063 - Lori Ryland

Lori Ryland PHD, Chief Clinical Officer from Pinnacle Treatment Centers joins us to talk about addictive disorders and the many ways she has encountered them in her career. She talks about being aware of her own vulnerabilities, having lived experience, the evolution of the industry and her work with Pinnacle. Enjoy.

The Illuminate Recovery Podcast is about Mental Health, Mental Illness, and Addiction Recovery. Shining light on ways to cope, manage, and inspire. Beyond the self care we discuss, you may need the help of a licensed professional. Curt Neider and Shelley Mangum are a part of Illuminate Billing Advocates (illuminatebilling.com). They are committed to helping better the industry and adding value to the lives of listeners by sharing tools, insights, and success stories of those who are working on their mental health.

https://anchor.fm/illuminaterecoverypodcast/episodes/063---Lori-Ryland-e15c326

Transcript (no grammar):

lori ryland phd chief clinical officer from pinnacle treatment centers joins us to talk about addictive disorders and the way many ways she has encountered them in her career she talks about being aware of her own vulnerabilities having lived experienced the evolution of the industry and her work with pinnacle enjoy welcome to the illuminate recovery podcast we shed light on mental health issues mental illness and addiction recovery ways to cope manage and inspire beyond self-care we will discuss you may need the help of a licensed professional my name is kurt neider i'm a husband father entrepreneur a handyman and a student of life i avoid conflict i deflect with humor and i'm fascinated by the human experience and i'm shelley maingame i am a clinical mental health counselor and my favorite role of all times is grandma i am a seeker of truth and i feel like life should be approached with tremendous curiosity i ask the dumb questions i fill in the gaps the illuminate recovery podcast is brought to you by illuminate billing advocates make billing and collections simple with leader in substance abuse and mental health billing services verification and analysis of benefits pre-authorizations utilization management accurate claim submission and management denial and appeal management and industry leading reporting improve your practice's cash flow and your ability to help your clients with eliminate billing advocates today kurt and i get to meet with lori ryland lori is a phd with a lot of initials behind her name she's the chief clinical officer at pinnacle treatment center in 2017 she had was given the outstanding alumni award for contributions in the field of addiction for over 20 years she's been working with addictive disorders serious mental illness and developmental disorder disabilities she's very proficient in accreditation and regulatory standards she's also trained in black belt six sigma methodology in her doctoral dissertation was on anger management strategies with the inmate population and she has enough a lot of other um very significant accomplishments and awards that we won't we won't hit them all because it would make you sound really incredible but um lori i love that you're with us today and and i'm so excited for some of our listeners to get to know you a little bit better because i love the way you think about treatment thank you shelley i'm so happy to be here um it's and it's kind of exciting i know you've worked with pinnacle for a long time and you've been in the industry for a long time um maybe talk for a little bit about how you ended up in substance abuse and mental illness because that's not everybody's dream and desire it certainly wasn't mine but it sure seems to it kind of like it chases me i don't know i i kind of like no i want to go here and it goes oh no you're not you're coming back here so talk about your journey and and you know you couldn't have said it better my i could have said it better myself that's sort of what happened to me as well you know as i started navigating early in my career many of the um the the specialty areas that piqued my interest also had addiction treatment components you know so you know i started my um my pre-doctoral internship year working with the va medical center with combat ptsd sexual assault in the military and you know addiction residential treatment and therapeutic community and you know in every realm that i worked in you know addiction was a prevalent issue you know so i had i started out you know early on you know working pretty closely with addictive disorders and um and it just you know as i as i gained more expertise throughout my career it just became more clear that this was an area that um was particularly interesting to me um and and you know i've worked in various aspects you know such as with serious and persistent mental illness with co-occurring specialty disorders you know and and even behavior analysis you know i do a lot of work with acceptance and commitment therapy and contingency management what we do very cool very cool and i can tell that you you're more on the um the technical side meaning you you you know the words right you know all the technical stuff um and and and the best practices um and and applying those in treatment which is important that's an important aspect whereas maybe someone who's sitting down with the client you know and using motivational energy interviewing isn't going to maybe use the same kind of terminologies that you do oh absolutely that's definitely the case you know i do um work more on that side of you know what works you know what do we know and what does the research show that is effective with our population you know and at you know pinnacle is um strives to you know not only be innovative but to make sure that we're using you know behavioral treatments and medication assisted treatment that has been shown to work you know um and that we have you know excellent ways to track whether or not patients are able to access our services and whether they're receiving enough of our services in order to be successful in recovery that's a good explanation um i um i you know i'm thinking about uh the best practices right the best practices we do research and we try and figure out what's working best and and we know that research is only as good as the data right and and so but it helps us get a little bit closer has there ever been research that comes out that you kind of go really like i don't think that's true i don't know if you have an idea but i'm thinking about like um medication assisted treatment right in the in the recovery industry the old school thought process is if you're on any kind of medication you're not really sober and we've been fighting that stigma and that thought process for a long time i'm wondering if you've come across any like that or want to talk about you know the mat because obviously it's very valuable absolutely and you know that's a really good example because you know having worked in the industry for over 20 years you know there have been a lot of changes that have occurred in the addiction treatment industry in the past 20 years so you know part of you know being aware of of you know trends and improvements in treatment protocols you know we're able to see you know that you know we're able to adapt and change as better technologies come in now medication assisted treatment has been proven to be even more effective than medications alone and behavioral treatment alone because although some you know think medication assisted treatment is literally just medication it's not it's a combination of medication to help you know alleviate cravings and help stabilize brain functioning and you know reduce you know some of the euphoric aspects of the substances you know those are all true and very vital components but it's more than that you know it is a combination of counseling and groups and other types of treatment to help support the medication assisted treatment modality now you know but when you look at outcomes you know it is clear that especially for the opioid use disorder population that medication assisted treatment is is extremely effective and and saves lives and it does regularly especially when it can be an injection where they don't have to try and remember to take that you know that pill every day that really helps them right manage the the mental illness and the other things that are going on that are they're biological they're physiological they don't get to choose those and they really have to work hard to change some of those things and some of them they can't change right right exactly i know that i've heard a lot of conversations um some a lot of research is going on as of recent about psychedelics and even kratom as as one of those kind of medication managements that they're saying is really making a difference do you have much of an insight on those types of approaches you know i don't you know i do know that you know the fda advises against kratom you know that they find that it's not as effective as as people are claiming it is and that it has some pretty harmful side effects um you know as we do you know as i did mention you know we're focused on you know being you know innovative and aware of the research we are aware of you know any types of new um medications that are that are approved that are proven and approved for use with our population um kratom is not one of those um so i don't really have you know a lot of you know insight into that other than you know we we tend to avoid anything that is advised against which i think is wise um right you know and some want to push up against that because there's you know they're looking at some of the positive results that have come but maybe not being as critical about about where that data came from as maybe they need to be right and we have you know um federal regulatory bodies that determine you know the safety of the substances that you know are are approved so you know we definitely rely on on what is approved protocols so i want to ask you maybe get a little bit more you know more about lori and laurie's lori's world um when i was in school as a therapist um they would always say in order to be a good therapist you've got to do your own work you gotta you gotta go get your own therapy has that proven true for you and and what's your experience in that you know that's a really good question and i definitely think there's truth to that you know that if if we're not aware of our own vulnerabilities as just being humans all humans have vulnerabilities and and um and issues that we we deal with if we're not aware of our own we can't really um help others to the extent that we can if we're aware um you know i for one you know i have a daily meditation practice you know so it's just a part of my life it's um it's something that i do regularly and i think it's extremely important to me because it helps me be more present um you know even even when i am working with a patient you know i want to be there with the patient and i want to be as present as possible and not caught up in my own world right you know that's not going to be very helpful so you know that's just one example but obviously if someone has you know you know let's talk about you know what what is um what does happen in our field which is you know we we you like you know strive to hire people who have lived experience right so um you know when you're hiring someone who has lived experience that's great and and that person can really connect at a real level with that patient but they also need to realize that it may not be the right industry for them if they're consistently struggling and they're finding that it's more difficult to maintain their own recovery because of the work they're doing you know so not being aware that that is a is an extremely stressful situation you know for someone who who is in recovery to be um you know facing you know situations with people who are using and actively relapsing and you know overdoses you know that it can it can be very trying so it's definitely important for someone who has you know um addiction history um trauma history you know different types of significant issues that they're they're doing their own work in addition to doing treatment otherwise it could harm them it could also harm the people they're working with well and it's absolutely vital i remember you know being taught about you know transference and counter transference in school and they would talk about it but it wasn't until i got into practice and watched it happen to me that i went oh i had no idea that it could show up like this right or that i could get triggered because this is something that's going on in my life and and so learning what i might want to avoid right the types of therapy approaches or or situations that i might want to to not focus on because those are harder and i need to do more work right and and the thing that i really love about that approach and what you talk about is that we get to we have the right to be human and it's not shaming right there's so often that we feel shamed because this comes up like somebody that you know struggles with ptsd they've had lots of trauma that's not just going to go away right they can do continue to do work on that but that's going to show up sometimes and they've got to learn how to self-care there too absolutely and that that does touch on another um area that i've worked on a lot in in my my positions not not just this one but you know when you're working on addiction treatment which is really not easy right i mean there are some challenges that come you know to with working with with the addictive population um you know you need to make sure that the treatment that you're providing is is hopeful it's motivating it it um elicits people wanting to come into treatment you know that that they want it they want to work with you is at times you may run into a staff member that their response to addiction is punitive you know or blaming or it exacerbates that shame response and you have to be ready to address that and to work through it with the staff member or work the staff member out of the position if it's not the right position for them because you know it's it's just not effective you know so having you know expectations within treatment that if you don't do x and y you're going to be punished is not it's not treatment it's not but isn't that how treatment started it used to be so punitive it's like yeah no no no and we're going to break you down and we're going to build you back up after we do that i'm like yeah that's traumatizing if you ask me right and the expectation that if someone isn't you know um begging for treatment they're not at rock bottom i mean there's a lot you know we've come a long way in treatment as far as understanding that we meet patients where they are that wherever they are showing up that's that's fine and you know and i guess you know as an industry we need to be not too hard on ourselves because even the payer expectations have changed significantly so so being able to get authorization for treatment when a patient is not at the very end right is a huge a huge win you know for us and for treatment because it is more respectful of where the patient is and they don't have to have lost everything in order to get treatment yeah definitely that's come a long ways and there's days that we fight for you know for a client's benefits or authorization and it's like what these this person is legitimately suicidal and you just turn them down for residential treatment like like you really want to take responsibility for that and every now and then you just get someone that goes yeah i'm gonna do that and i'm like oh that's a bad idea like that's so bad it's not right right i am i wonder lori if you could talk a little bit about your experience working with the va because i know that they do a lot of real cutting edge kinds of research there um and it's probably been a while since you've worked there but i'm curious what your experience was there that it is and it's i'm sitting here you know calculating in my mind i'm thinking oh my gosh it's been 21 22 years since i worked at the va so that was just yesterday actually no so um so my experience with the ba was a very positive one you know like i said i worked in both the residential treatment unit for combat ptsd and then i worked with a women's unit that at the time was you know all women but it wouldn't have to be women that was focused on sexual assault that occurred in the military which was often by people they knew right um and and often you know something that they weren't supposed to talk about or disclose you know back then it was um it was just a very shaming situation and then also um like i mentioned residential addiction detox treatment and um there was a therapeutic community as well that i was part of that was set up in like a barracks um scenario at the va campus so um so you know i it you know i really had a good experience now i i do have colleagues that have continued their work in the va and and from my understanding that it has just continued to grow as far as improvement and you know treatment and modalities just like you know our industry as well so a great deal of respect you know for the work they do with the va i would think i was talking to somebody the other day and and i don't want to i don't want to taint the military because the military i love what the military does i love these people these men and women that are willing to go out and you know fight for our freedoms because i think it's incredible but there's imperfections there's there's weak points in any system and oh yeah and when you you know when you're working with women who have been sexually assaulted probably by their cohorts right their their team members it creates a real unsafe environment for these women and yet there is a place for women in the military and so i don't know if you have a perspective on that but but i find that someone was telling me the other day they said if a woman is not married in the military she will be sexually assaulted or raped and i thought that's a pretty blanket statement that that i was concerned about absolutely and you know like i mentioned the work that i did was you know 21 years ago so my understanding is that it has has improved considerably you know the expectations and the ability to you know disclose and receive assistance has improved a lot um but you know for the individual women that i worked with it was devastating you know so um it's not and at the time you know as you know you had just described it wasn't something that they could just openly you know disclose and and get help for you know that there was a lot of shame that was built up in it as well so you know i'm glad to see that you know as a culture you know we have become a little bit more sensitized to these things happening and um validating them and providing some help when when we do discover that they've happened and it's really hard because if you say nothing which is what you know what a perpetrator i'll call him a perpetrator and that's not the word i want to use but somebody who finds themselves making really poor choices in that area you know they're asking that the victim says nothing because then there's no action right right and it becomes there's this pressure to to say nothing and do nothing but that can't that can't go on that way right that's just not safe for people and that's where trauma you know really embeds itself oh that's absolutely right it's an interesting topic and you know we could talk about it all day long um i would love to also talk and ask you about your work with anger management strategies with the inmate population um i know you must have spent gone in pretty deep on that topic being your dissertation right right and it was a follow-up from my my master's thesis as well so my master's thesis was more like a theoretical type of study around different types of verbal anger cues versus like what it what how do we know that something is an assertive cue versus an aggressive cue and then i followed up with that and for my dissertation i completed treatment programs with inmates looking at different types of anger management strategies so the the two specific strategies we looked at would be more of like a progressive muscle relaxation training like the idea of lowering stress to reduce angry aggressive impulses so we had a lot of measures but we wanted to look at reduction of anger as a state and then also aggression within the the jail population and then we compare that with more of what we would consider a cognitive behavioral approach you know reframing some of the dysfunctional thoughts and you know looking at how to you know establish some more better patterns of thinking that might help that as well so it was looking at those different types of strategies that today we may utilize together but we wanted to see you know whether there was one that was preferred versus the other and you know they as as you see with a lot of evidence-based research they both did pretty well you know so they both had some improvement and the reduction of aggressive impulses and improvement of the state of anger or reduction in the state of anger um but and and what one would have considered at the time that saying oh no no you're just stressed out let's reduce your stress might be more preferable to your thinking is not right right that you know both were pretty well tolerated and and they did a pretty good job so um so that was a it was a fascinating you know study um i had really good participation um i was a little bit surprised though because going into the study i had this expectation that you know what i would imagine would be a group of you know like domestic violence adult men you know that would be the the makeup of my population it ended up being just a very young like 19 year old impulsive you know um anger like a like aggression violent outburst type type of population which i didn't really expect but but that that's that's what it ended up being it was a much younger population that i had anticipated technically adult but much younger than i thought and how did you how did you get your population where'd they come from so so they were all inmates um serving time in a county jail after post-sentencing all of their their charges were violence related and or aggression or even property destruction you know had a few of those um but the participation was voluntary um you know we went through the irb you know to make sure that it was fully approved because they're considered a a protected population because they they are incarcerated um but you know it it did work out to my favor that although it was voluntary you know they they seem to really enjoy getting out of the cell and coming to group and sitting in group together right so it would it in and of itself they they preferred that to to being in their cells so it i i had really good participation i gathered um data for approximately about a year and then um did the statistical analysis after that that's that's fascinating did you have criteria around substance use and and what that looked like yeah so we actually did um what you call a disc uh a diagnostic structural interview to ensure that we understood the population would be those needing treatment in order to participate so we had a breakdown you know there was a significant portion of the population that had addictive disorders as well but also some mental health issues were were predominant very fun yeah how much research do you get to do now so so that's a really good question um you know a large part of my role is associated with outcomes and ensuring that we're tracking outcomes that we're utilizing the data that we're gathering in our electronic healthrecords and that we're able to assess whether or not our programs are effective you know so although i wouldn't technically call it research you know we do statistical analysis on change scores you know we do you know track you know like i had mentioned the quality of life indicators earlier today as well so so it to me it is very much in alignment with the research aspect it's just not technically research we're not publishing it yeah what do you um so talk about your work with pinnacle what you know kind of what pinnacle does where you know maybe where they're located and the type of population that they're working with talk about that a little bit okay so um pinnacle is a an organization that treats addictive disorders we provide all levels of care that one would encounter in addiction treatment you know from you know looking at you know medication assisted treatment programs outpatient partial hospitalization and intensive outpatient programs residential treatment detox we have you know one of our our facilities is in a hospital as well as a detox wing we are located in eight states california indiana ohio virginia kentucky georgia new jersey and pennsylvania so each state we have you know a different array of treatment services that we provide and and some of our states we have the full continuum and some we have a partial continuum of care and then we engage in referrals as well if we have you know if the patient that we're working with has needs outside of our continuum in that state so we treat primarily addiction primary disorders although you know as one could imagine you know any type you're any time you're working on addiction treatment you're going to have patients who have some mental health issues and concerns as well that's a lot of states that you work in how do you manage all of it [Laughter] so you know we have an amazing team you know we have a very dedicated team that is um is focused and passionate about doing this work right you know so we're we're focused on on trying to make improve like make significant improvements in the quality of life for people who have addictive disorders so all the way from you know do we have proper access you know can patients get into treatment do they have any barriers that we can try to remove you know we have a integrated call center so patients can you know pick up the phone or loved ones can pick up the phone get the call center and have that person connect them to to resources in their area so you know the team is is phenomenal you know and and we're very focused on making sure that we're providing the best care possible so you talked a little bit about you know staff members that may tend towards a little bit more punitive approach right and um and how to train that or shift their position depending on what they need um and also meeting a client where they're at so you know if you were to have a client come in and we and you know and i think we've talked before probably not you know not in this episode but we've talked before about you know homeless population when someone comes in with serious persistent mental health issues that you have to make some hard decisions there sometimes um but i love the approach so i'm going to try not to read too much into it but how do you look at someone like that right so so i i don't think it's that unusual because if you think about it in any setting you know if you're talking about a pediatric ward you know if you have a patient or i'm sorry if you have a nurse that just doesn't like kids right for whatever reason it's just not the right fit for them so in any type of work setting that you have you you may have someone that for whatever reason it's just not the right fit working with um within the addiction treatment industry you know it's there are challenges associated with that i mean you know individuals come in they don't feel well you know they're irritable they they they have you know things seem to be falling apart in their lives they may have a spouse that wants to leave their their job may be on the line so they have a lot of things that are going going wrong in their life so if you have any type of staff person who is not able to be compassionate about that you know that it just somehow rubs them the wrong way they may they may personalize you know what's going on in that person's life and think that it's it that interaction or dynamic with them and it's not so um so you know being able to identify it as you know leadership in that organization and coach you know patients a lot or coach staff along you know can be extremely helpful you know explain to them listen this behavior that you see happening may feel like it's about you it's not it's part of the disease it's part of it's part of the the issue that the person is coming to treatment for and here are some of the skills that i'm going to help you i'm going to give you tools that are going to help you in working with that person if you don't do that if you don't provide that additional consultation and training and support for the staff then you'll start to see things like you know one more time you do that you're out of here i'm kicking you out you know and and you don't want to see that you want to see programs you know trying to improve so that they can better meet the needs of their patients not you know moving patients along because they don't fit what they want in the program you know it's just a slightly different way of viewing it seeing it as the patient's just the patient how does my program better meet their needs as opposed to you know identifying you know this is a a a patient i just don't want in here so i'm going to move them along that's that that's that's not that's not treatment you know so we really want to make sure we're addressing that i love that a compassionate really compassionate approach and and when you have a client who comes in and and really just isn't a good fit for your program for whatever reason um it's it's very tempting to say look you just don't fit into our culture here and we're gonna have to you know send you away which is you know feeds into that very abandonment issue that most of them have in the connection issue that most of them have that's probably you know excuse me at the core of of of half of their illness right and we're going to repeat it that is such a great point and i'm so glad you brought that up because you're right you're right so so you know if you have and and here are some things i look for when i'm looking at a patient who has is either at risk of being discharged administratively or has been at discharge administratively a couple of things i'll look for is what were what were the interventions that we tried to use to help with the behaviors that that came up that were disruptive or identified as needing to be addressed now now don't get me wrong if we have you know we're residential treatment we're not a lockdown facility so if a patient comes in and is exhibiting dangerous behavior or violent behavior that's it's not the right level of care you know but some of the behavior is just you know challenging behavior right so if challenging behavior came up let's say it's cursing you know walking up and down the down the hallway fist clench cursing well that's that's you know not ideal right it's not going to be very helpful in recovery it's definitely a behavior that we we may see so what are the interventions that we tried to use to help that patient learn new behaviors to have them be more successful in recovery so i would expect to see that there are some behaviors or attempts to provide some interventions to help that patient be more successful in treatment so that's kind of what i what i would look for i would want to make sure that we're doing everything we can that we're expecting challenging behaviors first that it's it's not an anomaly we expect that people will come in and they'll struggle and that we have tools for the staff on how to help the patient learn new adaptive adaptive behaviors that will be that help them be more successful and that i want to see some of that in the treatment process prior to reaching the end of the line and saying okay you can't be successful in our program because what we haven't really even tried right so um and our programs are really good at that you know we we do have some really solid trainings that we do to make sure that that staff are aware of of how to how to handle challenging behaviors and how to work with the patient and keep them engaged i love i love that approach it makes me think i'm thinking about you know clients these this is a population that comes with a lot of trauma often right i mean very few of them do not have have experienced some significant trauma big teas lots of little t's and and that and especially when that comes from their childhood and they've experienced that that's what they've known they they really have the capacity to use and you know they're all a little bit different but they they learn how to use language to their benefit right either to either to calm everybody down and make keep the peace or to really really dig right to dig in and they'll know your weaknesses and they can use that right these guys have some skills these people have some skills that if you haven't done your work they're gonna they're gonna send you off the charts and triggers because they know how to protect themselves right and at times the behavior is it so behavior has a function right behavior just does it doesn't tend to be random it tends to have a very specific function and sometimes the behavior is you know don't mess with me right and and in the in the setting where that person came from it may have been very adaptive very helpful but then when you're trying to help improve connection right because as we know lack of connection can fuel addiction right so we want to help build connection and build trust which is not easy right and then at times if you see where the person engages in behavior and they're like you said abandoned or kicked out you know that reinforces that belief of okay i there's just something really wrong with me because look even you abandoned me right so we want to try to avoid that and try to make sure that our programs are designed to to to meet the patient where they are that we are highly skilled and we're able to help them with whatever comes up to the extent that we need to keep everybody safe as well yeah it's incredible work and and it's and it's and i say it's a challenging population and you've talked about that too but it's also these are these are some of the most highly functional intelligent people that i have ever met in my life that right they have skills and abilities that with just a little bit of tweaking they become some of the most successful people in the world they're that they're that talented right and it's so it's it's it's so interesting to me to watch them go through the program and get healthy and shift those skills and talents that they've been utilizing maybe in you know in um selling drugs and marketing drugs and getting really good at that and they shift that just a little bit because they're managing a ton of people right they're doing a career and and to be able to shift that into you know more community oriented building and growing environments is like there it's pretty incredible to watch that happen absolutely i couldn't agree more and that's what i find very rewarding about this work as well you know um one one thing that i i do tell you know teams when i talk with them about this is um you know we as a as a field as even as a professional field we do a really lousy job at predicting who's going to make it you know and we believe we know like i mean i've worked in this and more years than i can even like calculate my head back but um but you know you you don't really know who's going to make it because for every person who you were sure they were going to make it and they ended up relapsing despite everything they've done and then you have another person who you know comes back six months later and says you know thank you so much for all you've done i'm still clean you know i mean you just don't you don't know who's gonna make it so so what i recommend is it is in our best interest from a therapeutic standpoint to assume everyone makes it because then we come to the table you know with the kind of hope we need to bring hope even when the person doesn't have hope themselves that day and and that in that way we can if anything be a positive catalyst you know because we won't know who's going to make it because life is really challenging right i mean where we run into problems is when we assume life is supposed to be easy it's not life is really really hard you know so making sure that we consistently come to the table with you know therapeutic interventions that we are we are clear and um and uncomplicated in our communication but we also have hope for the future for each person that we meet i think is very very important well it's vital i mean it's vital because here's the piece another piece that this this population has learned right is they read body language there's so much body language out there and so much intuitive connection that we have as human human beings and this particular population is super in tune to that because they've had to a lot of them have had to as a survival technique and so if you come into a setting with them and you have a belief that they're not going to make it they may not consciously know and pick up on that but they will unconsciously pick up on that it's like you can't hide those those thought processes and those belief systems right and so if you if you really can't think of it in a positive way it really will impact them even if you can't see it and measure it right and i think that's that touches back shelly to how you described about doing our own work right because it you know we we need to come to the table being not just hopeful for the patient but hopeful in general right we you know that that things are going to be okay that we can you know navigate this world and you know and find our way because when we're working with with someone you know it's so critical that we are authentic and that we are um we're open and authentic as human beings because we expect that they're going to be authentic open and honest as well you know so if we can meet them there you know even if we're telling them something that they don't want to hear you know i remember what talking with uh with a a wife once you know where she's like you know i'm gonna divorce him he's never gonna see his kids again i said he will see his kids again right so but let's talk about this you know so i mean just being honest and and and you know and being able to to understand and have compassion but also be frank right i think that i think there's a lot of um a lot of value and power in that when you know they can have someone who is going to just be honest with them right be honest but caring at the same time right and be realistic because there's so much irrational thinking and hurt and pain that comes up in those conversations and to be able to you know state the obvious like well it doesn't really work like that and i recognize that you're hurting and you're in pain and that's where you're coming from let's deal with that so that you can be present with because of course you want your ch you know their father to be in their lives of course you want right right that's really what you want your kids to be healthy you want what's best for your children but you're hurt and there's been a lot of pain caused here right and that's it's so important to talk about what's going on right exactly yeah it's hard stuff and people have hard things it's i love what you said right life was not supposed to be easy it's right we want it to be right that's why we have an open an an opioid epidemic because we wanted to escape from all of the pain and somehow we've got to have a pain-free life and it just isn't it's not supposed to be that way that's not human human existence right it'd be nice but it's just not and you know to the extent that we can recognize that it's okay to hurt right it's okay to hurt and that it doesn't last forever and that there are you know there are days that are going to be good days right so let's let's talk about how to find that balance and and it's interesting as you as as i've done my work and as i've worked through my you know my pain and my trauma and my whatever i find that and and i've heard people tell me this right they would tell me this over and over again it's possible to feel joy in the hard in the in the really difficult and i'm like i don't know what you're talking about but today i can say oh i can be in the middle of something really emotionally hard and go i am so grateful right i am so grateful that i made it through this part so i can manage this parter i'm so grateful the sun is shining today or whatever that is and those are skills that you really can feel joy in the heart right beautifully said i couldn't agree more and i think the challenge with that is that if we are not being stretched if we are not being challenged then we're not growing and that's stagnation and and i don't think anybody's happy there either i agree so lori i love that that you come on and that you know you've got the background that you do because i love the research piece and and i love picking brains and going oh what about this because the one thing i love more than anything is to learn right to learn something new so i love that you bring that to the table um i have a i have a feeling i know that pinnacle does a lot of really good work and good quality work and is continuing to improve and and there's people that are going to want to connect with your program and connect with you what's the best way for them to do that um so um people could look look me up on linkedin um lori ryland you could also email me laurie.riland at pinnacletreatment.com and you could always just you know look up pinnacle call and and leave a message there that's fine very cool and there's lots of people you i mean you have a lot of staff that are highly trained that'll answer those phones and be able to get someone where they need to go which is exactly yeah exactly now our call center is extremely good at connecting patients to the facilities near them in fact they would know much more than i would as well you know if any particular state any community within that state what are the resources nearby they're not even just our resources but how to connect patients to what they need they would be the experts in that but um if there's something specific that i can answer i'm happy to happy to take the call very cool thank you for that and one last question just because you know i might need something really cool to read is do you have any books that are top of your list that like you've recently read or that you come back to every year that you would recommend um you know i'm reading a book right now called clean that's that's really good it's like a history of um you know addictive treatment um also there's one called beyond addiction it's about the craft model of um of treatment which is community reinforcement and um and family treatment i think it is craft but it's it's essentially looking at how family treatment can be improved to help the person who is struggling with addiction to be more successful so it's a very cbt approach which i really like and it kind of breaks down some of those those issues like like what does enabling me right you know like like it'll say something like a family member says well okay i don't want to enable my loved one can i make them pancakes on sunday yes of course you can love your loved one right you know but don't pay off their drug dealer you know i mean that it helps to navigate some of those more like addiction cliches and and and statements um for families to understand how best to support their loved ones so the craft model is very helpful as well um so you know but definitely um i you know i do try to keep up on the evidence-based practices as well i've been doing a lot of reading and training lately and acceptance and commitment therapy and how they're finding it being effective with addiction treatment so definitely check that out because that's that's a lot of um really good application and what we do it's excellent it is those are excellent topics so thanks for sharing that and thanks for being with us today lori of course i'm happy to i always have a great time chatting with you shelly well it's been fun and you know i'm like okay i got to get laurie back on again or at least just go out to lunch with her so i can pick her brains yeah let's do that can't wait and i noticed your cute little cat came in in the background i know people all the listeners can't see but they'll be interested to know that she jumps up in the windowsill and walks behind the stuff and she's just as cute as can be so yeah her name is karma that's kitty she's black and white and she's beautiful so anyway fantastic thanks lori all right thanks shelly have a good one