Exploring Culture Across Generations

Voice-Over: Bringing you unique perspectives from inside the world of addiction and mental health recovery, this is Recovery Unscripted.

David Condos: Welcome to another episode of Recovery Unscripted, a podcast powered by Foundations Recovery Network. I’m David Condos. Today, I’ve got two great guests who sat down with me at the Innovations in Recovery Conference in San Diego. Jamie Vinck and Doctor Tena Moyer serve at the Arizona Treatment Center, Sierra Tucson as the chief operations officer and associate medical director respectively. They discuss the presentation they gave at the conference on the mature adult treatment experience and share how exploring cultural implications across generations at both the macro and micro levels can help them better meet the needs of these patients. Now, here’s Tena and Jamie.

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David: Well, I’m here with Tena Moyer and Jamie Vinck. Thank you for joining us today.

Jamie Vinck: My pleasure.

Tena Moyer: Our pleasure. Thank you.

David: I thought we’d have each of you start off by telling us a little bit about your personal stories and journeys to where you are now, working in the behavioral health treatment industry.

Tena: When I was in medical school and I rotated through a big city hospital LA County, USA, we saw a lot of drug abuse and a lot of addiction issues. I hated treating those patients because those were the ones that I always had to wake up at three in the morning to admit to the hospital. I swore I was never going to do any chemical dependency treatment. Then I rotated through Sierra Tucson, my senior year of residency, and got exposed to this wonderful world of co-occuring disorders and trauma and recognized all of these maladaptive behaviors are interrelated: that it’s a tapestry of who a person is. Not every person has every thread in them, but everybody has a much more complex story than just the disorder itself.

There I ended up treating eating disorders and substance abuse full time. I guess the moral of the story is don’t predict your own future because you don’t know what’s going to happen.

David: Yes, and Jamie.

Jamie: I’m a Detroit native and worked for Chrysler Corporation for several years and then decided that I wanted to get out of the business world and go into the helping professions. I did an internship with the seriously mentally ill and then at a methadone clinic. Ever since that moment, I have found addiction. Addiction has found me, in terms of wonderful opportunities, so it has become my passion.

David: And then, you’re both at Sierra Tucson now?

Jamie: Yes.

David: Could you tell us a little bit about your current roles there?

Tena: Well, I’m the associate medical director. I work a lot with the medical students and the residents and do a lot of teaching. I also have a small patient census of my own where I’m dealing with a lot of the professionals and patients that may be particularly unique in their needs and treatment, so I’ll take on those. It’s a pretty broad position. I’m very lucky to have it because it allows me to not be a narrow treater of this disorder or that disorder.

David: All right, and Jamie.

Jamie: Currently, I’m chief operations officer and what that means is I oversee all of the program development and all the behind the scenes operational aspects to a large center, and that really draws on my business experience. But where I really I’m able to, I believe, impact most lives is I still have responsibility for the clinicians. That’s the essence of what we do is bring healing to folks’ mind, body, spirit. I have the honor and privilege of overseeing the therapy that goes on.

David: That’s the next thing I was going to ask about. For someone who is not familiar with Sierra Tucson, how would you describe their philosophy or your approach to treatment there?

Jamie: We have five major programs. Those programs are addiction or substance use disorder co-occuring, mood and anxiety, program for trauma recovery, complicated pain, and eating recovery. We’re an integrative model of treatment, which means that all of our treatment programs are intertwined with one another, and we have a vast and deep medical department.

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David: Here at the conference, you guys just finished doing a presentation together titled The Mature Adult Treatment Experience. Could you define that population for us and describe some of the unique characteristics and needs and stressors?

Jamie: Mature adults are defined by a recent Harvard study as anyone aged 45 and above. When Doctor Moyer and I conceived this idea, what really came up for us, two things, are the micro and macro cultural impact of someone aged 45 and above and the span, what that means. You can have someone that’s 45 and their experience of the world and their experience of culture is completely different than someone who is perhaps 65. That 20 years in between has been just unbelievable in terms of life events.

We actually had a video produced that started out with the bombing of Hiroshima and ended up with Ronald Reagan and the impact of the assassination attempt on him. We looked at everything in between such as civil rights, the assassination of both of the Kennedy brothers and Martin Luther King Jr, feminism, equal rights. If we look at the trans-generational trauma that we have in our generation and our parent’s generation and how we carry the wounds, if you will, the trauma of our ancestors but not just the trauma, the resilience.

We talked about trans-generational trauma and trans-generational resilience as well. The other thing that I wanted to mention about our presentation that makes it very dear to us is that we begin it with a story of my mom and stories that she passed down to me, and we end it with Doctor Moyer’s mom.

David: That’s really cool. I like the micro and macro cultural aspects you were talking about because that’s interesting. You think about– at least speaking for myself. I usually think about the micro. You’re trying to meet everybody on an individual basis of where they are and what they’ve been through. But there’s also some larger stuff that we all go through together, and for each generation, that’s a little bit different.

Tena: You should have born with innate traits, talents, characteristics, but those evolve within the context of your social experience, and by that, I mean both the family of origin as well as the greater society. To deal with older adults, you have to recognize they have a lifetime of experiences that they’ve collected. They have responded to those experiences by integrating some kind of a psychological conflict, defensive mechanism, or they’ve used it to grow in a more positive, resilient way versus in a more self-destructive or self defeating way, that you have to recognize that they have been through a series of experiences that they can bring to the work as strength and they can bring to the work as vulnerabilities.

To just identify that this is a disorder, loses sight of how they came be who they are and that that disorder, that drinking, or that depression or whatever serves a function for them that has to do with the history of their life and possibly and probably the history of their families: the generations before them. But also because that little life is acted out on the larger stage of the world that they grew up and continue to live in now. The example I use is if you look at who are Baby boomers in 1967, they were protesting the Vietnam War, but in 2007, they were forming the Tea Party. It’s the same age group. Actually, if you look at it, it’s the same action; the target may be different, but it’s occurring over time.

David: That is really interesting, thinking about how a generation shifts-

Jamie: We even looked at in the ’60s, I want to say it was 1962, less than 60% of Americans had television in their home and then by 1975, 80% did. If you think about the availability of news and media, it’s overwhelming and then you compare that with what we have now, instant update. Of course, the way that we view society and the way we view what’s going on in the world around us is going to be completely different and have a very different impact on how we function.

David: This may be off topic but it seems like back in the ’60s, for example, a lot of it was more shared experiences and now it’s so fragmented. It’s like, “Get your news from where you want to get it”, and based on your perspective, you can get different news of the same event even.

Tena: We’ve become, as a society, much more tribal. That is reinforced because we can pick and choose what we’re exposed to. Now, we’re talking about news and that, but the truth is we can pick and choose the kind of people we want to hang around with. If I want to justify my marijuana use, I just need to hang around with marijuana users. I can isolate myself in order tor reinforce my prejudices but also to reinforce my defenses and to reinforce my self justification for maladaptive behavior.

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David: Back to the subject of your presentation. As you’re developing treatment plans for a mature adult, what are some things you need to consider specific for that population? What are some practices that you’ve seen to be effective with that group?

Tena: It’s really important to have thorough medical evaluation. There’s a lot of problems that you go, “Oh, it’s because they’ve been smoking dope every day”, but that may be exacerbating a problem of an underlying cognitive disease developing. Maybe they’re smoking the pot because they sense that they’re developing something wrong. You just have to look at all the many kinds of medical problems that people collect over a lifetime, and how those things need to be stabilized and addressed in order to truly do the psychiatric treatment.

A really good example is our pain program because it doesn’t matter how you’re trying to wean the off opiates or anything, if you’re not addressing what the medical component of it is. But there are many times when we will get a mature adult and order cognitive testing very early in the work because we need to make sure we’re not dealing with an organic problem rather than just a substance induced cognitive delay.

David: What would be an organic problem? What’s an example of that?

Tena: I’ll say an early stage of dementia, where somebody is still very functional, but they’re having little symptoms and they’re recognizing it. They’re anxious about it. They’re ashamed about it, so they start drinking more because it gives them some relief. Well, the alcohol is a problem. It’s going to make anybody look worse, even if you have every neuron still alive. What will happen is they come in and they’re getting brought in by their kids because now they’re drinking, and they never used to do that before. It’s not fair to put them through a treatment program that doesn’t take into consideration what their brain is actually capable of doing. That would be one example.

Jamie: I would say just to piggyback on what you just mentioned, when their kids bring them into treatment, the family component is essential when working with a mature adult. At Sierra Tucson, our family program is a four-day program. What we see are years of denial, years of enabling, a lot of intense resentment and a lot of financial concern.

It’s imperative that we get in there, and not only look at the individual as the identified problem, but look at the entire family system to see what has been working, what hasn’t been working, and what other things need to be addressed so that when the mature adult leaves treatment and leaves this bubble, if you will, then they’re going back into a healthy family system. Because so often, they’ve been living a life of isolation.

Being a mature adult, we have more of an opportunity to isolate because the demands are no longer there. We don’t have to carpool. We don’t have to do all these different things. There’s financial freedom and not necessarily being tied to a lot of obligations, so that continuum of care and getting them connected back into community to a 12 step program to provide purpose and that life becomes larger than them and actually brings joy again.

Tena: I want to add another thing. When you look at, for example, Erik Erickson’s discussion on stages of development, and you look at stage seven and stage eight, that’s basically 45 to 60 and over 60. What are our developmental milestones in that age group? It’s about coming to term with your life. It’s about both being able to face mortality and simultaneously be satisfied with your life. But a really important component of it is your capacity to form stable caring relationships.

As people in their mid 40s and up come into this part of their growth, one of the values of the family program is to reinforce these primary relationships that may have had a lot of conflict and damage caused by whatever behavior got that patient in there in the first place. The important piece of the group work is in part helping older people establish new relationships that are supportive of new behaviors. Because remember, especially as you get over 60, there’s a lot of death. There’s also a lot of sickness in your age cohort and that sort of thing. There is a lot of disruption of the social system, and by introducing them into groups, they can reinforce the social experience.

But again, most importantly, by working with the family, it helps them establish a new more mature relationship with their children, with their spouse, whoever it is. Because as people age, they change and therefore the relationships need to change with them.

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David: We’ve talked a lot about the cultural aspect of treating this population. Why is that so important?

Tena : Again, back to Erickson. One of the tasks of mature adulthood is to make peace with the world as it is and to come to terms with your role: what your role has been in the world, and what it is becoming in the world. There’s two things. There’s the culture in the present tense, but there’s also the cultural background of when somebody grew up.

A good example that I would say is let’s say you have an older adult who’s child came out as gay at some point. When that older adult was growing up– we’re talking in the 1960s. That was just an unacceptable behavior. The psychiatric community still defined it as an illness to be gay. That’s the culture from an historical perspective. But now we live in this day and age where both the American Psychiatric Association and the community, in general, has changed their attitudes.

Helping that parent, and for that matter, the child, repair the damage that’s occurred between the two of them because of very different cultural experiences when they grow up. And also that together they can recreate a new micro-culture within the family that’s inclusive and kind and accepting of one another.

Jamie: The word that keeps coming up for me as you’re talking is to develop empathy. Empathy and cultural awareness, not just what you’ve been through in your life but your parents, so that ancestral dimension to it. That’s why what we recommended in our presentation is that good treatment for a mature adult would include a genogram where we look at transgenerational trauma, transgenerational mental illness, transgenerational substance use disorder but also transgenerational resilience. Where we can say, “Yes, grandmother was a widow who raised three children on her own”, and that’s the stock you’re from.

Also, develop some empathy for your adult parent who was raised by that depression era woman who had mustard or ketchup sandwiches for breakfast, those kinds of things. In opening up that dialogue with our families and attaching to the culture, then they will not only know who their parents are but they get more of a snapshot of who they really are as well, and they will have that transgenerational empathy, if you will.

David: Getting a big picture view of everything that is gone into wherever they are now.

Jamie: In one’s early developmental stage, there isn’t necessarily the awareness or the willingness to do that, so that’s the thing that I love to see emerge in families.

David: We’ll just wrap up with this final question. Everybody who is part of this industry, part of this community has different reasons for why they chose to be in this helping profession. Why would you say that helping people in recovery and helping them find recovery is important to you?

Jamie: To me, the answer to that question is that, that is where I find peace is when I can step outside of myself and to really work closely with someone to me to hold that sacred space for them, and to just be with them and to allow them to experience that healing. To me, it’s the greatest gift of my life to be able to do that.

Tena: One of the things that amazes me about people with addictions or other kinds of maladaptive behaviors is their capacity to come into treatment and grow and change. I am in constant awe of these people. They have the gift of recovery. My feeling is that they give me this enormous gift, and the gift is that I can participate in their lives in a way that is helpful to them and makes my life meaningful. It’s more than just earning your carbon footprint. It’s that sense of connectedness and universality of the human experience. I feel like I’m the luckiest person in the world. I’m really honored to be part of my patient’s lives. I’m lucky to be part of my colleague’s lives. It’s a gift from the universe to me. I’m very appreciative of it.

David: Awesome. Well, it’s been great having you guys on the show. Thank you for your time.

Jamie: Thank you.

Tena: Thank you for having us.

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David: Thanks again to Tena and Jamie for being with us today. Now, I get to welcome Will Harbeck to the show. Will is from the Life Challenge team which is the after-care support network for those who have completed the foundation’s recovery network treatment program, or anyone else up for accepting the challenge of growing through a life in recovery. Last month, the challenge was to complete TJ Woodward’s seven-day e-course about consciously creating your life. Now, let’s turn it over to Will to introduce the new challenge for this month. Welcome, Will.

Will: Hey everybody. How are you doing today?

David: Doing all right, man. How are you?

Will: I’m good.

David: Excellent. Now, what’s this new challenge you got for us?

Will: Well, we figured with summer right around the corner, a great challenge would be go outside and get active. Spending some time outside every day, even if it’s just 30 minutes, getting that sunshine is definitely a good thing for you.

David: Yes, definitely got to take advantage of it while it’s here. What are some suggestions or things that people might be into?

Will: Going for a walk is huge. I love going for walks. I have a dog, so it’s good for me. It’s good for her.

David: I’m totally with you. My wife and I love walking around our neighborhood, exploring new streets and going to new shops or restaurants, whatever we could get to.

Will: There’s plenty of parks here. There’s always people playing soccer out there. People out there with their kids. It’s a playground. Other people walking dogs, hanging out with pets. There is just endless possibilities out there.

David: As always, they can go on Life Challenge and submit pictures and all that stuff as part of the bragging rights, correct?

Will: Yes. lcaccepted.com is our website, and you can see all of the other bragging rights. There are some great photos out there of our members doing awesome things: People hiking, people rafting, people getting their one-year chips. It’s awesome to see all the amazing things our people are doing.

David: Awesome, man. Get out there, and don’t forget to share about it on lcaccepted.com. Thanks, Will.

Will: Thank you.

David: This has been the Recovery Unscripted Podcast. Today, we’ve heard from Sierra Tucson’s Jamie Vinck and Tena Moyer. To learn more about the care they offer, visit sierratucson.com. As always, thank you for listening. Please take a second to give us a rating or leave us a review on iTunes or your preferred podcast app. We’d love to hear your feedback. See you next time.