Episode 4: Harm Reduction

Sally Sanders, a SMART Recovery facilitator and advocate for harm reduction explains the principles and science behind harm reduction. We talked about how harm reduction saves lives and why it should be included as a treatment option. Sally is a proponent of increasing the availability of narcon to help saves lives that are needlessly lost to overdose from opiods.

The Harm Reduction Coalition describes the principles of harm reduction on their website harmreduction.org as:

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. Harm reduction incorporates a spectrum of strategies from safer use, to managed use to abstinence to meet drug users “where they’re at,” addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction. (harmreduction.org)

Transcript

00:00 John: My Secular Sobriety is an addiction recovery podcast, giving voice to the secular person in recovery.

[music]

00:15 John: And more and more, I’m feeling like a total nerd when I do these podcasts.

[chuckle]

00:21 John: But I love it.

[chuckle]

00:23 Sally Sanders: What’s that music all about?

[chuckle]

00:26 John: Oh Sally, you should see me on YouTube. I’ve got a whole studio, green screen thing behind me. I’m really crazy.

00:35 Sally Sanders: Oh, you’re embarrassed.

[chuckle]

00:37 Ben: You definitely are getting into it.

00:39 John: I am.

[chuckle]

00:41 John: So, here we are. Ben, how are you?

00:47 Ben: I’m pretty good, I’m a little bit tired. My nephew and I went over to Iowa City this weekend to go watch a basketball game, so… But it was a fun little trip, but I’m tired but good.

00:58 John: Okay. And our guest today is Sally… Sally, I’m forgetting your last name. Sally…

01:06 Sally Sanders: Sanders.

01:06 John: Sanders. How are you, Sally?

01:09 Sally Sanders: I’m very good, thank you. I’m good.

01:12 John: Thank you for joining us on the podcast. I was very excited about getting to talk to you, because I’m interested in learning more about Harm Reduction. And Steve Bergier, who was on our podcast a couple episodes ago, mentioned that you were passionate about it. And I listened to an interview that you did with somebody, Teresa, and I found it really interesting. So, can we start with you just kind of explaining what harm reduction is?

01:47 Sally Sanders: Yeah, of course. Harm reduction is a set of principles and practices that reduce the harm of something. So harm reduction for substances include things like supervised injection facilities, needle exchange programs, never use alone, just basic, simple, scientific, evidence-based things that prove… That has been proven to work and save lives. And especially, Narcan is a huge tool in the Harm Reduction community. So I… Since my meeting… My smart meetings usually have a lot of people in rehab, they call this the “Rehab Riviera” around here in Southern California, because we have so many… Such a high concentration of rehabs.

02:39 Sally Sanders: I think we have about 500 treatment facilities in Orange County and they have about the same in LA, and we are a fraction of the size of them. So it’s just… We’re recycling people. People come from all over the country to get “clean and sober” in an ocean view facility. And I want to get them home safe, get them back on the plane safe, because sometimes they go home in a body bag, it’s dangerous. People do use drugs in treatment centers, they use drugs in sober living homes. And they’re scared and they’re young and they’re detoxing and they’re far away from home, and I want to get them back on that plane and get them home safe. That’s why I’m doing what I do with Narcan.

03:25 John: And Narcan is… Okay, it’s an antagonist that reverses the effects of an overdose, right?

03:35 Sally Sanders: Opiates, only opiates.

03:37 John: So only for opiates, okay.

03:39 Sally Sanders: So Narcan is the drug that reverses the opiate overdose. If you’ve got multiple substances in your system, which usually people do, they don’t just pick one drug, they usually got alcohol and Benzyls and something else, or maybe alcohol and meth and something else. But multiple… It won’t do anything, Narcan won’t do anything to any of the other drugs that are in your system, it only will reverse the opiate overdose. So what it does is it knocks the opiate receptors off of the brain cells, and so that you’re able to start breathing, it restores respiration basically. It’s kind of like an extension of CPR.

04:20 Sally Sanders: I’m a retired nurse and I’ve given Narcan in the hospital plenty of times to reverse an opiate overdose. It’s the same exact drug, same principles. But now, we can give it to each other out here in the community and it’s, the kind that I have is a nasal spray. You don’t have to draw it out and get an IV or anything.

04:39 John: Okay. So it’s pretty…

04:41 Sally Sanders: So I also have some Fentanyl test strips. So Fentanyl is usually the opiate that’s killing everybody. When you hear about the opiate crisis, it’s really prohibition that causes the Fentanyl crisis. Fentanyl is an illicit, very, very powerful opiate shipped over here from China mostly, and it’s in all kinds of stuff. It’s not just in heroin anymore, it’s in meth. They call it “sleepy meth” in Orange County because people are expecting to get speed and they’re getting Fentanyl in it, they’re getting an opiate. So if they’re not used to doing opiates, just a little bit can kill you. They have no tolerance built up to it.

05:25 John: Is it…

05:27 Sally Sanders: So…

05:28 John: Is it from cross-contamination or is it intentional?

05:31 Sally Sanders: I don’t know, that’s a good question, John. I don’t know the answer to that. I don’t… I have a feeling a lot of it is accidental cross-contamination.

05:42 John: Yeah.

05:42 Sally Sanders: because who wants that in their meth? It’s in cocaine, it’s in… It’s pressed into pills. We’ve had some deaths in our county lately. So look, there’s counterfeit Oxys and there’s counterfeit Xanax. And you just can’t tell by looking at them, but you can test them. There’s Fentanyl test strips which I have as well. So you can test your drugs and find out if it’s got Fentanyl in them or not. It won’t tell you how much, it’s just a little strip like you used to check and see if you’re pregnant, it’s either positive or negative. So you can tell if it’s got Fentanyl in it if you use the test strip. That’s another thing that the harm reduction community uses.

06:25 John: Yeah, I could see how that would be really helpful. I’m new to all of this, but I was talking to someone from Canada who’s familiar with the safe injection sites, and he was telling me about fentanyl, that it just takes like, is it just a speck of…

06:42 Sally Sanders: Mm-hmm.

06:43 John: That’s incredible.

06:45 Sally Sanders: Yeah, it’s very, very powerful, very, very strong. But there is a, there’s a myth going around that just touching it can make you overdose, and that’s definitely not true. And it’s a dangerous myth because it prevents the first responders from helping the person, because they think they might die from it if they touch it. And it’s just not like that. Just because it’s super powerful doesn’t mean that it’s all of a sudden spread in a different way. I don’t, that doesn’t even make sense to me. It’s scientifically impossible. [chuckle]

07:21 John: Right, right.

07:22 Sally Sanders: Yeah, it just doesn’t make sense. I’ve given fentanyl enough, so plenty of times. You don’t need to gear up in a hazmat suit just to handle fentanyl. Just a pair of gloves is fine.

07:33 John: So part of harm reduction then is we understand that people are going to be using, we want to keep them alive, they’re never going to get better if they’re dead, and so being able to test for fentanyl is going to save their lives because now they know it’s there and they can make a choice right to avoid it.

07:55 Sally Sanders: Exactly. My first question when I found out about this stuff, and that’s just a few years ago, I’m very new to all this, my question was, back then I used the word “addict”, I don’t call people addicts anymore, I said, “Does an addict really care?” Will they change their drug use behavior according to the results of the fentanyl test?” And the answer is yes, they do. So you know, yeah, I don’t use that word anymore, I can’t believe I even said it. [chuckle] I’ve learned all the correct language to use in the last couple of years. SMART doesn’t believe in stigmatizing language, so that’s one reason why I like SMART.

08:38 Ben: Yeah, absolutely. I was going to ask, it’s a little bit off base, but when did that change for you, Sally, and what led to you feeling that way, as far as changing the language of use around it?

08:48 Sally Sanders: I think it was when I became interested in harm reduction. Because I hang out in these harm reduction groups and they just don’t… Part of reducing the harm is not saying words like “addict”, and “alcoholic”, and “relapse”, and “disease”, and all of those things are full of stigma. And I hadn’t really thought about it too much before I quit. I quit drinking old-school. I just did it almost four years ago. And I did it for a particular reason. My daughter was struggling with drugs herself and I was going to have to take care of my grandchildren, because I was going to report her to Child Protective Services, which I ended up doing.

09:36 Sally Sanders: And when I decided to make that decision to report her to CPS I also decided at the same time to quit drinking because I knew that I was next in line to take care of my grandchildren in case her kids got taken away. So I felt like that it was time to get my shit together, so that, and I’m 61 years old and this was just, I was late fifties, this was just four years ago. So I went ahead and quit, and my daughter kids were taking away from her. She eventually decided she wanted her kids back more than she wanted to take drugs, so she quit. She got her kids back. She forgave me for turning her in.

10:22 Sally Sanders: And then I went to AA when I decided to quit drinking because I just thought that’s what everybody does. So I went, but even though I was really confident when I first walked in the door, they started making me feel afraid, like I had some kind of a disease or something, and that if I didn’t believe I had a disease then I’m in denial. And it’s just a real mind fuck. Excuse my language. But it’s just not healthy.

10:51 John: I found that interesting too, SMART approaches addiction more as a behavior, is that right?

11:00 Sally Sanders: Exactly.

11:01 John: And the disease model is kind of dangerous. And also I was reading, I think I was reading on the harmreduction.org website and it was talking about some of the problems with treatment, and it’s really, when you think about it it just makes sense. Like it is kind of strange say for example, you have a problem with substance abuse and you want to get help, so they’re going to require that you not be on the substance that you’re abusing before they treat you.

11:33 Sally Sanders: Wow.

11:35 John: And that doesn’t kind of make sense does it?

11:39 Sally Sanders: No. No, I worked at a rehab, two years ago I worked at a really nice ocean view rehab here in Laguna Beach, and as a detox nurse, and that was a very rude awakening to what the treatment centers are really like. It was a good one. It was very well respected, and it had all the proper accreditations and everything, but nobody there really knew what they were doing. As the detox nurse, as the RN on staff I was taking some inventory in the medication room, and I’m looking for their Narcan and they said, “We don’t have any Narcan,” and I’m like, “You gotta be kidding me. Why not?”

12:18 Sally Sanders: So I thought, “Well, this is a good chance to teach them.” So I printed up all the educational supplies that they needed, until they realized that people in an abstinence-based rehab are very high risk for dangerous overdose upon completion of the program due to a change in level of tolerance, and nobody should walk out of a treatment center or a sober living home without a dose of Narcan.

12:45 Sally Sanders: And so this is part of my goal, and I have a few other people I’m working with here in Orange County to get this implemented. It’s so important. People, to try to pretend like people are not using drugs, I mean this is a good opportunity to teach people, when they’re in rehab and they’re in treatment centers. Let’s teach them harm reduction. Let’s keep them safe.

13:07 John: And also it seemed to me that harm reduction has a philosophy where it’s more respectful towards the person who’s using it. That it recognizes that they can make choices and it gives them… I guess when you go through the therapy, through a harm reduction, that you have a lot more control over what you’re going to be doing.

13:36 Sally Sanders: Right. Right. You want to put the power back into the person, let them make some choices. And like you say, you’re being respectful to them. because calling them addicts is not very respectful.

13:47 Ben: Right.

13:48 Sally Sanders: But we call them people who use drugs.

13:50 John: Yeah.

13:50 Sally Sanders: Or you can initial it, PWUD, people who use drugs. Yeah. So we don’t just… We don’t call people addicts and say other stigmatizing language. And I’m just out of the habit of talking like that now and now when I do see it, it makes me cringe. It’s like somebody saying the N word or something.

14:13 John: Right.

14:14 Sally Sanders: It just seems like hate speech to me.

14:17 John: Yeah.

14:18 Ben: I’m especially that way with a word like “clean” and “dirty”. Those are real triggers for me too.

14:24 Sally Sanders: Same. Me too.

14:26 Ben: What kind of… If you’ve received pushback, would you mind describing some of that, for people who would counter what you’re saying or feel like you’re enabling people by harm reduction?

14:39 Sally Sanders: Yeah, that’s what the pushback would be, that I’m enabling drug use, that these types of harm reduction things encourage or condone drug use. And… But like John said, it is more of accepting that people do use drugs, rather than sticking our heads in the sand and pretending like the problem doesn’t exist.

15:02 Ben: Absolutely.

15:04 Sally Sanders: It’s much more realistic and helpful and practical and sensible to just go ahead and assume that people do, and go from there, try to make them as safe and as healthy as they can be.

15:18 Ben: I don’t know if you found this, Sally, but just the way you describe that and my experience with it too, it tends to encourage more interaction from the person who’s been abusing or using drugs as well. And to me, it makes them more likely to, if it’s in a therapeutic setting, they’re more likely to develop a decent therapeutic relationship when they’re talking with somebody who they know is on their side and isn’t necessarily just making it a moral thing where it’s like, “Well I don’t want to encourage you in any way to use, so I’m going to talk in this certain language. There’s something about the language that’s used with people that are encouraging harm reduction, that to me encourages more therapeutic relationships with the other people they’re working with.

16:00 Sally Sanders: Right. There are such things as harm reduction therapists. They’re not necessarily just for substance use, but they believe in the goal of starting where the person is and let them define their goals.

16:15 Ben: Right.

16:15 Sally Sanders: Rather than let’s put the goal on them that society wants them to have. For instance abstinence is the main goal that everybody wants people to use drugs to have. They all want them to just quit. But people who use drugs don’t necessarily want that, so let’s try to work with them and let and start where they are and work from there.

16:41 John: And there are safer ways to use drugs. If you check out, if people are listening to this podcast, if you check out harmreduction.org, they got some really interesting PDF files of different types of drugs and suggestions of how to use them, more safely. I just found that really interesting. But not only that, there was also like for sex workers, even how they could reduce harm. It’s just… I thought, I found it really really interesting, that information is out there. It does make sense to me. I know like I was telling you Sally before we started, that in Canada they have these safe injection sites, which are proven to save lives. They absolutely save lives.

17:30 Sally Sanders: They do.

17:31 John: And there’s evidence to support that, yet we won’t allow it in the United States, our Justice Department won’t allow it. I think California wanted to have some safe injection sites or some cities in California wanted to have them, but the US Justice Department won’t allow it.

17:47 Sally Sanders: Yeah.

17:50 John: That’s…

17:50 Sally Sanders: Yeah it’s… We’re very conservative and very backwards. I don’t know, maybe religion is involved in it, probably somehow. Usually religion is at the root of the problem. [chuckle]

18:03 Ben: Let me jump in there now, since this is My Secular Sobriety.

[chuckle]

18:08 Ben: Well I do feel like either religious belief sets us up, or a person who’s may be more prone to binary thinking, like something is either right or wrong, or you’re either using drugs or you’re not using drugs, it tends to dehumanize a person, I think. And it’s almost, forgive me, I don’t know if this is delving into the political too much, but it’s almost like people who don’t want toencourage children to learn how to use condoms or contraception because they’re worried that they’re encouraging someone to have sex.

18:39 Ben: So then well getting pregnant or getting an STD is your punishment for doing something wrong. It’s almost, to me from a religious standpoint, it’s a way to be able to distance yourself from other human beings so that you can still judge their behavior, and that you can feel okay yourself because you never did anything that would have remotely encouraged them to continue doing a behavior that you find wrong. Does any of that make any sense? I rambled on quite a bit there but…

19:07 Sally Sanders: No, you said exactly what I said recently. I compare… That’s a very good example of harm reduction. The talk that you have with your kid about having sex. Of course, it’s your kid, it’s your angel, it’s your baby, you want them to be abstinent. But you want them to be safe. So you tell ’em, you assume that, “Okay, I want them to be abstinent,” but you have to assume that they might not be. So you talk to ’em about condoms and diseases and pregnancies and stuff. That’s harm reduction, that’s all it is.

19:37 Ben: Right.

19:37 Sally Sanders: So basically you just assume that something’s going to happen because it does, and so you want to give people knowledge. Kids are getting harm reduction education now in schools, for substances. So I think that’s really encouraging. But yeah, that’s exactly what it is.

19:56 Ben: Well, and it’s education. When it comes down to it, call it harm reduction education or anything. It’s like when, I have little kids now too, and I hope to have open conversations with them about all of these issues. And it’s I think we’ve been scared of just educating people and giving them the information, and just so scared that we might be encouraging them to do so by saying so. And it’s just not true. I mean the statistics would show that… And I would imagine, I don’t know this, but I would imagine this works for harm reduction too.

20:28 Ben: The more likely you are to be educated on safe drug usage, just like the more likely you are to be educated on sex, the less likely you are to do it or the less likely you are to probably end up dead or overdosing. And I think the movement towards Narcan too, I think a friend of our program too, Megan, in the past is a big proponent for everybody carrying Narcan, just like all of a sudden there’s AEDs all the time in every building. It’s kind of like that.

21:00 Ben: So, there’s definitely still that moralistic tone of like, “Well, you use drugs, you run the risk of overdose. That’s what happens, you die.” And like you were saying, we have these people in front of us. This might be the only chance… “These people ”, that sounds like a derogatory term on its own.

[chuckle]

21:16 Ben: You have people who are struggling with substances, at a facility or as a nurse, if you work in an ER, we need to take every chance because every interaction with them may be our last chance to even educate them on any level.

21:30 Sally Sanders: Do you think that people that work in treatment centers listen to this podcast?

21:36 John: Probably not. I don’t think anybody’s listening to the podcast yet.

[laughter]

21:39 Ben: Not yet. Not yet.

21:41 John: Maybe eventually they will. We’re going to really go to… This will be a very popular podcast one day. We’re not quite there yet, Sally.

[laughter]

21:50 Sally Sanders: No.

21:51 Ben: But I was a counselor in the past as well, Sally. So yeah, I’ve worked in treatment facilities as well and it’s definitely, even when I was first getting my certification, I can remember we went to a methadone clinic. And at that time, I was attending a lot of 12-step meetings, and I’m much better now though. But anyway, I struggled myself with the idea of methadone clinics and things like that, but I’ve definitely done a 180 on that compared to when I first was interacting with methadone clinics and learning about how they worked.

22:24 John: Sally, I’m kind of interested, how would harm reduction fit in with people who are having problems with alcohol?

22:32 Sally Sanders: Well, there naltrexone.

22:35 Ben: Oh yes, that’s right.

22:36 Sally Sanders: Most recovery’s considered MAT to be methadone, Suboxone, and naltrexone.

22:43 John: Yeah.

22:45 Sally Sanders: So the first two I mentioned were opiate replacement drugs, which sometimes that’s stigmatized in itself. And naltrexone of course is not an opiate at all. So there’s not so much so much stigma against that, but I get a lot of people at my SMART meetings that are on naltrexone for alcohol use disorder. So that’s considered MAT for AUD.

23:12 John: Yeah, and I think it’s actually effective. Okay, I’m not a scientist or anything, but I know there’s some science behind it, but also I have known a lot of people who have taken naltrexone and have drank on it, and it has absolutely helped them. They did not go on and get drunk and use it. And then of course, I’ve talked to people who use The Sinclair Method, which I find absolutely fascinating. Where you, what you do is you take the pill, naltrexone, before you drink.

23:45 Sally Sanders: Right.

23:47 John: So…

23:49 Sally Sanders: I’m very okay with The Sinclair Method, I would highly recommend anybody to try that. If they’re really, really struggling with putting drinks in and they feel like they need medication, I would definitely try The Sinclair Method. Like I said, I quit old school, I just put it down. I quit it the same way I quit cigarettes. I just decided one day I was going to quit. And then I set a date a few months in advance and then I just followed through.

24:16 Sally Sanders: And I don’t know if it’s just my stubborn streak or what, but once I make up my mind, I don’t really go back. But I did feel like I was heavily programmed by the 12-step community, with the whole sobriety dates and the abstinence thing, and the disease model, and all that shit. So I did go ahead and have a few drinks. I’ve had maybe four drinks in the past four years. So I just did that to just to de-program myself, and prove to myself that I’m not a diseased fucking alcohol.

24:50 John: Yeah. Yeah.

24:53 Sally Sanders: It has no power over me.

24:56 Ben: So, how long were you attending meetings, Sally?

25:00 Sally Sanders: How long?

25:00 Ben: If you don’t mind me asking? How long did you attend AA meetings, if you don’t mind me asking?

25:02 Sally Sanders: I went for about a year-and-a-half. And at about my year-and-a-half mark is when I got the job at that rehab two years ago. And I was also taking my SMART facilitator training at the same time. And I was just so proud when I got my SMART facilitator certificate, and I took it to my boss at the rehab and I said, “Look, I’m going to teach… ” And she said, “Oh no, you can’t do that here.”

25:31 Sally Sanders: And they advertised as a SMART Recovery rehab or I’d never even would’ve gone there, I wouldn’t have taken the job if they had said they were just 12-step. So I was having some really bad anxiety, because I was having to take these clients, escort them to 12-step meetings and listen to all that bullshit. And then I would take them back, and I was trying to teach them some really decent tools that they could actually use. I was teaching them SMART Recovery. But yeah, when my boss found out, she said, “No, you can’t do that. This is 12-step only.” And I was like, “Wow, how culty, how culty is that?”

26:16 Ben: Well, and it’s very culty and I’ve spent a lot of my life back and forth between the two, not that I’m a proponent for any one thing, but you can relate a lot of things in AA to SMART. So it’s not like you were trying to brainwash someone into going to SMART, it’s just good healthy, yeah, whatever, that’s frustrating to hear.

26:35 Sally Sanders: Yeah, it was frustrating. Like I said, it was very eye-opening. I was only there for two months, but I learned that they don’t care about Narcan and they refused to carry it, and I had, part my job was taking those people out on little field trips on the weekend, and I remember taking them to a restaurant and one of the guys disappeared in the bathroom for 15 or 20 minutes, so long that I was worried and had to get a employee to go over there and get him and looking back on it now, I would never have taken anybody on field trips without keeping Narcan in me, because he was probably using.

27:13 Sally Sanders: Fortunately, it turned out fine, but when I talked to the employers about it when I got back to the rehab, they were more concerned about catching him with a urine test, than actually keep him alive with Narcan. These places, their heart’s not in the right place. Or their mind or something, they’re not thinking.

27:36 John: So does harm reduction work well with SMART. Do the two…

27:39 Sally Sanders: Yeah.

27:40 John: They go together pretty well?

27:42 Sally Sanders: Yeah, because they have the same general philosophy of meeting the person where they are. We are abstinence oriented. They just recently changed the name from “abstinence based” to “abstinence oriented”, and that’s because they want to include people on MAT, the recovery community is so generally against people on MAT, that we had to, SMART Recovery National said, “We need to come out and have an official statement about this, because it’s just, it’s just not right.” And…

28:16 John: MAT is Medically Assisted…

28:19 Sally Sanders: Treatment.

28:20 John: Treatment, okay.

28:20 Sally Sanders: Yeah, methadone and naltrexone and Suboxone.

28:25 John: I ran across a YouTube channel here that’s totally made up of people who are supporting each other with their medically-assisted, that whatever. [chuckle]

28:36 Sally Sanders: Yeah, MAT, just that.

28:38 John: MAT, yeah. Medically Assisted Treatment, yeah.

28:43 Ben: Well, and John you had asked…

28:45 Sally Sanders: One time a rehab, a rehab reached out to me about a year ago because they found me on Facebook, which I’m on there all the same. And they said, “Would you mind coming to start a SMART Recovery meeting at my rehab because my MAT track clients are not being accepted as ‘clean’ at 12-step meetings?” I said, “Seriously?” [chuckle] So I did it. I went and started a meeting there at the rehab. Now, and this was a volunteer gig, we don’t get paid for this. So finally, I kept talking to them about trying to get them trained. Why don’t you get trained in SMART? Why don’t you get trained in Narcan? Why don’t you teach these people?

29:28 Ben: Right.

29:30 Sally Sanders: So anyway, it’s a very real problem. There’s a huge stigma against people on MAT.

29:36 Ben: Well, and especially in a treatment facility, a therapist, a counselor, the nurses, everyone, you just have a lot of different tools in your toolbox. You would think they would want to have knowledge of everything possible to be able to help anybody with.

29:50 Sally Sanders: You’d think so.

29:52 Ben: Yeah. Well, it’s kind of a short cut, and I’ll use it as a chance to bash the 12-step thing a little bit too. It seems like it’s got such a stranglehold on things that no other thinking is allowed in. There’s that cult-like aspect of it and I’ve definitely witnessed that plenty of times where people would be like, “Oh, that person’s taking medication for this or that.”

30:16 Ben: And it’s very frustrating to me, and I can hear the frustration in your voice as well. It’s almost like people think, “Well, I didn’t have to do that, so they shouldn’t have to, either.” It’s like, well. Everyone’s different, it’s… Would rather have them struggle, and constantly be going back and forth into rehab constantly, or would you like to see them get better any way they can? So it’s a very self-centered way of thinking, I think.

30:40 John: Sally, are you familiar with Jon Stewart? Not the comedian, but the British guy? He’s in a rock band, and he speaks about The Sinclair Method quite a bit. Have you ever heard of him?

30:52 Sally Sanders: No, I haven’t.

30:53 John: Well, he’s really an interesting character. If you Google him, you’ll probably find some videos of talks that he’s given, and he is basically a proponent of choice, that people have choices in how they want to get support for their addictions or treated for their addictions. And he pointed out that he thinks that one serious problem is that Alcoholics Anonymous being the big player is in a silo and it doesn’t reach out to other support groups or include them in the recovery and I can see how that could be a problem because that kind of trickles down to all the people that go to these 12-step programs, they think that they can’t interact, they can’t do anything else but that.

31:49 Ben: Right.

31:50 John: Which…

31:51 Ben: Well, especially even in a smaller town, like John, I’ve shared with you about experiences at 12-step meetings where there were definitely old-timer people who would say, “And if you’re taking anything you shouldn’t be in here, and you can’t be in here.” So yeah, that’s frustrating. Sorry, I kind of stepped on you answering there, Sally.

32:09 Sally Sanders: I remember when I was, when I found out about secular sobriety, about AA Agnostica, I looked it up and I bought the book and I got the alternative 12 step book, and I was just like, I was so excited, I thought, “Oh my God, I’m not the only one.” [chuckle] So I was like, “Oh, I discovered this whole new thing.” So I went to my traditional AA meeting and tried to share about that there’s such a thing as agnostic AA. And they took me aside and gave me shit. “Don’t you dare talk about that here.” [chuckle]

32:09 John: Yeah, I’ve been, I’ve gone through that myself, actually. [chuckle]

32:09 Ben: Yeah, sure enough as well.

32:09 John: Yeah, yeah.

32:09 Sally Sanders: So I was like, “Well, that is so silly. I know that there’s people struggling with the God part, I know they are, so why can’t I talk about it, why can’t I tell them?” I found a meeting, I started going to these meetings on Oceanside, didn’t like ’em that much but I tried it. They wanted me… We didn’t do any praying or reading any of the shit out the book, [chuckle] but we had to hold, we had to hold hands though afterwards and say the responsibility pledge. That’s what we did. And I thought, “Ah, that’s weird.”

33:29 John: Nurses as a group don’t like holding hands, do they?

33:32 Sally Sanders: No.

33:32 John: I didn’t think so.

[laughter]

33:36 Sally Sanders: No.

33:36 John: It’s germs.

33:38 Ben: Yeah. What’s up, how was… What was the process like for you stopping going to meetings, Sally? Was it kind of hard to quit or did you find yourself feeling lonely or like you had been separated from the group? Or was it kind of like, “Screw this, I’m out of here.”?

33:54 Sally Sanders: You know, it kind of happened… At the same time I was working at that rehab it all started to click. Because AA is okay if it’s offered as a support group, but if it’s treatment…

34:08 John: Yeah, totally.

34:09 Sally Sanders: For serious substance use disorders, it is really jacked up.

34:13 John: That’s the problem I have with it too, is it’s not treatment. It’s not treatment. Treatment is when you have a therapist and a patient relationship. That to me is treatment. AA is peer support. It’s not treatment, but unfortunately people view it as treatment and they view it as a solution, and that’s really sad because that’s not the way it’s supposed to be. It’s not treatment.

34:43 Sally Sanders: No, not treatment. So that’s what made me wake up to the whole thing and I stopped going to AA meetings at, well I was… The only reason I was attending meetings at that point was because it was my job and I had to take people to meetings. But on a personal note I was done with AA.

35:01 John: Yeah, well it definitely doesn’t fit with harm, because there is that… There is a judgment, there are people that count the days and the years of their sobriety, and that’s like a huge big deal I think in the culture. Even though they say it’s not it is. And so harm reduction probably wouldn’t be welcome there.

35:28 John: But I always thought too, and the more I think about it it’s like if you were someone that was getting drunk every other day, and getting arrested and thrown in jail, and having problems with your job and then you change from doing that to maybe just drinking occasionally, and maybe just getting drunk once or twice a year I think that’s a huge improvement. Or what if you were just, you were not drinking for a year or two and then just one weekend you went out? That doesn’t mean that you wipe out everything that, all that you got the first couple of years. It shouldn’t anyway.

36:13 Sally Sanders: Right, better to better.

36:15 John: It’s improvement.

36:17 Sally Sanders: Yeah, any, harm reduction celebrates any positive change. So yes, definitely a huge positive change. Like one of the guys, my regulars at my meetings, he still drinks. And he drinks almost every day. But it’s only, it’s a very small amount, it’s measured out. And he has made it work for him. A year ago this time he was in the hospital about to die with alcohol-related problems, and he said, “If I was still trying to do it the AA way I’d be dead by now. At least I’m just… “

36:47 John: Isn’t that interesting?

36:50 Sally Sanders: Yeah, he’s doing the harm reduction way, and he likes to come to SMART meetings. Now he does, he says, “I don’t really talk about moderating when all the rehabbers are here,” because they have to be abstinent and he feels like it would be rude, so he only talks about it when they’re not there. [chuckle] But I like to keep the meetings open. I want people to be able to talk about whatever they want to talk about, and if they’re having success with moderating, that’s fine, they’re certainly welcome to attend my meeting. And it’s not really a closed meeting it’s open to family, friends, loved ones. And three times I’ve been able to put Narcan into the hands of concerned parents, and that’s wonderful, a wonderful feeling to know that…

37:39 Ben: SMART facilitators have a lot of leeway don’t they, with how you run the meeting?

37:43 Sally Sanders: Well, yeah, we’re all a little bit different. I’m fortunate to be close to San Diego, which is where they have a whole lot of SMART Recovery. And Tom Horvath is down there and he’s one of the founders of SMART. In fact, I went down there yesterday to meet with a bunch of the other facilitators, and they… Tom says, “You know, everybody can run your meetings differently.” Some people have tool meetings where all they work is the tools, and then some people have harm reduction type meetings like mine. And he said, “That’s fine, everybody can run it a little bit different,” but we have one basic agenda, kind of a format that everybody kind of follows. So I can read through that if you want?

38:34 John: Sure.

38:35 Sally Sanders: Okay, see if I can find it here. So I’m lucky to have them down there. It’s really cool to have them close by me.

38:44 John: Yeah.

38:45 Sally Sanders: So he said, “As long as everybody has, self-empowering is the main thing that people should feel when they leave a SMART meeting. They should be self-empowered.” So self-management and recovery training that’s what SMART is. So I actually, self-management is the key, I did all the smart training online without ever going to a meeting. So, “You don’t have to go to meetings to do SMART. It’s the main alternative to 12 Steps. We use a self-empowering approach rather than powerlessness. It’s based on CBT and RADT. It’s secular, it’s free, world-wide, non-profit. Meeting leaders are trained, there are facilitators and hosts.”

39:31 Sally Sanders: “Most require a little less training and it does cost quite as much money. It cost me $100, two years ago. It discourages stigmatizing labels like addict and alcoholic. We hold meetings that are discussions rather than a series of monologues. The program evolves as science evolves. We support MAT or any prescribed medication.” And I think that’s it.

40:00 John: I like it. I’m really interested in SMART. I was telling you Sally, before we started recording, I did sign up on the SMART website, so I can now go to the meetings, the online meetings, and so forth. I’m going to try some of those to get a feel for it. I’ve been talking about it a little bit with some people here locally, too. We’ve got a couple of SMART meetings in Kansas City.

40:23 Sally Sanders: Cool.

40:23 John: Yeah, it’s nice to have that.

40:26 Sally Sanders: I’ve never been to an online meeting in my whole life, of any kind.

40:29 John: I’ve been to some online AA meetings, and I honestly don’t like them. I’m kind of hoping that the SMART meetings will be a little bit better. [chuckle]

40:36 Sally Sanders: I hope so, too. [chuckle] I hope so, too.

40:41 John: Well Sally, I really appreciate you coming on and talking to us. It was really, really nice of you to do that.

40:46 Sally Sanders: You’re welcome, my pleasure.

40:48 John: And if you would, if anybody in your SMART group might like to come on and share their stories with us, I would love to have them on. I’d really like to explore SMART more. We’re going to have the executive director of LifeRing on actually, next weekend. I’d like to get some people from LifeRing on.

41:06 Sally Sanders: What’s his name?

41:08 John: His name, I will tell you. What is his name?

41:13 Sally Sanders: I might know him.

41:13 John: I will tell you. It is, doggone it. Ben, I can’t remember, I will find it in my email.

41:21 Ben: I’m trying to look it up myself here, John.

41:24 John: because we’re going to meet with him just next week. It’s going to be nice to…

41:26 Ben: Is it next Saturday?

41:27 John: Yeah. Okay.

41:30 Sally Sanders: Well, I might have to listen.

41:32 John: Oh yeah. I was surprised, he was really nice. Okay, here it is. LifeRing…

41:39 Sally Sanders: Brian Cur?

41:40 John: No.

41:41 Sally Sanders: No, okay. That’s who I know.

41:42 John: Robert. His name is Robert… Stump. Robert Stump, Executive Director of the LifeRing Service Center. So yeah, he’s in Santa Clara. No, he’s in Hayward, California. So anyway, we’re going to talk to him.

42:04 Sally Sanders: Cool. Alright.

42:06 John: That’s what this podcast is going to be all about, is secular options for recovery. So anyway, I’m going to play that music again, Sally.

[music]

42:14 John: No, that’s the wrong one.

[laughter]

[music]

42:19 John: So, thank you for listening to My Secular Sobriety. Thank you again, Sally, for joining us. Please come back. And let the people in your SMART group know that we’d love to have them on, as well. And Ben, as always, is always great to talk to you.

42:35 Ben: Yeah, I enjoyed it a great deal, Sally. Very nice to meet you.

42:39 Sally Sanders: Nice to meet you, both of you. Thank you.

42:41 John: Take care. Bye bye.

42:42 Sally Sanders: Okay, bye bye.


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