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Navigating the Complexities of Mental Health and Addiction with Kimberly Bitz
263 Plays8 months ago
In this episode of "Growing OT," host Wilmari Myburgh engages with Kimberly Bitz, an occupational therapist committed to improving mental health and addiction practices. Kimberly shares her professional journey, starting in various settings in Weyburn, and evolving into her dream role with the Community Recovery Team, focusing on acute mental health and addictions. She passionately advocates for harm reduction, challenging the abstinence-based models prevalent in healthcare.
Kimberly discusses her research, particularly her dissertation on advancing Canadian occupational therapy practices for harm reduction among women who consume alcohol. The conversation delves into the challenges and nuances of addressing substance use, misuse, and addiction through an occupational therapy lens, emphasizing the importance of meeting clients where they are and reducing stigma.
The episode also explores the impact of Canada's new low-risk drinking guidelines, societal biases, and the necessity of a trauma-informed, client-centered approach in healthcare. Kimberly underscores the significance of community engagement and social prescribing in her practice, advocating for a holistic approach to care. She concludes by highlighting the importance of continued learning, professional development, and advocacy to improve client outcomes in mental health and addiction services.
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Transcript
Podcast Introduction
00:00:03
Speaker
Welcome to today's episode of Growing OT, the podcast that's developed and produced by the Society of Alberta Occupational Therapists.
Meet Kimberly Bitts
00:00:12
Speaker
I'm your host, Wilmarie Myberg, and today on the show, we are lucky enough to spend some time with Kimberly Bitts. Kimberly is an accomplished occupational therapist, passionate about advancing mental health and addiction practices and promoting well-being.
00:00:28
Speaker
Since 2018, Kimberly has been part of the community recovery team at Wayburn Mental Health and Addiction Services, working for the Saskatchewan Health Authority. In her work with the community recovery team, she advocates for equitable services and inclusion for a vulnerable and diverse population. Additionally, she works with community partners to promote community engagement and well-being.
Advocacy and Community Engagement
00:00:52
Speaker
Kimberly is an active member of CAOT's Addressing Suicide and Occupational Therapy and CAOT's Mental Health and Substance Use Practice Networks.
00:01:03
Speaker
She's a Doctor of Science candidate in Rehabilitation and Health Leadership at Queen's University, and her dissertation, Missed Opportunities Advancing Canadian Occupational Therapy Practices for Harm Reduction Among Women Who Consume Alcohol, stemmed from her concerns over the health of Canadian women and her desire to advance clinical practices for vulnerable populations.
Kimberly's Career Journey
00:01:28
Speaker
Kimberly is dedicated to improving the lives of individuals through evidence-based occupational therapy services, research, and education. Welcome, Kimberly. It's so great to have you with us and to spend this time chatting with you. To get us started today, I'm wondering if you could speak about the different practice settings that you've worked in as an OT. And if you could let us know how you found your way to this area of practice.
00:01:58
Speaker
Well, thank you for having me. Practice areas, I've actually only worked here in Wayburn and I've worked in a couple different settings. So when I started as an OT in Wayburn, I started as a generalist working in their therapies department. So Wayburn therapies, it's a rural community. So we really were responsible for going to all the different long-term care centers in the area. We would go to the hospital, working on the acute care unit part of the day. And you would also see some pediatric
00:02:28
Speaker
patients and then you might have some old patient or outpatients in the hand therapy area. So it's really diverse, which I really enjoyed. But it's also very demanding because obviously there's lots of travel. Some of our rural communities are two hours away. So you'd spend the better part of the day running all over the place. When I did my field work, I
00:02:52
Speaker
really loved working with more of the marginalized populations. And I was connected here in Waborn with CMHA, so Community Mental Health Association. And I've been a volunteer with them for a long time. And one of our other board members is Community Mental Health Nurse here in Waborn. And she approached me one day and said, you know what, we're starting this community recovery team that is going to be all acute mental health and we're
00:03:19
Speaker
really advocating hard to get an OT on the team and we're really hoping that you'll apply. So I thought, okay, this is great. Like my opportunity is coming up. So I just waited on that and it all went through. They got their funding, they got their program in place. And so I applied and I got my kind of dream job, I guess you could say, working with the recovery team.
Motivation for Advocacy and Practice
00:03:40
Speaker
So
00:03:40
Speaker
It's all acute mental health and then a little bit of addiction has worked into there. So that's been my two OT positions here in labor and then, yeah, I've been really fortunate. Yeah, I lucked out to your dream area of practice just quite early on, it sounds like. Yeah, yeah. Can you speak to us a little bit about your motivation for driving practice and advocacy in this specific area of healthcare? Sure.
00:04:11
Speaker
When I was a student, like an OT student, I did a placement at Boyle Street and so I really got a lot of exposure to that marginalized population dealing with being unhoused.
00:04:26
Speaker
the need for more harm reduction. I really enjoyed working in that place. But when I came to Saskatchewan, what I'm noticing, and I'm sure you guys are going through this now in Alberta, but those different political lenses that guide how healthcare operates. And so here in Saskatchewan, I'm finding harm reduction is just starting to become a little bit more popular. It's becoming
00:04:52
Speaker
more of how they're using that lens for practice. But when I first got here, it was don't talk about harm reduction. We don't do that here. That's not appropriate. Everything was really focused on abstinence-based treatments. And when you look at the research and you see what's helpful, if you're taking that equity and justice focus,
00:05:19
Speaker
toward your treatment, you really can't say that harm reduction isn't appropriate. In fact, it's the only appropriate way to approach our
Challenges in Mental Health & Addiction
00:05:27
Speaker
treatment. I've really tried to work to advocate for that and provide education. So I do a lot of just in services with my team, even just advocating even today.
00:05:36
Speaker
standing around just having conversations about, oh, you're doing a podcast interview? What are you doing a podcast interview about? So explaining a little bit about the workshop that I'm going to be doing in September, and then really approaching that harm reduction piece again, because
00:05:51
Speaker
where we're at, it's such a gap, right? There's so many silos. Obviously, that's a big problem, right? So you've got mental health, we've got addiction, and we have cis, med, and the three don't really seem to want to work holistically together, where if we could come get that approach and we could approach harm reduction a little bit more comprehensively, that would be wonderful. So I'm always really just pushing to try to get that lens and offer more for our clients to fill that gap.
00:06:20
Speaker
Great. And so you mentioned the silos of healthcare. I'm wondering what patterns or trends you've possibly noticed in your OT practice that made you want to explore harm reduction and substance use specifically.
00:06:39
Speaker
What we're seeing a lot of in the community recovery group is we're getting a lot of referrals for a psychosis that's drug-induced. It's not mental illness-based. It's drug-induced psychosis. So the clients are being put on community treatment orders. They're being given antipsychotic medications and being referred to our team for management. But they're really not true mental health
00:07:07
Speaker
cases. It's drug-induced and the problem with this is that the psychiatrists are advocating for full abstinence which is understandable. These patients are unwell and they want them to stop using the substances that are making them unwell but the patients don't necessarily want to quit and the addictions program won't see the patient
00:07:29
Speaker
unless they're agreeing to quit. And then we're doing the medication management. So again, there's this really big gap. So it was kind of like, well, we have to come up with a better way because it's so prevalent in our communities right now, especially with we're seeing a lot of kind of teenage to young adult with a lot of cannabis induced psychosis because they don't know how to moderate their use. They've never really had any education. They're just,
00:07:55
Speaker
I'm just going to vape. I'm going to use really high doses because I think that's what I need. I think it's managing my anxiety. And there's that really big education piece that's missing for these kids and young adults because we don't talk about it or we don't talk about how can you use substance safely and in a way that not going to be harmful for you. So that's just a huge, huge problem that we're seeing in community that's falling through the cracks a little bit.
00:08:26
Speaker
And it sounds like these individuals don't have anywhere to go if they don't qualify for that addictions program. Exactly. Yeah. So that's the thing. They don't necessarily want to not get better.
00:08:42
Speaker
And I think that's a bit of that bias that we have where people who are using substance was if the substance use becomes problematic, we automatically judge them and say, obviously, they're not agreeing to abstain, therefore, they don't want to get better. It's like, well, no, they just don't want to quit using completely.
Substance Use and Occupational Therapy
00:09:00
Speaker
And if you think about it, there's lots of us that use different substances.
00:09:05
Speaker
coffee that I go hard on all day long. And if you said to me, I want you to stop drinking coffee because it's driving your anxiety, I would probably be no.
00:09:15
Speaker
It's not going to happen, but maybe I could reduce my coffee use. And some of these clients are open to that, and that's that harm reduction piece that is really important. But again, we let our stigma and those biases kind of drive our response to them not wanting to quit.
00:09:36
Speaker
How do you view substance use in the context of occupational participation or through an occupational lens? So this is actually really interesting. There's a lot of really good OT research written right now. Dr. Nikki Kepic has some really great stuff and there's actually
00:09:56
Speaker
an article I was just reading today that came out. It's an occupational perspective on psychedelic therapy and it was written from U of A, Gabriella Hogan, Tim Bartlett, a few others where I won't hit everybody's names, but it really speaks well to you.
00:10:12
Speaker
how we can view occupation and substance use and it can have so many positives benefits and regardless of whether the substances elicit, elicit, great there's social benefits, there's physical benefits and sometimes we forget because of those biases and the stigma that can be associated with substance use.
00:10:35
Speaker
we forget that there are a lot of really good occupational outcomes that can come from substance use. So I try to frame it a little bit more from how is this substance meeting the needs of the client? If we look at the new CAN model, what are those needs?
00:10:53
Speaker
that the substance use is catching. Is it something to do with connectedness? Is it something physical? There could be some social needs that it's fulfilling for people to really look at it as how is this part of their occupation and not looking at it from that dark side perspective that can be so prevalent.
00:11:15
Speaker
Yeah, and I'm wondering while we're on that if you can tell us or talk to us a bit about why it's important for us to be having these conversations and to explore how societal and personal biases even influence variational participation.
00:11:35
Speaker
So I think when we look at our personal bias and the societal piece too, it does come back to those unmet needs and the gaps that are in the practice. So if we've got a bias that someone has to be completely abstinent, then that drives them away from coming in for different things. So if there's a bias that this person's just drug seeking, well then they're going to avoid going to
00:12:02
Speaker
the physician are going to avoid getting health care altogether. And so right there, you know, where it's jeopardizing health and safety for someone. So again, it's a little bit of an ethical issue when our bias and stigma is getting in the way, helping that person.
Biases and Healthcare Equity
00:12:18
Speaker
The other thing comes to looking at that equity and social justice, right? So we come back to that again, where is it equity? Is it equitable practice to deny someone services or a treatment that can be beneficial to them based on our
00:12:38
Speaker
bias that what they're engaging in is not appropriate. I was thinking about the questions that you had sent ahead of time and that piece about what do you do if your program is saying they can't be coming to program if they're using substances.
00:12:54
Speaker
And that really shines on that equity and justice piece, right? Because maybe there's something we can do to come to a compromise where we can still help them out if they're willing to have that give and take within the treatment program.
00:13:09
Speaker
I think the other piece too is that policies, advocacy work, we're not really advocating for our clients well if we're not examining how our bias is influencing what we're bringing to the table. And this is actually a conversation I had at work today because if we think about some of those reactions and the words people choose,
00:13:32
Speaker
So our inpatient unit here, the psychiatric inpatient unit, is getting a lot of admissions for, again, the drug-induced psychosis. And I think right now, the drug of choice is methamphetidine. And on more than one occasion, you'd hear someone saying, oh, not another meth head.
00:13:53
Speaker
And immediately that bias throws up a treatment barrier for that patient because now they've put that wall between them. There's not going to be a rapport gets developed for that person to say, okay, how can I support you? How can I help you? Because perhaps that person just needs someone to sit down and help them sell out a funding application or help them get housed.
00:14:19
Speaker
And then putting that into place can help them reduce their substance use because now some of their other units are being met. So it's, it comes into a really large bubble of different things that get affected, including again, occupational performance and their health and
Trauma-Informed Care Approach
00:14:35
Speaker
safety. We really have to really examine those biases and make sure that's not happening. And it sounds like we have to find more opportunities for
00:14:46
Speaker
meeting people where they're at in that gray area as opposed to being stuck in this, you know, black and white policy. Yeah. Yeah. And that's, it's tricky because we're stuck, right? You work for an organization that says, this is the policy and this is how it's going to be. So then it's okay. How can I, maybe I can advocate in a different way. Maybe I can't see them, but maybe I can take the time to connect them with someone who can support them and can make any
00:15:16
Speaker
that they have, right, rather than just say, okay, you're out, we can't help you. So I think that's a big part of it is even if we can't deliver a service, maybe we can advocate for it in a different way. So along those lines, how does a trauma-informed and intersectional lens inform your practice?
00:15:37
Speaker
For me, the trauma informed and intersectionality piece really comes with first asking the client, do you want to come to me? Do you want me to come to you? Do you want to meet in the community? What's going to work for you? Because for some of them coming into the facility where I work is traumatic right off the bat. Maybe they just come in and have an appointment with psychiatry. Maybe they don't like going out into the community.
00:16:02
Speaker
Maybe they don't like using transportation. There's a few different things. So I will spend some time on the phone just getting to know what's your comfort level, what's going to work for you, and then checking in on different languages, different cultural things. Does your spouse need to be there? Is that something that's going to be important for you that's going to make you feel more comfortable?
00:16:22
Speaker
Or do we need them to not be there? So really, there's that checking on those environmental pieces, making sure that there's no stressors that are going to impact them and taking time to get to know them. And that's the other big thing, just creating that rapport before really digging. So I know with occupational performance coaching, the first big component is to connect.
00:16:48
Speaker
and make sure that you are connected and that they're comfortable with you before you really dive into all the other stuffs. And I think I can't remember which instructor at your base at it, but probably the best advice I think was don't open a can of worms unless you know what to do with them.
00:17:08
Speaker
And so it was like, without a trauma-informed piece, it's knowing what your skill set is capable of dealing with, right? So if a client starts to go down a road within the practice that you're really not comfortable with or you don't know how to handle, being trauma-informed, just knowing what your own limits are and backing off and saying, okay,
00:17:30
Speaker
You know what, I'm going to connect you with someone else that has a better grasp on this than I do. So we're all experts in our own right, but we also all have limitations.
Building Rapport with Clients
00:17:41
Speaker
And knowing what those limitations are is a huge part of trauma-informed practice. Yeah, definitely.
00:17:48
Speaker
And so when you're in that situation with a client, how do you meaningfully connect with them so that they're comfortable opening up and sharing their level of involvement with substances and alcohol and even getting into how that's impacting their daily lives? What process? That's a big question. So we can take it in steps. It varies. It just depends on the client.
00:18:16
Speaker
and on what's going on, what's happening in the situation. Sometimes I might see someone a few times before I really dive into that piece. It depends on what the referral was for as well. I had a pediatric case before I moved over to the community recovery team where
00:18:34
Speaker
The mom was a no-show for a lot of appointments and it was starting to get really frustrating. And this was before I had a really good understanding of how substance use is so interrelated with so many other things. Someone would come in and the point, the referral was for like a failure to thrive. Like the baby just wasn't meeting all of those developmental milestones.
00:18:57
Speaker
and that mom come in one day and she just seemed awe and but we had got together enough times and I finally just said you know what can I ask you something because I had some concerns but it's not about the baby it's it has more to do with you and do you think we can have this conversation and she was yeah okay like what's up and I said is there something going on with substance use wise like
00:19:23
Speaker
I said, you don't seem quite yourself today. I know you've missed a few appointments. This is something we want to talk about. And she broke down and she said she's been drinking a lot. And she was missing the appointments because she couldn't drive.
00:19:41
Speaker
She didn't want to get an impaired coming to the pumice, but she's too ashamed to talk about it and to bring it up. And I thought, okay, now we can work with this. And really, it turned out that the failure to thrive and hit those developmental milestones had a lot more to do as postpartum depression and self-management of symptoms by using alcohol than anything else. Once mom got treatment,
00:20:07
Speaker
for her depression, everything else just fell into place. I like to say to use the five A's, pits that ass first, so once you have that kind of rapport, and you can just say, hey, can we have this conversation or can I do a formal assessment or is there anything you want to tell me about your substance use?
00:20:25
Speaker
And then once they are okay with that, then you can move into that assessment piece. An assessment, depending on what your skill level looks like, could include using a standardized assessment. It could just be having a conversation and saying, okay, I'll refer you to talk to someone else. And then after that assessment piece is done, move on to offerings and educational, some advice.
00:20:49
Speaker
really talking through what the assessment really said, because that's the other thing a lot of people want to know, and then talking about, okay, what do you want to do about this?
00:20:59
Speaker
Do you want to stop using? Do you want to change how you're using? Is there something that I can support you as? And then moving on to that, our re-insured piece. How are you going to take next steps? Are you going to be the person that follows them or are you going to prefer it and want to someone else who has more expertise to meet the needs of whatever it was that they identified in their goal setting with you?
00:21:22
Speaker
So if I had to pick a, this is how it would look, it doesn't always look like that. Sometimes it's messier, depending on the clientry, but it always comes back to focusing on what do they see for themselves as an appropriate goal.
Understanding Substance Use
00:21:37
Speaker
And it sounds like within that, there's a lot of opportunity to offer them some choice as you go through the process too, in terms of how much they want to share and how they want to engage with you and engage in future services. Yeah.
00:21:52
Speaker
Because one thing that you'll find or I've found is they might disclose one substance. They might disclose the most socially acceptable substance. They might be using other substances as well, but they don't want to share that part with you. Sometimes they're gauging your reaction to speaking. If I tell her that I'm doing this, then will she be open to
00:22:16
Speaker
something else that's maybe a little bit more illicit. So that part too, if you're being tested, can be really meaningful to the clients if you're being supported. Then they may open up and share a little bit more. That makes a lot of sense. For real. Can you talk to us about the difference between substance use, misuse, and addiction? Sure.
00:22:42
Speaker
I like to use my coffee habit as a bit of an example, just because a lot of people, when we talk about substances, we don't really think about the legal, more socially acceptable substances that people use. And I think for most people have one or two vices, coffee being mine.
00:23:01
Speaker
So substance use would just be your casual coffee drinker, you might go to Starbucks once for choice and you can pick up the coffee. And that would just be substance use. So you're getting some social benefits out of it, probably getting a little bit of a physical benefit out of that little caffeine bump.
00:23:18
Speaker
And because if you're not using a volatile, you probably noticed the caffeine bomb. And then there's pleasure, right? There's something really pleasurable about the act of going to pick up a coffee or brewing coffee in the morning, right? So every substance use comes with all of those, that host of occupational benefits.
00:23:39
Speaker
And then when we look at the substance abuse piece. So for me with coffee, I'm definitely moving more into that substance abuse piece because I probably drink sick, strong coffees a day. I drink it all day long. I think about coffee first thing when I wake up in the morning. I think about coffee at five o'clock. Is it too late for me to have coffee? Have I had too much coffee today? And I know that I'm overusing caffeine.
00:24:08
Speaker
When we talk about substance abuse and addiction, and then when you try to quit the habit, then you're starting to have physical symptoms, physical withdrawal symptoms. So for me, trying to quit coffee, I wake up in the morning about a wicked headache. I'm grouchy. I am shaking. I want a coffee. It's all I can think about, right?
00:24:30
Speaker
So that's when we're looking at that. There's an addiction element here. And then despite effort to stop, we keep relapsing, right? So I might go a day or two without coffee, the headaches the whole time, miserable the whole time, but then I can't stay quick. We get back on drinking coffee again. I'm picking that habit right back up where I left off, going without it, trying to find it, getting my coffee.
00:24:57
Speaker
I was commenting today that where we were, our building is outside of town, out of the main downtown area. So when you can't walk to a coffee shop, it's about a five minute drive to get to any coffee. And I was like, oh man, I really wish that there was a coffee shop nearby. So on a coffee break, I could go for a coffee and then shut my mouth because my desk is full of coffee. So it doesn't matter, I just make some. So really the differentiation is,
00:25:27
Speaker
the degree that it's affecting our lifestyle. And then when we're talking about addiction, there is a physical withdrawal. Some people talk about being addicted to shopping. Obviously, there's not a chemical addiction there. So that's where the differentiation lies is in the degree of problems.
00:25:48
Speaker
Okay, so along those lines, how would you then address treatment planning for clients that are actively using substances and possibly at that point of being addicted where it is impacting function and their kind of day-to-day lives as well?
00:26:08
Speaker
I guess it comes back to what they think their problems are. So they might not identify that there's a problem and that might be where you need to use a little bit of motivational interviewing or other exploratory practices to say, okay, are you sure there's not a problem? Because if they don't identify that there's a problem and they don't identify it as something that they want to change,
00:26:32
Speaker
then really our treatment plan may focus on other things like establishing funding or a way to reduce harms. So it does come back to that. The action over inertia program booklet that COT has, there are some really good tools in there that I've used for people to go through, have a look at, am I needing my physical health need? Am I needing my
00:27:02
Speaker
job requirements, am I meeting my household requirements? And that can give them an idea of maybe where they are, missing some pieces, and then we can move forward into coming up with a plan how to address those things. Because addressing the substance use itself might not be where we end up
Handling Complex Cases
00:27:21
Speaker
focusing. Again, that just comes back to their individual goal. So it's always going to look a little bit different as to how we're approaching it.
00:27:28
Speaker
And I may, depending on if they do want to quit completely, then that's where I would end up referring them out for other services or maybe start like a co-treatment with someone from addiction services who has a little bit more of that specialized treatment knowledge when it comes to dealing with completely quitting.
00:27:52
Speaker
And I'm wondering in those more complex cases where you're working with clients that possibly have suicidal ideation in conjunction with a substance use, how would you approach that as a clinician?
00:28:09
Speaker
So when you say ideation, I guess that would be, is there, is it just ideation or are they actually having plans? So just really exploring that and having that, we would typically follow that standard protocol for our suicide safety planning and moving through that. And then just looking at, do you need some strategies for coping skills? Because maybe there's something missing there. So exploring what's leading them to that ideation.
00:28:39
Speaker
Often it's family conflict or perhaps it's because they've been placed on a community treatment order that they don't want and they're not happy about the anti-psychotic medication that they're on. That's where we tend to get a little bit more pushback. So it's exploring, okay, how can we support you?
00:28:56
Speaker
to deal with these suicidal thoughts and coming up with that safety plan that's going to include a lot of coping skills, but then probably also going to include some education on reducing the substance use to a level that's maybe not quite as harmful so that maybe you could get off of these community treatment orders.
00:29:15
Speaker
if you can get things together. So really again, yeah, just follow me some of those protocols that we have on place. I'd like to hear a bit more about Canada's new low risk drinking and treatment guidelines and also maybe the rationale for these guidelines. Yeah, so I guess my question for you is have you looked at them and what did you go? I know they're they feel quite strict.
00:29:44
Speaker
It's my impression. As part of my doctoral research, I interviewed 11 occupational therapists, I think, by the time I was finished. And part of one of the questions was, are you familiar with Canada's low risk drinking guidelines? Most of the clinicians that I interviewed were familiar with the old guidelines. So they knew there was guidelines for women and there's guidelines for men.
00:30:11
Speaker
five to six drinks of meat, or most people would laugh. They scoffed at that even, oh, I don't even drink within that. That's okay. And then I would pull up the new ones and show them and say, okay, what do you think of this? And then it was that jaw drop. What do you mean low risk?
00:30:28
Speaker
right down here at that one to two drink mark for everybody, not just women versus men. It's that little for everyone. So it was entertaining because most people are like, heck no, I couldn't advise anyone to do that. I can't even do that myself.
00:30:44
Speaker
Well, yeah, it was a pretty big change. A big change. And I think part of it is socially, we've all been taught or sought through social media and other avenues that red wine is good for us. So a glass of wine is good for us, right? There's a lot of that initial hype around red wine. But the rationale came from
00:31:07
Speaker
looking at, I can't remember how many different studies they looked at, but they reevaluated. They went back to all of their research and really took a close look. And based off of all of their research and professional input and some lived experience, they
00:31:22
Speaker
basically said, no, you know what, we have to re-think and rewrite these because cancer risk for women, breast cancer risk goes up quite sharply after so many drinks and heart disease and all of the other factors. Yeah, that's where those guidelines got reconfigured and
00:31:40
Speaker
I don't know that they've been well accepted. I think it's like smoking. I think it's going to take time for people to really wrap their head around, right? Because people used to think smoking was good for you. And it took a long time for that shift for people to understand and realize that the risk actually gets significant and it's not that good
New Drinking Guidelines in Canada
00:32:04
Speaker
for you. So maybe we should reconsider it, especially for women, because that's where my doctoral research
00:32:10
Speaker
started was the social shift to the wine mom. And I'm not judging, there's nothing I drank while I share a wine, but it just seemed like it was so pervasive. There might be wine in here. It's like someone's caution cup and the t-shirts for babies that said, my mom wines because I wine. And there was just so much of that wine culture that seemed to be really creeping in. And I thought, this is interesting.
00:32:36
Speaker
Is this good for us? Because it happened before with cigarettes. They started marketing cigarettes and tobacco to women, almost as this like, faux feminist movement, right? And it just causes more harm because really, we're just pushing a chemical that we now know does cause heart disease and it does cause other problems. Yeah, so that's where my research popped up from.
00:33:04
Speaker
That's really interesting. I wonder, do you present those guidelines ever in client sessions? How does that go over? Any tips or tricks to help us sell those more? I have them. I do present them.
00:33:21
Speaker
And it's more about just initiating that conversation. I'm like, okay, so this is what the research is telling us. What do you think of these guidelines? If you had to say, because I don't like to get people to tell me, I don't want to know, are you drinking four bottles of wine tonight or are you drinking two?
00:33:38
Speaker
I use it more of a, if you looked at these guidelines, what would you say your risk level is? So they can just go up because it has this nice little risk meter right on the side. So they can look at that and they can say, you know what, I think I'm drinking in this high risk range. And I say, what do you think about that?
00:33:58
Speaker
probably could be less. Okay, if it could be less, how can you make it less? What can you do differently to reduce your risk? I could switch from drinking hard alcohol to drinking coolers or I could switch to
00:34:15
Speaker
Right? So they start to kind of examine for themselves. If they're not really coming up with any ideas, I might offer some different suggestions to do with that. Is something that you would feel comfortable with? Or do you think this is important? And sometimes they just say, I like how much I'm drinking. I don't really care. That risk is fine for me. And that's a risk that they're willing to take. Okay, fine. How can we reduce the risk to other? Because that's a really important consideration, right? Are you drinking and driving?
00:34:45
Speaker
because that risk is not your risk. That's my risk. You're putting me in jeopardy by driving. So what can we do differently? You can call a threat. You can make arrangements ahead of time.
Community Engagement and Social Prescribing
00:34:58
Speaker
There's different things that they can do to reduce risk in other ways without cutting their own substances back. Great. Those guidelines are definitely challenging though. There's some quite entertaining videos.
00:35:12
Speaker
on YouTube that people have made about making fun of the new low-restricting guidelines and yeah, definitely a shock to the system. I'll have to go check those out. Now I'd like to shift gears a little bit and ask how you work with different organisations and colleagues to promote community engagement.
00:35:36
Speaker
I am a big fan of social prescribing. So I really like to, when I see someone who is maybe struggling with isolation. So we have a lot of clients that like to stay home. They like to do video gaming. They might be on Twitch or other platforms where they spend a lot of their time.
00:35:58
Speaker
So using social prescribing is a big key to getting people out and reengaging their community. I have the benefit of Wayburn's a small community. There's maybe 11,000 people, everyone knows everyone, and I've been involved with most of the different
00:36:17
Speaker
organizations entail. Once you've made those connections, it's easy to pick up the phone for me and just say, hey, do we have Envision counseling services? We have Canadian Mental Health Association of different events at the library. So you can just pick up the phone and say, hey, I have a client here. They're willing to
00:36:35
Speaker
Come and check out your programming over there. Can I bring them by? Can they just show up? Make those introductions. Hang out with them. That's my other thing. Just spend some time introducing them to the different community services, getting them engaged. That way we have a big walking truck here that we need to take claims to just introduce them. And I might go with them several times.
00:36:59
Speaker
and spend an hour just walking at the walking track, get them comfortable engaging with different community members and checking out the different services that are available to them. Because for me, I guess that's part of that being an occupational therapist, but it's at the end of the day, there's, you know, I've done something with them, but then they're not willing or comfortable enough to go do that again on their own. I haven't really done my job.
Advocacy and Influence in Practice
00:37:24
Speaker
I want to make sure that
00:37:26
Speaker
what I'm showing them they're willing to start doing on their own afterward. So that's a big part of what I like to do, just get those community relationships built for them and help them feel comfortable. And I wonder, how are you using your clinical experience, skills, and training to make a broader influence in this area of practice?
00:37:51
Speaker
It's so interesting because I was just writing a conclusion to my dissertation and I said, I'm never really the person that wants to be in charge. I'd rather just be in the background. Maybe I'll just facilitate a workshop. Maybe I'll just stand on my soapbox and talk to someone about something, but I never really wanted to be in charge. And so when I started the doctor alert,
00:38:17
Speaker
and then opportunities have presented themselves. I've just taken that just a yes approach where, okay, I'll get involved and I'll start to offer what I have to help other people. Volunteering with other groups, so being part of the professional practice networks. To me, that's like a key thing that we all should be doing because then we can use our experiences and our knowledge to work on committees, advocacy groups,
00:38:47
Speaker
There's different working groups within some of those professional practice networks that actually do work on some research and other stuff. So really just lending myself to those things and putting yourself out there to try to raise awareness is the biggest thing.
00:39:03
Speaker
That's great. That's where the important work really is because this is an important message. So yeah, I commend you for going again to maybe the initial reaction of not wanting to get involved. It's vulnerable work, right? You're putting yourself out there and work like this is hard because not everybody agrees.
00:39:24
Speaker
Right. There are people that are in the camp, um, abstinent for this type of thing is the only thing. And that's where they're very focused and on, on the other camp. And so it can be challenging, right? Because sometimes we don't necessarily want to listen to the other side. We're like, no, I don't agree with you. And that's the end of that grade. So not obviously everyone who listens to the podcast, not having to agree with everything that I had to say. And that's okay, but it's important.
00:39:53
Speaker
to share what you know and post that information out there because it might impact somebody positively, it might change how someone frames their approach with a client that really benefits that client and that's the key.
Resources for Clinicians
00:40:06
Speaker
At the end of the day that's the most important thing is that we're improving client outcomes and that's all I can ever really hope for.
00:40:12
Speaker
And along those lines, can you speak to us about the additional education and professional development that you engaged in to better support and bolster your skills in this area and what you might recommend for clinicians looking to explore this further? Besides your upcoming workshop with SAOT that we'll plug later.
00:40:37
Speaker
The list actually, for me, it's a lot of reading and reading the current research. So that can be a challenge because not everyone has access depending on if there's a paywall for the different research. COT's got some great stuff with Canadian Journal of Occupational Therapy. There's some good work being published in there. BC Centre for Substance Use has a really great free online course for substance use care that I encourage everyone to check out.
00:41:06
Speaker
It really is a no-nonsense approach to teaching people about the different substances, what the evidence-based treatment protocols are, or those substances. So when you're working in a team environment, you know what the doctors, the nurses, what everybody's talking about. And you'll know too, right? Because maybe your team hasn't taken that training.
00:41:27
Speaker
and they're not up-to-date on what the current evidence base is saying. So I really encourage that one. So at Species Center for Substance Use, Fabian Center for Substance Use and Addiction has some really great resources. That's where a lot of those guidelines are. So there's the low-risk guideline, there's treatment guidelines, and those offer a lot of different suggestions. For things that really do work well, they mesh well with the OT approaches. So whether or not you adopt a can lock,
00:41:57
Speaker
or you have a different treatment model that you like to use, you can really integrate those things in nicely, which is really good. I don't have it on my desk, but Dr. Nikki Kepic has a really great book. It's available at CRT online.
00:42:13
Speaker
And it lists it, elicits it, and prescribes. And it's substance use and occupational therapy. It, like my little Bible, it has some really excellent information in there about different approaches. And again, like really no nonsense information, a lot of really good evidence-based information, which is nice.
00:42:35
Speaker
Harm Reduction International, I've taken a few little pieces from there. So I work for the SHA, Saskatchewan Health. We don't get a lot of funding for additional training. So most of what I've done is really my own research.
Rapid Fire Questions and Conclusion
00:42:52
Speaker
through my doctoral program. Like I said, lots of mother reading. So I have a reference list that's probably a mile long. Oh, one that I highly recommend is it's called Drugs Without the Hot Air.
00:43:08
Speaker
Dr. David Nutt. Yeah, David Nutt. He's written a few different books. So he is part of homeless in the UK. Excellent book. And it frames, so what they've done is they've looked at basically the risk scale for the different substances or the harm scale for all of the different substances and they've given them all a rating.
00:43:31
Speaker
And so you can see which substances are truly, based on the evidence, harmful and which ones really don't have as much of an impact. And it's interesting because our most socially acceptable legal substance, alcohol, is right at the top of having the highest degree of harm. And it's above meth and it's above heroin. So it really, the whole Baptist challenge is your perspective.
00:43:56
Speaker
on substance use and what the risks really are for applying. So it's a good one.
00:44:02
Speaker
Wow. Thanks. Those sound very interesting. So I'm sure many of our listeners will investigate further. Thank you for sharing. You're welcome. To finish things off here, we like to ask fun rapid fire questions that you can't think too hard about. So just your kind of first gut answer is the right one. Drink the water real quick. Yeah, of course. Okay. Okay. If you could have any other job, what would it be?
00:44:32
Speaker
A veterinarian. Okay. Do you have pets? I have two big hairy dogs that I'm surprised have kicked the door open. Awesome. Do you speak more than one language? No. Unless pirate count as a language. Okay. Just swearing a lot. Interesting. I've never heard it called that before. That's quite funny.
00:44:58
Speaker
Are you currently in the profession you dreamed of when you were a child? No, that would have been a veterinarian. Okay. Would you ever skydive? Oh gosh. You know what, I like to think I would. I have a terrible fear of height, though. So I don't know, but I think it would be such an amazing experience. But I've never actually considered going to do it. Okay, maybe once your dissertation is done.
00:45:26
Speaker
What's your favorite breakfast? Oh, I like omelet or waffles. Good choice. And where did you go on your last vacation? Oh my gosh, with COVID, that's been, I guess we just took a little winter break. We went to Eucluluit. Oh, cool. For a little storm watching session. A writing break. So it will break from my dissertation.
00:45:53
Speaker
Yeah. Wow. That sounds really neat. Just watch the waves crash. That's beautiful. Wow. And that's it. That's all from us. We really appreciate you taking the time to chat with us today. It's been great to have you on the show. We wish you all the best of luck with finishing your dissertation and continuing your work in this very important area. Thank you. It's been fun. Thanks for having me.