s saying like, what are the triggers and what are the exposures? Someone with substance use, their exposures are going to be the triggers, the withdrawal symptoms, the day-to-day thoughts that come in. Someone with anxiety or OCD, it’s going to be whatever triggers their anxiety or OCD. And the relapse—I mean, the response prevention for addiction is we’re not using. We’re not using that substance. 

It’s really a lot of compassion. It’s a lot of not shaming when relapse happens because it happens, and this is like, your symptoms are reoccurring. I want to make note that with treatment for substance use, just like with anything else, there are medications that can help people. There’s so much stigma around using medication for addiction recovery. 

Like I mentioned before, I worked in a methadone clinic for several years, and there were arguments about, is this harm reduction? My stance, I will own this as my personal opinion, I do not believe that those medications, like methadone, suboxone are harm reduction. They’re valid and effective and researched treatment approaches, just like an SSRI is a valid and researched medication for anxiety or depression. It’s just finding out where that person wants to go, tailoring their treatment to what the outcome is that they want to see, and helping them get there in a compassionate way. Because again, we know that it doesn’t build momentum if we’re shaming ourselves throughout the process.

Kimberley: Yeah. I know when I was being trained as an anxiety and OCD specialist, we were talking or trained to believe that a client needs to be abstinent for a certain amount of time before we start ERP or habit reversal training, or whatever it may be. That was also 15 years ago or 10 years ago. What would you say the most up-to-date philosophy or strategy could be for anxiety disorders, particularly these CBT models that we’re using?

Tori Lynn: Again, opinion-based, and I know that there is research to back this, but I’m sure there’s research to back every other opinion as well, but from my position, the sooner you get someone on a medication, if they meet the criteria for that medication—the sooner you get somebody on a therapeutic dose of that medication, the sooner they’re going to be able to put their energy and their time into the behavioral work. Because if you have someone in addiction who’s suffering from physical withdrawal symptoms—so imagine you have the flu times 12, and then we say, do some cognitive behavioral therapy, they’re going to be like, the last thing that I want to do is cognitive behavioral therapy while I have the chills and I have nausea and I’m vomiting. I have diarrhea and I’m sweating and I am unable to even. I feel like I’m crawling out of my skin. I can’t imagine doing any work feeling that way. When I have a cold, I don’t want to do anything. So I can’t imagine someone who’s literally physically suffering with these withdrawal symptoms and saying, “Yeah, you can do this behavioral work. Just power through.” That’s telling people like, this is a willpower thing. It’s not a willpower thing. This is also a biological thing. We need to treat your physical symptoms the way that we would treat somebody who has diabetes. We wouldn’t say, “We need you to hold off on the sweets before we can give you a medication that’ll help you hold off on the sweets or that’ll regulate your blood sugar.” We would never do that to someone because it’s just not humane. I think that’s where it comes down to.

As far as the medication for OCD and anxiety, you would probably have more information on that than I would, but if it’s anything like when I’m thinking with addiction, it’s like, treat those symptoms so that we can get to the good stuff and they can pour their heart into the work rather than white-knuckling it or just trying to get through and not absorbing the content that we’re trying to share with them. 

Abstinence or Harm Reduction? 

Kimberley: Yeah. I think what you’re really sharing is that—correct me—it becomes a tandem work of you’re going to be writing urges for urges to use while you write urges to have compulsions, like how can we incorporate these together in that they’re different, but they’re similar in the tools that you’re using. Let’s talk about alcohol and marijuana use or other similar substances. Would you encourage clinicians to have a 30-day abstinence, or is that unrealistic at this? What would your thoughts be?

Tori Lynn: In terms of?

Kimberley: Starting ERP or other treatments?

Tori Lynn: I think that, again, this might be a yes and no. Part of me thinks that if somebody is in withdrawal symptoms, let’s go back to opioid use disorder. If you’re in withdrawal symptoms, you’re not doing any ERP. But if you are still using, you’re managing those withdrawal symptoms. You’re managing those cravings. You’re actually just functioning. You’re just functioning at that point. There’s a point in somebody’s journey of opioid use disorder where they’re not getting high anymore. They’re just surviving. Your brain now needs this as the way that it needs food. That’s what it thinks, and that’s how it responds. You are more likely to get buy-in from someone in terms of like this. You’re more likely to get buy-in from someone whose physiological symptoms are managed. 

I would assume abstinence within the first 30 days, you are not getting any work out of that person. You’re not going to get any ERP work out of that person. You are going to get them just trying to white-knuckle it. Now we add on a medication like methadone where it satiates. It gets rid of those withdrawal symptoms, and it mitigates those triggers and cravings. Now you have someone who can focus their energy on ERP. The abstinence piece, I can also see how in maybe other types of substance use, like marijuana, like alcohol, if you are actively using, you’re not also going to be able to engage fully in ERP. I think that it’s got to be case-to-case. 

Kimberley: It is. It sounds like. Yeah. I think I’m understanding is it’s about the degree in which they’re experiencing physical withdrawals that can help us to determine that, and maybe would we get a medical professional to come on to help us with that?

Tori Lynn: A hundred percent. I think that the team approach, which is something that I learned thoroughly when I was working at that methadone agency, was like, you had a doctor, you had nurses, you had case managers to help you manage your basic needs. Do you have a home? Do you have clothes? Do you have food? You have a therapist in there who can help. A substance use counselor, who can help you navigate the motivational interviewing and relapse prevention. On top of that, you might have a mental health counselor to help you work through the other symptoms that are coming up, like anxiety or trauma. A team approach to this, I think, is always ideal, and I would argue that for most mental health concerns. Whenever you have a team approach and when you have support from family and when you can build group into it, there’s so many ways in which that can be helpful to build that community and get rid of the stigma and validate. Support is what it takes.

Kimberley: I feel like I just got a masterclass in addiction. It was so good.

Tori Lynn: It’s such a great opportunity to have this conversation because we don’t talk about it enough.

Kimberley: No, we truly don’t. Because I’m looking at the time, I’m wondering if you could, like, what is it that you want us and me to know. Like mic drops final statement? I know that’s silly, but what is your thoughts? Where would you leave us, or where would you leave us to go?

Tori Lynn: Yes. First and foremost, I would encourage counselors, therapists, case managers, patients, clients to find a way to educate yourself on addiction. Because whether or not you are affected by it or you know someone who is affected by it, it’s there and is very prevalent, and it comes in all different shapes and sizes, and it is not always obvious. I think I would say treating someone with substance use concerns with the amount of respect and dignity and compassion that they deserve, just like anyone else who’s struggling with a mental health or medical condition, I think that is first and foremost. I think that we can be mindful of our language. They’re not addicts, they’re human beings who are struggling with substance use, which is a really challenging—it’s not even the right word for it—thing to overcome and to work through just like any other mental health concern. Know that you don’t have to white-knuckle it. Get the medication support if it’s what’s right for you. Get the support from therapists. Get the support from friends and support groups. This is applicable to all things addiction and other types of mental health concerns. 

Kimberley: Oh, thank you. I want to just take a moment to really just enjoy you and make sure you know how much I appreciate you. Tell us where people can hear about you.

Tori Lynn: Yeah. I will say I’m not the most active on social media, but people can reach out to me through Instagram. I have Tori Lynn Panzarella Counseling on Instagram as my handle, and they can reach out to me. They can DM me through there or just take a look at some of the posts that I put up occasionally. Just forewarning, there’s not a ton up there, but a lot of my efforts has been in office. But that is a good place for people to reach out.

Kimberley: Okay. Do you have a website as well?

Tori Lynn: No website for me. It’s just going through. 

Kimberley: I love it. 

Tori Lynn: But I open practice. There was a lot of need, and so it was like, we’re just hitting the ground running. I don’t have time even to build a website. We just got to get into the work.

Kimberley: You’re obviously known throughout your community as somebody. This is incredible.

Tori Lynn: It’s just really exciting to have the conversation. I’ve always had the desire to talk about this as much as possible.

Kimberley: Yeah. Oh, you’re the perfect person for it. Thank you. I’m so grateful for you.Tori Lynn: Thank you. I appreciate this.