Substance Abuse: "I Don't Have a Problem"

Greg Sutmiller is a licensed professional counselor and founder of Evolution Mental Health with offices in south Tulsa and Broken Arrow, OK. This episode focuses on substance abuse, including the dangers of alcohol and fentanyl, and the differences between substance abuse and addiction. Greg emphasizes the importance of addressing the underlying issues and changing one's lifestyle to achieve long-term sobriety. The episode concludes with encouraging words for those struggling with addiction, stressing that change is possible with the right support and commitment.

Transcript

TOPIC: Substance Abuse – “I Don’t Have a Problem"

GUEST: Greg Sutmiller, LPC, LADC

Season 4, Episode 7

Greg Sutmiller (00:00):

Fentanyl is extremely potent. It is so strong that just the amount that you could fit on the lead of a pencil is enough to cause an overdose in a typical adult who doesn't use opioids. Like, if you or me took just that amount, we would be in a serious medical situation.

Ric Shields (00:29):

Thank you for joining us on the DoorWays® Ministry Network podcast. I'm your host, Ric Shields. We're currently in a series with a focus on mental health, and as a reminder, maybe it's a disclaimer, I am not a mental health professional but I'm fortunately smart enough to speak with those who are.

(00:46):

My guest today is Greg Sutmiller. He's a therapist and the founder of Evolution Mental Health with offices in South Tulsa and Broken Arrow. Greg, thanks for joining me today.

Greg Sutmiller (00:57):

Thank you very much, Ric. I'm glad I could be here. I appreciate you reaching out to me.

Ric Shields (01:01):

Greg, you're a licensed professional counselor and a licensed alcohol and drug counselor. You're also a board approved licensure supervisor for those who are studying and training in those fields, and you've been providing counseling services in the Tulsa area for the past 12 years. So, I'd like to spend the rest of our time talking about substance abuse. That's something you seem to know a lot about. You're well acquainted with it, well versed in it. It's a huge problem in our state of Oklahoma and for that matter throughout the nation. When one mentions the term “substance abuse,” what are they really talking about?

Greg Sutmiller (01:37):

The term "substance abuse" I think generally refers to someone who is drinking alcohol or taking some kind of drug essentially in a manner that has caused problems. You know, if someone goes out to dinner and has one glass of wine and goes home and goes to bed, no one calls that substance abuse. There were no alarm bells that went off throughout that evening. But if someone goes out and has six glasses of wine and gets a DUI on the way home, now there's an alarm bell that's gone off. Maybe we're not calling them an alcoholic, but we might argue that it was an abuse. They went too far and it caused some problems.

Ric Shields (02:16):

Is there a difference between abuse and addiction? How do you know if somebody has a problem?

Greg Sutmiller (02:21):

They're definitely two different things. Obviously if someone's addicted, they abuse, but it doesn't mean that everyone that abuses is addicted. Let's take for instance, say you have, back to the example of the person going out and having a few drinks. Well, let's say this person, they go out, it's their birthday, they meet up with some friends, they have a few drinks, and for, in whatever way, things get a little out of hand. Maybe they say some things they regret. Maybe they get a DUI, maybe they, whatever, maybe they just get sick and embarrass themselves. And then they don't do that again until they're on their birthday next year. It's not a regular occurrence for them. It's a rarity that they would indulge that much. Again, we could say that is abuse. I mean, it's drinking to excess, right? But you wouldn't say that person has a dependency or an addiction.

(03:10):

Where it becomes an addiction or a dependency is when there's either a physiological or psychological or both need for that substance. You know, if you drink alcohol frequently enough in large enough amounts, you become physiologically dependent. And meaning, if you don't have something to drink, you have physical symptoms, you have withdrawal symptoms, you have the shakes or maybe even worse. You might have seizures and have all these problems that come with it. And the same thing happens with other drugs. You know, every drug has some kind of withdrawal symptom if you go far enough down that path. So that's, I think when you would call it a dependency is when someone can't cut back or stop without experiencing those types of effects.

Ric Shields (03:57):

And so, when we're talking about alcohol, maybe one question we can ask is, “how much is too much?”

Greg Sutmiller (04:03):

There are different ways you can answer that, but when I have this conversation with clients, I usually, a lot of times we'll start with, let's just look at it from just a basic health perspective. So, the CDC, the Center for Disease Control, recommends first off, if you don't currently drink alcohol, don't start. And then secondly, if you do drink alcohol, they recommend a maximum of two drinks per day, 15 drinks per week for a male, for an adult male. One drink per day, and it's either seven or eight drinks per, I think eight drinks per week, for an adult female. And so that's the CDC is saying. If you are going to drink alcohol, don't do more than this because doing so is detrimental to your health. They're not trying to define addiction, they're just saying, this is not good for you medically, you know, to drink that much.

(04:53):

One thing that I think a lot of people don't realize is alcohol, or the type of alcohol that people consume, which is ethanol, that type of alcohol is toxic to humans. We're not meant to ingest alcohol. And for that reason, it has to be processed, filtered by our liver. And the liver can only filter so much alcohol at a time, a small amount, which is why if you have more than like a drink, you start to feel the effects because It's more than your liver can keep up with. So, when you think about what is too much, well, there's just the basic baseline of like, what's going to cause me health problems. And really that's a much smaller amount than people realize. I think that's why the CDC says, if you don't start, if you don't currently drink, don't start drinking because no amount of alcohol is healthy at all, it has some effect.

(05:42):

And then when you think about things like, “When does it become a problem? How do you know it's too much?” Because it's become a problem. Again, that's where I go back to, well, how is it affecting your life? Is it causing problems in your relationships? Is it causing problems with your, is it causing health problems? Is it causing mental health problems? Are you recognizing the need to cut back and you're not being successful at it? Things like that. And, and if we're answering yes to those questions, well now we know it's too much because now it's controlling you instead of you controlling it,

Ric Shields (06:14):

You're listening to the DoorWays® Ministry Network podcast. My name is Ric Shields and I'm joined in this episode with Greg Sutmiller. Greg is a licensed professional counselor and a licensed alcohol and drug counselor for the past twelve years. We're talking about mental health and substance abuse.

(06:32):

There are so many substances, Greg, that we could talk about other than alcohol. Off the top of my head, I'm thinking about cannabis, methamphetamines, fentanyl, ecstasy, opioids, and there's so much more. Currently, fentanyl seems to have a corner on the market in the news. I recently read that fentanyl is being mixed with some other substances in our metro area. What's the deal with the increase in fentanyl and why is it so dangerous?

Greg Sutmiller (07:02):

Well, you know for a few years there, we were hearing a lot about the opioid epidemic, and opiates were a big problem. And during that period when people were talking about opioids, they were talking mainly about prescription opioids, prescription pain pills like Oxycontin and things like that, or heroin. When I started in this field several years ago, the most hardcore opioid addict was the person who injected heroin. That was the, that was like the ceiling pretty much for opioid addicts. Well, there have been a lot of changes over the past few years that have curbed the use of prescription opioids and even heroin. Once you know enough alarm bells went off, there are a lot of restrictions and different things placed on the pharmaceutical industry, placed on the physicians that prescribe those medications. That definitely caused a decrease in the amount of opioids that people were prescribed and that they could fill at one time and things like that. So that diminished the prescription problem. It didn't, it's not gone, but it helped.

(08:08):

There was a period of time at the kind of the height of the opioid epidemic where, this is a number I got from the DEA, 97% of the heroin that was coming into America was coming from Afghanistan, which, you know, we were at war in Afghanistan, so it was all coming. Well, we're not in Afghanistan anymore. So that pipeline isn't there anymore the way it used to be. So, heroin use has diminished greatly as well. But opioid addiction is one of the hardest addictions to kick from a drug perspective. Any addiction is difficult to give up, but opioids are, can be really hard for people too.

(08:48):

I think one of the reasons in the rise of popular of fentanyl, not the only reason, but a reason is when you get that void, you don't have the pills readily available. You don't have heroin readily available. If there's another opioid that can jump in and fill some of that demand, well, fentanyl can do that. One thing I've learned from doing this job is it's, it's just like anything else, it's the law of supply and demand. Where there is a demand, someone will figure out how to supply that demand. And unfortunately, there's always a demand for substances, for drugs. Alcohol, I mean as far back as human history goes, you can find evidence of people finding a way to alter their state of consciousness. So, you have these industrious individuals who see a demand for an opiate, and they figure (or an opioid) and they figure out that we can get fentanyl. You know, in years past, if someone was using fentanyl, it was always, almost always medical. It was like they, it somehow, they got it from a doctor or from a prescription or maybe from like a veterinary clinic or something like that. It was a medical grade fentanyl. Well now it's almost all coming from Mexico from the drug cartels. So, it's the supply is available now. So, there's been a big increase.

(10:12):

Another thing about fentanyl, and this answers both questions, I think as to why it's become more popular and why it's so dangerous. Fentanyl is extremely potent. It is far more potent than the other opioids I mentioned. Again, just a few years ago when it came to pharmaceuticals, Oxycontin, that was like the top one. Heroin, you know, someone, an IV heroin user, that was the most hardcore. Well, fentanyl is way stronger than Oxycontin or heroin. It is so strong that just the amount that you could fit on the lead of a pencil is enough to cause an overdose in a typical adult who doesn't use opioids. Like if you or me took just that amount, we would be in a serious medical situation.

Ric Shields (10:59):

Can you help someone who's abusing meth or fentanyl or other dangerous substances? What can you do?

Greg Sutmiller (11:05):

Yeah, you certainly can. Even something as strong as fentanyl, there are options out there. So, you have a variety of treatment programs all the way from preventative type programs to hardcore like hospitalization, you know, medical supervision type programs. So, there are a variety of treatment options depending on the person's need. I think you kind of alluded to this earlier, there are Twelve-Step groups for practically any addiction that there is. And it’s not just Twelve-Step, there are other options as well, you know, community-based support groups. So that can be really, really helpful for individuals. There are pharmaceutical interventions for certain drug addictions that can help, you know, some people. Like with opioids for instance, somebody who is using fentanyl regularly might have a hard time stopping fentanyl, cold Turkey, but they could use a medication like buprenorphine or the, it's more commonly known by the, the brand name Suboxone, to help them kind of bridge that gap where they don't have to go cold Turkey off the fentanyl. They can use Suboxone to help manage those withdrawal symptoms.

Ric Shields (12:08):

So, you're a licensed alcohol and drug counselor, so this is something you can help with at Evolution Mental Health?

Greg Sutmiller (12:14):

Absolutely. Yeah. We help people struggling with addiction issues all the time. One thing I always tell people is we're, so we're outpatient. We see people in the office that are people that are living and operating in the community. If somebody needs a higher level of care than that, then we can help them get there.

(12:33):

For example, I had a person not that long ago who came in. He had scheduled an appointment with me. He came in, as he came in, as soon as I saw him, I knew this guy was in really bad shape. He looked awful. And he, you know, he gets in my office and he tells me, “I'm hooked on fentanyl. I've been using fentanyl all day, every day, pretty much.” And so, after we talked for a little bit, I tell him, “Man, I want to help you, but the kind of thing we do here is not, you need something more than that.”

(12:59):

“I'm not going to be able to provide you with the level of care that you need in this office setting.” So, I helped him get into an inpatient program and I told him, “When you get done, call me.” You know, and then he did. So, he did the inpatient program and then he got done, then he came back here for follow up for kind of maintenance type care. So, we do a good job with people who are either, their addiction hasn't progressed to the point that they need to go somewhere else. They can still operate in the community or people who have done a higher level of care and need follow-up services once they get out. That's really our bread and butter.

Ric Shields (13:37):

And I like that he came to you because he knew he had a problem. But how about somebody, friend or family member of a listener, they've got someone with a problem, but that individual won't acknowledge it or do anything about it. So, what can the friend or the family member, what can they do to help this person with a problem?

Greg Sutmiller (13:58):

Yeah, so this question comes up a lot. This is a common problem. There are a couple of ways to approach it. I'm a really big fan of a counseling technique called “motivational interviewing.” And the basic premise of motivational interviewing is that trying to coerce people doesn't really work very well. Telling people what they need to do doesn't always work very well. In fact, a lot of times people just kind of dig their heels in and get stubborn and defensive. So, if you have an individual like that who's already told a dozen people in their life, “I don't have a problem, leave me alone,” me adding one more voice to that chorus isn't going to help anything. So, with somebody like that, the more motivational interviewing approach is, find out what they do care about, find out what is important to them, and try to go along with that.

(14:43):

So, a couple of things that, a couple of examples that come up a lot. You'll have the person who doesn't really think they have a severe substance issue, but they've had custody issues because of their substance use. They either they've lost custody of their child, or their custody's been restricted or something like that. And they want to get their kid back in their life. Okay? So, I'm not going to beat them over the head with the idea that they have a drug problem. We're just going to talk about what they need to do to get their kid back, right? And of course, part of that is going to entail not doing drugs, being able to pass drug tests, things like that. Work is another situation, where like an employer sends somebody, "Hey, you failed a drug test. You need to go see somebody.” They don't think they have a problem. Okay, do you want the employer off your back? You want to get back to full regular duty, full paycheck, all that? What do we have to do to get you there?

(15:39):

Legal problems are another common one. There's some kind of arrest that has been made or something. You don't want to go to jail or prison or whatever. Okay. How do we keep you out of that? What I've learned, taking this approach with clients is it doesn't matter what goal we set. Doing drugs or drinking all the time isn't going to help. If your goal is to get your kid back in your life. Drinking or doing drugs is only going to make that harder. If your goal is to get your employer off your back and, and progress through your job the way you want, drinking and doing drugs isn't going to help. So, I don't have to beat them over the head with that. We just talk about what their goal is and look at what's helping and what's not helping. And I just trust the fact that inevitably we will identify the fact that drugs or alcohol are not helping.

Ric Shields (16:26):

So basically, what I hear you saying is that shame does not help.

Greg Sutmiller (16:31):

No shame doesn't help. No, not at all. In fact, so often I've seen shame just to exacerbate the problem. People going back to the issue, like if someone has custody issues, they lose their kid because of a drug problem. That shame they feel from feeling like they failed as a parent or whatever, just triggers them to want to get high more. It doesn't make sense on paper, but it doesn't matter because they just feel so bad. They just want to, they just want to escape that feeling, that shame feeling.

Ric Shields (17:01):

Greg, I bet that you have some success stories to share. Could you give us a good success story today?

Greg Sutmiller (17:09):

There's a, this old one is one of the first. It's early in my career and it was a good lesson for me. I had this guy, so at the time I was doing a lot of work with court ordered clients, people that have been arrested. And I got a folder handed to me with this new client that I was going to start working with, and I started reading about him. And this guy had been to prison, I think six times, several times. He was a little bit older for someone in his position. He was probably around 50-ish, which in the drug world, 50 is pushing it.

(17:40):

I saw his criminal history. He looked like kind of a scary guy in his picture. I looked at what some of his crimes were and I took his folder to my boss and I was like, “What are we doing? How did this guy get in? This guy just needs to go back to prison.” And now I'm kind of ashamed that that was my attitude, but at the time it looked like a lost cause to me. But the court program, they were thankfully willing to give him a chance.

(18:07):

So, he shows up at my office. The very first time I met with him, the first thing he tells me, he says, “Brother, I've been doing drugs since 1960,” whatever. And he said, “Every lick of trouble I've ever been in, I was either drunk or high, and I'm tired of it.” And he meant it. He was sincere. I wasn't sure at the moment that he was sincere, but I came to learn that he meant that. And he was the model client. He showed up to everything. Everything you asked him to do, he did it.

(18:34):

He participated really well. In the middle of all this, had someone very close to him pass away. A lot of times, something like that, straight back, straight to relapse. Showed up to my office the day after it happened, just sobbing in tears. But he said, “I know that getting high is not what they would want for me. They were proud of me and so I'm, I’ve got to stick to this path.” And he just doubled all his efforts, started going to more Twelve-Step meetings, started going to church more. And I remember when he finally was discharged and completed the program, I confessed to him. I was like, “Man, I didn't have any hope for you when I first saw your file. And boy, I was wrong, dude.” Yeah. So that, that lesson always sticks with me that it's the cliche, you can't judge a book by its cover.

(19:20):

And once he really wants to change, they can change. The more recent success story is probably a more common story that people would be more likely to run into. The guy I worked with more recently, he got hooked on pain pills, which is easy to do. He got hooked and spent several years just slowly building his tolerance and use of opioids to the point, you know, he didn't get arrested, go to prison, none of that dramatic stuff, but it was causing problems in everyday life. You know, it was big time relationship problems that it was causing for him. Family problems, problems with friends, you know, he was losing relationships. He recognized that it was holding back in his career. So, not a guy that again, that anything like dramatic happened to, but he just saw it in himself like, this is a problem.

(20:06):

So, he came. He was able to get on a medication to help him come down off of those drugs. And he started working with me and he started going to Twelve-Step meetings. So, he did a variety of things, just stuck with it and, and was able to get off. He eventually got off the, the medication he was on that was helping him come off the opioids and has made a lot of, a lot of change. And I know his significant other is very pleased with the changes he's made. And he just last week celebrated one year of sobriety, so that was, so that's a recent success story. That was, you know, when he was telling me like, hey, it’s tomorrow is going to be one year for him.

Ric Shields (20:41):

Good for him! That's, that's great news. Greg, we need to draw our time to a close. I wonder if you have any special words of encouragement that you would like to share with our listeners today.

Greg Sutmiller (20:53):

Yeah, well I think like the stories that I just mentioned, it's hard, but people can change their life. People can stop using these substances, can have sobriety and not just, not just be sober, but change their whole life around. And I would say that's the approach you need to take. If you're tired of drinking so much, or you're tired of the drug that you're using and the hold it has on your life, you have to realize that it's not just as simple as putting down the drug or the drink. You have to be willing to change your life, your lifestyle. And the Twelve-Step programs you talk about, your people, places, and things, you know. But if you're willing to do that, it works. I used to tell the clients that I would meet with in jail, I would tell them it's really simple, but it's really difficult.

(21:38):

But it's really simple. It's simple in that if you just listen to the people around you trying to help you and do what they tell you to do, it'll work. It's difficult because the stuff they're going to ask you to do, it's a lot and it's not easy. But if you will do it, what I'd always tell them is, if you do it, two years from now, the people you interact with, if they didn't know you now or before, they will never know that you had a drug problem or an alcohol problem. You'll just blend in with society. And that's one of the things I like about working with people with addiction issues is that you see that, you see somebody go from such a low place to just blending in. They're just like everybody else now. So, it's totally possible if you're willing to hang in there and do what's necessary.

Ric Shields (22:23):

I hope you've noticed the theme as we have discussed some mental health issues in recent weeks. If not, maybe I should say it more plainly. There is no shame in getting help. If you need help get it. If friends or family members suggest you need help, get it. If your boss says you need help, get it. If someone says, "you just need to pray and spend more time in the word," do it but get help from professionals, too. Please don't misunderstand me to say I don't believe in miracles. That's not true. Anyone who really knows me will tell you that is not the case.

(23:02):

I think this verse from Proverbs 24:6 can apply to this situation. It says, "For by wise counsel, you will wage your own war. And in a multitude of counselors, there is safety."

(23:16):

Addiction is like a battle for your soul, and you'll need to fight it with everything you have. You'll need to wage war for your emotional, physical, and spiritual health. When Proverbs speaks of "a multitude of counselors," I have an idea of what that could mean. Find a mental health professional, find a physician, get an accountability partner. Go to a Twelve-Step program like Alcoholics Anonymous or Narcotics Anonymous. Not one or the other. Get them all.

(23:44):

You may say, Ric, "I don't have that much time." You're right, life is short and time is running out. You don't have time to be addicted. You don't have time to negatively impact your family and friends. But if you'll not just "find” the time, but will "take" the time, your life will change, your relationships will change, and your future will change.

(24:07):

I'm glad you joined us for this episode. I look forward to you joining us next week. Until then, may the Lord's grace and peace be with you and with those who you hold dear in your life.