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Apr 3
  • Written By Scott Drochelman

    • # 178 – Ask the Expert – Dr. Alison Tarlow

    Dr. Alison Tarlow

    Hope For Families With An Addicted Loved One

    Dr. Alison Tarlow is a Licensed Clinical Psychologist in Florida, New Jersey, Indiana, and Pennsylvania. She is also a Certified Addictions Professional, Internationally Certified Alcohol and Drug Counselor, Qualified Clinical Supervisor, and Florida Supreme Court Certified Family Mediator. 

    Dr. Tarlow’s clinical work has focused on the treatment of substance use and co-occurring mental health disorders. In 2014 Dr. Tarlow became Clinical Director of a substance use disorder treatment program in Fort Lauderdale, Florida. 

    Today, Dr. is the Chief Clinical Officer for Boca Recovery Center. Additionally, she uses her social media presence to educate on subjects that relate to substance use and recovery.

    Episode Resources

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    Episode Transcript

    Ashley Loeb Blassingame (00:00):

    Coming up on this episode of The Courage to Change sponsored by Lion rock.life,

    Dr. Alison Tarlow (00:06):

    I don’t know anyone that’s ever come home who did well living under a microscope. Nobody wants to do that in any kind of like, sort of intimate, you know, relationship to begin with. And that certainly can happen is like, you know, you’ve been through Hellen back and your loved one finally went to treatment and got sober, right? And now they come home and you’re sort of like sneaking around and looking at where they’re going and you wanna see their phone or you know, and it’s like, and it’s completely understandable, but I don’t think those are conditions in which anybody is going to be able to thrive in their recovery. Cause it’s very stressful, not just for the person who is trying to stay in recovery and continue on this path of wellness, but it’s also life is hard enough.

    Ashley Loeb Blassingame (00:43):

    Hello, beautiful people. Welcome to the Courage to Change a Recovery podcast. My name is Ashley Loeb Blasting Game and I am your host. And today we have Dr. Allison Tarlo. Dr. Tarlo is a licensed clinical psychologist in Florida, New Jersey, Indiana, and Pennsylvania. She is also a certified addictions professional, internationally certified alcohol and drug counselor, qualified clinical supervisor, and Florida’s Supreme Court certified family mediator. Dr. Tarlow’s clinical work has focused on the treatment of substance use and co-occurring mental health disorders. In 2014, Dr. Tarlo became clinical director of a substance use disorder program in Fort Lauderdale, Florida. Today, Dr. Tarlo is the Chief Clinical Officer for Boca Recovery Center. Additionally, she uses her social media presence to educate on subjects that relate to substance use and recovery. As you just heard, Dr. Tarlo is incredibly qualified to talk to us about mental health and substance use disorders.

    (01:47):

    We get into all sorts of conversations around family members. We even go through various situations. I give her circumstances and she gave me feedback on those particular circumstances. We called them vignettes and we had a really great conversation about what the brain looks like in the first year of recovery. There’s so many nuggets of wisdom here, lots of information. Please check out Dr. Charlo on Boca Recovery, TikTok. She has a lot of great questions answered there and you can reach out to her if you have more. So without further ado, I give you Dr. Allison Tarlo. Let’s do this.

    Ashley Loeb Blassingame (02:41):

    You are listening to the Courage to Change a Recovery podcast. We are a community of recovering people who have overcome the odds and found the courage to change. Each week we share stories of recovery from substance abuse, eating disorders, grief and loss, childhood trauma, and other life-changing experiences. Come join us no matter where you are on your recovery journey.

    Ashley Loeb Blassingame (03:10):

    Dr. Tarlo, thank you so much for being here.

    Dr. Alison Tarlow (03:13):

    Thank you for having me.

    Ashley Loeb Blassingame (03:14):

    So tell me a little bit about your childhood and what brought you to this field.

    Dr. Alison Tarlow (03:20):

    That’s a really interesting question because as a child, I never thought I was going to be a psychologist. You know, probably like most small children, I had dreams first of being Wonder Woman, then I wanted to be an airline hostess cuz that just seemed like super glamorous. And I actually grew up in London, England. My father and my grandfather were both physicians and I wanted to live in the United States. And so when I was 19, I came here to go to school to attend college in South Florida. And I took courses in psychology and I fell in love immediately. I felt a passion for the subject. I excelled in it, which I think was sort of important because I was not academically a big success in like middle school and high school years. I was sort of like the goof off. You know, coming here to go to school and taking the psychology courses was, you know, probably the first time that I really sort of felt a sense of self-esteem in terms of my intellectual capacity and being able to develop a career in something that I really wanted to do after I graduated and got my doctorate.

    (04:23):

    I found there was really a need for a lot of the sort of mental health component of psychotherapy because a lot of substance use disorder treatments at that time was sort of focused primarily I would say on the substance use disorders. And, you know, sometimes with a sort of tough love approach or not necessarily helping some of the stigma that we know exists with people who struggle with substance use disorders and mental illness. You know, 10 years later and most of my time, in fact all of my time is spent working with, you know, patients who struggle with substance use disorders and mental health and doing a lot of clinical supervision and, you know, guiding the clinical teams that we have at all three locations.

    Ashley Loeb Blassingame (05:01):

    Did you grow up with any addiction or alcoholism or substance use disorder or eating disorder in your family that spoke to you and, and gave you clarity on, on your childhood?

    Dr. Alison Tarlow (05:12):

    While I never personally struggled with any substances in, in terms of having any addiction, somewhere along the way I was having a conversation with my father about my grandmother, his mother who I had grown up with and we were very close. I would sleep at their house every weekend and it was, you know, I loved to stay there. They would spoil me with candy and I could eat whatever I liked for breakfast and stuff like that. They were very loving. My grandmother was always bedridden for much of my life, I I, I remember the very early years, she wasn’t bedridden, but probably I would say by about maybe nine or 10 years old, she was in bed all day and I always believed that she had some sort of horrible stomach cancer. I don’t know that I was old enough or wise enough to question it.

    (05:49):

    It, it just was. And my grandfather was a physician, you know, he would, you know, go to work and do whatever he needed to do. But every four or six hours she would call down to him and he would come upstairs and he would give her an injection. He had all the medications on the counter and he would, he would write down how much he was giving her and what time he was giving it to her. Several years after my grandmother passed away, I was talking to my dad about family history of cancer and wanting to kind of know more specifically what kind of cancer did my grandmother die of. And it was only then, and I must have been probably in my mid twenties at that point, that he said, well, I mean ultimately at the very end she did have breast cancer. But you know, for all those years that she was ill in bed, it wasn’t, it wasn’t actually some sort of stomach cancer or anything like that.

    (06:32):

    Essentially what it boiled down to was that she had an opioid addiction. She was being given every four to six hours an injection of perine, which is a morphine derivative. She certainly seemed like she was in pain and, and it certainly seemed like after like four to six hours, the pain seemed to get worse. And, you know, I would see her get her injection and sort of what I now know as sort of nod, nod out. But it really wasn’t until all those years later that I was able to put the pieces together with the help of my father’s information to learn that she actually for many years was addicted to opioids, you know, what she was experiencing and what I think my grandfather was avoiding would’ve been the symptoms of withdrawal. So that was really sort of a powerful eye-opening discovery for me.

    Ashley Loeb Blassingame (07:14):

    You know, I think one thing that you talk about, which I absolutely love and support, is this idea of I’ve never met anyone who had substance use disorder, who didn’t have some other mental health thing going on, at least at that time, right? Maybe eventually they, they, it, it resolved because your life is such a shit show. What, by the time you need help, like of course you’re depressed and Hank have anxiety. So it’s nearly impossible in my opinion, to not have some sort of co-occurring, right? The substance use disorder is the visual, right? When I gave up drugs and alcohol, it was like my relationships with men, oh boy. And then my relationships with food and my relationships with money and who knows what’ll come after that. And when people think that they are just going to arrest their meth use or their alcohol use or whatever and not do any other work, it is not even worth quitting the drug.

    Dr. Alison Tarlow (08:09):

    I mean, I really feel like it’s sort of a, I don’t wanna say necessarily a recipe for disaster, but I think that, you know, there’s a couple of things. So first of all, anyone who’s coming in and looking for help and who has struggled with or is struggling with a substance use disorder, you’re typically gonna see one of two things going on. Either they have mental health issues, significant family environmental issues that they grew up with including, you know, depression, anxiety, trauma, things of that nature that somehow then led them to finding substances that in the, uh, you know, in the early using made them feel better. So they were self-medicating and then the substance use disorder of developed. So they had the mental health stuff going on and then they started using substances and now they’ve, you know, come along and they have both, you know, the flip side to that is people who may not have had those mental health issues on, but they got into using substances became addicted and then in the course of their addiction, and certainly when we see people coming in for treatment, they have been using and, you know, pretty hard for a length of time, the experiences that come with that lifestyle.

    (09:10):

    The, you know, people say, oh, you know, tell, talk about, you know, P T S D and substance use disorder and it’s like, I don’t know too many people that haven’t experienced some sort of trauma either in their early life and then they were using to self-medicate and deal with it because they weren’t dealing with it any other way and didn’t have those opportunities. Or as a result of using, they have been in situations where they have had to, you know, sell their bodies for drugs or they have been in places where, you know, bad things are happening and so they experience trauma just from those periods of the years or you know, however long it is that they’ve been using. So you’ve got those things that are going on, certainly from your brain chemistry perspective. You’ve got the dopamine, the serotonin, all the things that we know are impacted by substances that also play a massive role in our mental health.

    (09:56):

    And now your brain is just like a mish mush of too much of this and not enough of that. And it’s all, everything’s firing at the wrong time and your neural pathways are going haywire. And then also what as we’re diagnosing, and this is where I think everyone has to be really careful, is that you have to really have, in my opinion, a good solid year of sobriety to really then be able to take a look at a person to really be sure like these were symptoms that were occurring before your substance use. You’re now a year sober, you still have these mental health symptoms going on. So we can say with a higher degree of certainty that yes, you have this disorder or that mental health disorder because a lot of people come in, you know, it’s like everyone has bipolar disorder, everyone has bipolar.

    Ashley Loeb Blassingame (10:35):

    Yeah. I have some incredible stories of being in detox over, you know, over the course of trying to get sober as a teenager and whatever, and all the different diagnoses that they gave me, like while I’m coming off of cocaine, right? Come on guys, who isn’t bipolar coming off of cocaine, right? Right. I mean that, that’s the name of the game. But you’re, you’re absolutely, we can’t look at an altered brain and give it a theoretically permanent state diagnosis when it’s purging toxic chemicals from it.

    Dr. Alison Tarlow (11:04):

    And when you look at even post-acute withdrawal syndrome, I mean, you know, we know that yes, in in, in most cases post-acute withdrawal will last for, you know, a relatively short period of time. But we also know, and there’s a lot of research out there to show that when you are using heavy benzodiazepines, when you are using heavy alcohol for many years, the post-acute withdrawal and, and certainly with opioids as well, post-acute withdrawals can go on for 12 months or, or more. Certainly it’s not gonna look as bad as it looked in the early days when you’re detoxing. But there are plenty of people who are really struggling with symptoms for up to or over 12 months.

    Ashley Loeb Blassingame (11:39):

    Absolutely. Absolutely. And your brain is just trying to, to find some sort of balance there and how in some of these situations, I’m gonna toss you some of the questions that we get a lot. How do you deal with family members or loved ones, whomever who are going back and forth about wanting to get help and wanting to be well for a long time? They, you know, they’re there for a week, they really, really want it, they really, really want it. And then a month later that changes and when the family or loved ones, whatever that support circle is there and they’re going through this washing machine vacillating decision cycle, what do you tell the support system on how to manage that?

    Dr. Alison Tarlow (12:22):

    So a couple of things. First of all, it’s important for the fa. We like to certainly have the families very involved in treatment and you know, provide them with education. They’re in on family calls, they’re in on aftercare calls, treatment planning, and also they’re really a part of the process. But it’s really important that these family members look at what work they need to do. Because generally by the time somebody comes into treatment, they have been through the ringer. Literally it’s been an exhausting journey that hopefully has now come to an end because their loved one has agreed to come to treatment. So a couple of things. First of all, I like to really let people know that treatment is like a foundation course. It’s just the beginning to give you some basic skills. It’s going to help clean out your system and you’re gonna get certainly psychotherapy and individually and in groups and you’re going to learn some skills and we’re going to be planting a lot of seeds, but you’re not staying in treatment forever.

    (13:16):

    And so when you leave, that’s going to be really where you are sort of launching off and that’s where you’re going to need a lot of support from family, from loved ones, aftercare, pro, you know, 12 step meetings, whatever that looks like. And that the family really needs to really understand and feel comfortable with where they are at with the process so that they can work on themselves, heal from their trauma. You know, watching a loved one go through all of this can be very traumatizing and you feel very helpless. And, and so really getting that support and also recognize where their boundaries are because holding the line becomes really important. The person who’s struggling with addiction will vacillate. They will decide or mu over or sometimes just be straightforward and say, I don’t know if I really wanna do this recovery thing. And so the family needs to sort of prepare themselves for any eventualities so that they’re not caught off guard and that they’re comfortable with how they are going to respond and handle something like that.

    (14:10):

    Certainly you wanna provide support in a loving way, but, but that doesn’t mean enabling. I always like to tell families you have to be really comfortable with what you are saying that you can follow through on it. Don’t say, I’m gonna kick you outta the house and never give you money again and blah, blah, blah. If, if that’s not actually true because you just need to do that one time and your loved one is gonna say, yeah, they’re full of crap. Like, we don’t, we don’t, you know, that’s silly. You know, I know that I can get around mom or whatever that looks like. And also, unfortunately, and thi, and this is, this is hard, but it’s something that along my journey I’ve sort of learned is that, you know, there’s no guarantees You can have somebody who is speaking the big book all day long or speaking recovery and it just seems so invested.

    (14:53):

    And it looks like we got someone here who’s really that this, this one’s gonna do it, they’re gonna get recovery and they’re gonna stay in rec. You know, and we know it just doesn’t work that way. And so understanding as loved ones and family members that however positive and however motivated or, you know, whatever this looks like with them in treatment and, you know, moving through treatment and aftercare and, and returning back into the home life and whatnot, there’s no guarantees. So you have to really be able to, to steady yourself for whatever may be coming at you. We can all do our work and, and hope and pray that that never happens and we wanna support the person and, and, and have a positive outlook. But I think we all sitting here know better than that addiction is a beast and it’s a tough one.

    Ashley Loeb Blassingame (15:36):

    Yeah, it is. And and I think that understanding what we’re dealing with is so vital to being part of the support team, being part of the family. I wanna throw three vignettes at you, three kind of general vignettes that I hear all the time and I’ll, I’ll generalize some of the details so that they apply more broadly. And the first one is mom and dad or mom sends their adult child to treatment. They do so using small amounts of leverage because the, the adult child is not legally under their care and it’s a bit contentious, right? There’s a little bit of anger and this adult child goes to treatment, inpatient treatment and is convinced to stay longer, get some sobriety under their belt, does the halfway house, and then they really, really, really wanna come home and mom and dad or mom does not get the family week experience. And so they bring them home, they start to see changes and they see a relapse and can’t figure out what’s going on. When you hear that chain of events, it gives,

    Dr. Alison Tarlow (16:42):

    It gives me a little bit of a knot in my stomach just listening to I to the video. I

    Ashley Loeb Blassingame (16:45):

    Know it does. I know.

    Dr. Alison Tarlow (16:46):

    So a couple of things, you know, certainly when you say, you know, the, you know, the family’s like, why do I have to go to the family week? You need to go to family week cause you need help in figuring out how to navigate what could be a very tumultuous course in front of you. It’s particularly difficult when you’re dealing with what we call the adults child, right? Because they’re over the age of 18, but they might be, you know, 21 or 22 or 25 years old. And also as a mother, you know, they’re always your baby. I mean, I have a daughter who’s 20 and she’s my baby. I mean, and she’s a legal adult. It’s really important for family members to understand that our natural inclination as a parent is to step in. We do want to help and fix for our children in normal circumstances.

    (17:30):

    When you’re talking about addiction, there have generally been enough other issues that have occurred through the earlier years leading up to that point where this adult child is likely experiencing things like low self-worth, codependency issues, feeling sort of comfortable in allowing the parents to step in and help because, you know, why not failure to thrive? Absolutely. There’s oftentimes manipulation involved. So all of these things are more than likely, if not one, than all are going to be occurring. And the other thing too that I would wanna say before I continue is that, you know, the relapse often happens before the relapse happens. So you are going to see different things are going to unfold in terms of, okay, you can move back home, but you’ve gotta be outta bed every day. You’ve gotta do this, you’ve gotta do that, you’ve gotta take care of your bedroom and participate in this, that, and the other.

    (18:18):

    And it’s like slowly you’re very slowly these things start to fall by the wayside and you start to see signs that are sort of mild but sort of alarming. And you know, what we know is, yeah, these are all red flags and also parents have this fabulous ability of really only wanting to see the very best or believe in their child and believe what their child is telling them. And kids can be very convincing when they wanna be, especially to their parents. So, you know, all of that kind of comes together and therefore it creates bit of a disaster, not in every scenario, but in enough scenarios where we say, Hey, as professionals, as people who’ve been through this, we would advise against it, that we would advise that they live in and finish out their commitment to the halfway house, to the three quarter way house that they find other sober people to live with, that they are responsible for their own bills and stuff.

    (19:08):

    And that’s not to say that if the child needs a little bit of help with something like they’re on the family plan for their cell phone or you know, something like that there, you know, there are, and and I saw, and and I personally am a believer that if you are truly able to see your loved one, especially in the case of children doing the next right thing and showing that they are thriving and they’re moving clearly in that direction, and hopefully there are other professionals involved who are verifying and validating that the picture is looking okay, yes, then yes you can give some more support. Sure. But when you are just allowing them to come home and they are just sort of kicking up their feet and not really doing anything that they need to be doing and all these, you know, all these red flags are starting to come up, you know, at that point you have enabled that it’s a very difficult line.

    (19:55):

    And again, i I say it as a parent, I say, there must be nothing more difficult than having to be a parent and say, Hey, no, you actually cannot move back home, or no, we’re not gonna give you a front door key or, you know, no, we’re not gonna get you a car. One of the most wonderful things that I’ve seen in a lot of instances is where people have these adult children have gotten jobs that they love and feel good about. They’re getting a paycheck, they are able to put money towards, you know, their rent and put money towards a car payment. You know, as they’re, you know, getting more and more time sober and they are being more productive members of society. You see them blossom and row in self-esteem and that is far more powerful than any mothering could ever do. Yeah,

    Ashley Loeb Blassingame (20:36):

    Yeah. No, I, I agree. And, and I think, you know, one thing I remind people is like, it’s so difficult to say no to your kid and to feel and have them be mad at you and, and all these things, the the phone call that says that, you know, they’re using again and they’ve overdosed, that phone call is way more difficult. And I think that parents often don’t realize how much power they have because they feel powerless. Yes. And the feeling overrides the reality, which is they actually hold a lot of power. One thing I see that’s different from when I was using and, and frankly honestly in the last 15 years of being in the field, is there is a different fatality risk than there used to be. And when I was a kid, when, you know, early on in, in my career and, and the risks were very different. And I wanna know how you advise with these new risks in mind. An example would be, an example I hear is, well, if I kick them out, they’re just gonna go use and they’re gonna go die and fentanyl in the street. What’s the conversation with regard to that and fentanyl?

    Dr. Alison Tarlow (21:46):

    So it, it’s funny, I was just reading a new, an article, uh, yesterday about, I don’t know why I was sort of randomly researching something else and it, and it came up about, you know, some big drug bust that occurred somewhere else in the country where they found pills that had been made to look like, including with the packaging. And I forget if it was benzos or, or opioids, but it was, it made, it was made to look like pharmaceutical pill et had been pressed with fentanyl. And you know, I just thought to myself, wow, like these people, they are going to such lengths as to make these pills legitimately look like the oh yeah, natural pills that you would get from the pharmacy packaging and all what are, what are frightening prospect, even my own poor kids, I can’t drive home enough like one’s 17 and one’s 20.

    (22:30):

    And it’s just like, listen, you’re going to parties and like you have to understand these are, these are the rules of engagement. You have to understand like it’s, it’s, it’s game over like it’s that quick. And so yeah, working with these families, having them understand and also having the fact that we understand that the stakes are so high, it makes it even more difficult. But here’s the thing, we can’t stand over them every moment of the day. We can only encourage sobriety and recovery and encourage them to seek support in sponsors and or getting help at a treatment program or whatever that looks like. What can be most effective is really just in sober moments. Hopefully they have, you know, they’re in treatment for example, over a length of time. So it’s not like they’re sober for a day and they’re gonna like go out and use again later that night.

    (23:15):

    Is having them really understand the impact of dying for themselves on their family members. Now I have certainly met people along the way who struggled with addiction, who basically said, I don’t really care. And also most shocking, and this was a number of years ago, I was in a group and we were actually processing that somebody who had recently left the facility that I was at at the time had gone out and, and got a, what they would call like a bad batch of heroin. And so we were sort of processing in the group because they all knew this person, they were all in treatment with this person. And then the word spread like wildfire that this person had overdosed and died. And so in processing it and going around the room asking this one individual, you know, talk about your thoughts, talk about, you know, what’s going on for you?

    (23:54):

    How are you feeling? And he said, you know, honestly, I’m gonna be honest with you. He said, my first thought was where to get that batch? That must have been good shit. That’s what we are dealing with. If it could kill someone, it must be really good shit. And, you know, and that’s all to then say and, and can sort of segue then into the very beneficial effects of medication assisted treatment. And there are, there are instances where it’s not recommended and it’s not going to be helpful, but certainly, especially when you’re dealing with this opioid epidemic, the fentanyl losing jumbo jet of individuals every day in the United States to overdose. There are medications out there that when taken correctly and appropriately under the care of a trained physician who understands medication assisted treatment, that can be the lifesaver. That’s really good treatment work that you’re getting.

    (24:44):

    But the drugs are even more powerful. The chemicals in your head are going to be really loud. So whatever skills and stuff that you’re learning through treatment, we are going up against a serious contender in these, in these drugs. We need to call in the reinforcement. These are all things that are really important when talking to family members. And a lot of family members will say, well what, you know, why are you gonna treat my son who has an opioid addiction with, you know, synthetic opioids? And it’s like, okay, so your son’s been using for X amount of years and it, you know, they’ve had X amount of overdoses and by the grace of God they’re still alive. And as a result of following this medication assisted treatment, your son could hold down a job, stay outta jail, not die, lead a productive life, all of these things and not have this significant urge craving to go out onto the street and buy something who, who knows what’s in it.

    Ashley Loeb Blassingame (25:34):

    I wanna move into the next vignette with the partner couple where one of the partners is encouraged by the family, probably under duress to go to treatment and they’re like, I’ll go for 30 days. That’s it. I’m gone for 30 days, I’m gonna come out, I’m gonna be fine. They’re like, I got this, I’m fine. And the family in particular, the spouse who was spearheading this movement to try to get their spouse help brings them home and has no idea how to support them. What are some of the conversations that you have in that scenario, let’s call it drug of choices, alcohol.

    Dr. Alison Tarlow (26:14):

    So a couple of things. First of all, if they were in treatment for 30 days, you know, that’s, that’s be certainly better than nothing. But my hope would be that where they are in treatment, the spouse is getting a significant amount of education and support in understanding what it will look like when their loved one comes home. And so that may include conversations about other, other, including the spouse, other family members in the house who, who are drinking, using what is their willingness and understanding about how that will this person coming home after 30 days, what they would need to do to understand how to best support someone because I, I don’t know anyone that’s ever come home who did well living under a microscope. Nobody wants to do that in any kind of like sort of intimate, you know, relationship to begin with. And that certainly can happen.

    (26:59):

    It’s like, you know, you’ve been through Hellen back and your loved one finally went to treatment and got sober, right? And now they come home and you’re sort of like sneaking around and looking at where they’re going and you wanna see their phone or you know, and it’s like, and it’s completely understandable, but I don’t think those are conditions in which anybody is going to be able to thrive in their recovery. Cause it’s very stressful not just for the person who is trying to stay in recovery and continue on this path of wellness, but it’s also life is hard enough. And then you are trying to sort of manage or watch over or try, you know, you’re trying to micromanage what your partner is doing and every time they leave the house to go to a meeting, are you, you’re worried, do they actually go to a meeting?

    (27:34):

    Are they going down the street to the local bar or you’ve got Johnny down the street who sells drugs and, and used to hang out with him. I mean this, there’s so many stressful factors. So it’s really about understanding how to support and how to also detach and again, sort of detaching with love so that if and when somebody relapses, you know, how are you the other person, the support system going to navigate your way through that? What are you going to be doing to support their recovery and also be able to handle any issues or problems, relapse that may come along because we don’t have control over what other people are going to do. We don’t, we wish we did, but we don’t. So we can support them, we can encourage, we can do things to really hopefully make the environment a conducive one in terms of recovery, maybe deciding that you’re also gonna give up drinking and if you didn’t really have a problem with alcohol to begin with, you’re gonna get it all out of the house.

    (28:27):

    And if you really feel like you need to go out for a girl’s night and have a drink, you’re going to figure out how you’re gonna navigate your way through that. But more importantly, I think it’s just understanding that, you know, if this person is going to relapse, you still have your children perhaps that you need to raise and you still have, you know, bills you need to pay or you know, all of these things. And so you have to also have a sort of protective mechanism. And that’s hard because you know, when you really love someone, whether it’s a romantic partner or a child, again, I don’t say these things like they are easy to do. In fact, they are probably the most difficult things that one will ever have to do in their life.

    Ashley Loeb Blassingame (29:00):

    I wanna stop here and lo and talk about a few things that are taught in those family groups that we’ve been talking about because I think that, you know, I want to belabor the point here. People think family groups are just gonna tell you that you, you know, need to support and love your loved one and, and just, you know, back off right or whatever. But the reality is they teach you about what’s going on in your loved one’s brain. They teach you skills about how to manage a relationship with someone who maybe was sober and has decided not to be the Al-Anon meetings. I was in a meeting and I, I go to a double winner’s Al-Anon aa meeting and I was in this and this young woman, her mom has been in and out of sobriety for 20 years and she was talking in the meeting just sharing her experience about how the, the relationship that she set aside with her mom is like, they have a phone call for X amount of time on Sundays and that here’s the parameters and that is what she, as the daughter who’s been through hell and back is willing to give to the mom.

    (30:04):

    And, and and when I was thinking about that as it relates to this is when you go to these family meetings, you learn all these skills about hey, this other woman, she’s sharing her experience about her husband coming home from treatment. They had a agreement in the house, there was no driving after a certain time and that kept everybody safe. And so I wanted to go into like, are there some things, what are some of the similar situations or skills or things that you’ve heard and seen families do that are boundaries for families that help keep everyone on the same page and safe?

    Dr. Alison Tarlow (30:37):

    So one of the things that I really like is, is that when somebody is returning home, let, let’s say it’s an adult child for example, that there’s transparency with the bank account. Okay, so there’s, the kid wants to manage his or her own money, but the parent is going to have access to looking at what goes on on the app just to see what’s going on with the bank account. So there’s, you know, that has been something that I think people have found very helpful having an outpatient therapist. I mean I think so many times we are quick with our, you know, at treatment facilities with aftercare, we’re quick to kind of find, you know, some sort of outpatient i o P in the area and it’s very much focused on substance use disorders. But I think there’s, it’s so important to have and consider having a individual therapist or a therapist who’s focusing on working with the individual but is also willing to communicate with the family, sort of like in a case management role.

    (31:30):

    Yeah. Whereby every now and again there’s a check-in, right? So that it’s mom and dad and therapist and loved one patient on the phone talking about whatever is going on or questions or concerns or questionable behaviors, which we sort of talked about earlier where you can kind of all have a finger on the pulse because they think, again, as, as parents and as loved ones, we sometimes don’t see things as they really are. We see what we wanna see. Denial is not just the river in Egypt, you know, it’s, there’s, there’s a lot that goes on and we wanna see uh, or believe the best in our loved ones. And so having a neutral third party can be very helpful to really just make sure and do check-ins like hey, we are all on the same page here. And also that therapist can then serve as the sort of check-in point that then allows the parents to not be hovering all the time or the wife hovering over her husband or whatnot.

    (32:21):

    So I think it, that can be a very valuable tool to have. I certainly think being able to attend some meetings, I mean I certainly know family members that will go, you know, once a week or once a month to a meeting with their loved one to understand the sort of scope of what people are dealing with. Not just to hear their loved ones share or not share in a meeting, but to hear people sharing. There’s a lot of value in that sort of common humanity and the experience that people have that you’re not alone. And again, like you said, I mean you can sit in meetings and people can share things that, you know, their stories could be very different from your story and what your family situation or whatever your circumstances were. But there are common themes that run through and certainly when it comes to establishing boundaries or understanding the, the weakness that people experience around drugs or alcohol or things like that, I just think that people need to kind of stay involved and there are ways of staying involved that don’t include micromanaging and hovering over the loved one who’s struggling with addiction.

    Ashley Loeb Blassingame (33:20):

    What is the conversation you have with people when they are concerned about a loved one, a sibling, a someone’s sobriety, someone’s been sober for a year let’s say, and everything’s been going well. We’ve got some, some norms established some boundaries, but something seems off, but they’re afraid to ask or to have a conversation because they, the person’s been doing so well for a year, they don’t wanna hurt the relationship, they don’t wanna any drama, but they’re seeing things that they just have that feeling in their stomach. What’s your conversation with the support?

    Dr. Alison Tarlow (33:55):

    I think that’s called gut instinct. And I think that if you’re having those feelings and they are that troublesome that you’re even thinking about how can I, what should I do? What’s the conversation? Can I have it, can I bring it up? Are they gonna get mad at me? I think all of those things are indicative of the fact that something probably does need to be addressed. You can’t walk on eggshells. It’s sort of a manipulation tactic where, you know, perhaps you are making your family members feel like they can’t bring things up. I think there’s a big difference between micromanaging at every point versus being afraid to even say anything when there are certain, when you have that feeling in your stomach, that sort of gut feeling that is keeping you up at night, you know, that to me is an indicator that it is time to sit down.

    (34:35):

    And if you are really that concerned about the harm it’s going to do when you bring it up with your loved one, then you want to explore the possibilities of having somebody else, a professional ideally be a part of that conversation. If you let this go by and you don’t address it, you don’t wanna look back and say, you know, gee, I did see some concerns or red flags and I did not bring it up because I was afraid to. There’s so much value in having a sort of a neutral third party who then can identify or help identify and support from that sort of non-emotional perspective. When you are partners romantically with somebody or if it’s a child or a parent, it can be very difficult in normal circumstances, <laugh> to see what they’re up to and you really just wanna believe the best, you know, I know what I was saying at 17 wasn’t the truth, the whole truth and nothing but the truth <laugh> so that, you know, you gotta, you gotta kinda remember that piece.

    (35:27):

    Yeah. And then when you are throwing alcohol and drugs and addiction into the mix where there’s a propensity towards lying and trying to make it look like everything’s okay, but written really not, we tend to ha sort of very easily have these rose colored glasses on. But when you have another person in the picture, a professional who is not a blood relative or involved in that way, you know, you have the benefit of their eyes and their, you know, professional expert opinion, they can have some tough conversations or help you have tough conversations. You know, if you really believe that things are, you know, taking a turn for the worst.

    Ashley Loeb Blassingame (36:00):

    I want us to close with a conversation or description from you about what the brain looks like in the first year of recovery, what’s going on with the brain. Because I think that with your professional background and your expertise, understanding what’s going on from the brain science perspective is so valuable. It helped me tremendously. I would love to hear your rundown on a recovering brain in year one of sobriety.

    Dr. Alison Tarlow (36:29):

    So I think that that, you can think of it like any other injury that has been sustained over time. Like if you are an athlete that has been continually injuring your knee over and over again for a length of time, the rehabbing of the knee in a circumstance like that with an athlete who was playing daily, you know, football or whatever, that is gonna look a little bit different than somebody who just twisted their knee, uh, you know, walking on the sidewalk on a, on a one time occasion. You know, really important to understand that it takes a lot of time for the brain to sort of not only heal, certainly research shows that in, in a lot of instances there is a regeneration of, you know, the cells and the neurons and things that you know, are damaged during those years of addiction. But certainly with, with significant and heavy drug or alcohol use, there is a lot of damage that’s being done and it’s going to take a good amount of time for the damage to clear out.

    (37:28):

    And in certain areas of the brain there will be like a regeneration and a regrowth and a rewiring as well, which is really important, right? Because you know, when we use substances, drugs, alcohol, our brain is learning and rewiring in a negative way. And that’s why we continue to want more of it, more often, more amounts. Our impulsivity, our thinking is off track. Our decision making is off track, everything just kind of goes haywire. Clearing the alcohol and drugs out of your brain is sort of like the first step, but then to have the rewiring that is going to take a good amount of time. But we certainly have enough research to show that not only can you rewire, not only can you regenerate important parts of your brain, but also you can rewire so that you are not continuing to have the urges and cravings to use or the poor decision making or the impulsivity that was going on when all everything in your brain was sort of wacky and haywire.

    (38:27):

    But it takes time. I think people also need to understand and families need to understand that, you know, when you come out of treatment, there are still going to be consequences that have occurred in the brain, damage that has been done in the brain. And so you are not going to see, you know, this sharp, vibrant, clear thinking human being immediately because they came outta treatment for 30 days. Just doesn’t work that way. But certainly over time, particularly with psychotherapy, certainly with good nutrition in some instances, psychotherapeutic medications, psycho-pharmacology, things of that nature, you can, you know, really move into a direction where your brain is starting to get a lot healthier and your functioning and your thinking is all going to be in a much better place. Certainly, you know, you’re gonna see improvements within three months, six months, a year, but really a year or so out, you know, with abstinence you’re going to see a much better, healthier looking brain.

    (39:20):

    And in a lot of instances, and I was talking about this the other day, you know, I worked with a young lady, she came in to see me actually, gosh, probably about eight years ago and she still comes in and out of therapy. She checks in and out with me. She came in with a massive, what I call like a mental health rap sheet, right? Like she had diagnoses like up and down bipolar disorder, I mean you name it. And she, you know, had been using drugs for a while and she was, she was a late adolescent I would say when she was using drugs and, and ultimately got off drugs probably around sort of the age of 20 or so. The, the diagnostic rap sheet that she came in with, you know, that different facilities had provided with her was, was just, I mean it was shocking and extensive and the family member was also clearly concerned about, you know, what does the future hold for her?

    (40:03):

    She was a lovely, lovely young girl, lovely family. She’s now been sober for I think probably about seven or eight years. She went back to school, she got her bachelor’s degree, she got her master’s degree and she became licensed in the field that she got her master’s degree in. And you know, any medications that she was on, you know, I mean lithium and Depakote and all these like heavy hitting major, major, major drugs over time with the right psychiatrist, he was like bringing her down and bringing her down and bringing her down and bringing her down to the point where it was like she did not need any medications. She was not struggling with any kind of mania or depression. She went on to after getting her, you know, master’s degree, got married, had a baby, lives a lovely life with a lovely husband and it’s like I’m still in awe.

    (40:48):

    And we sort of chuckle occasionally about the rap sheet, the mental health rap sheet that she came in with because, oh yeah, and by the way she was doing some pretty wild things, you know, once she got sober in that first year or two after that there were some really alarming and questionable behaviors that were not using behaviors, but they were certainly suggestive of some mental health stuff. You know, there was sort of like this trickle, trickling off effect, like there was still some impulsivity and some questionable behaviors going on in that first year or so. She went back to school, she started using her brain, she started getting involved in student organizations and, and it’s just like this girl’s life just blossomed and when you look at what she’s accomplished and the grades that she got from established, you know, academic institution, clearly she was to regenerate these neurons and these cells and put her brain into sort of a healthy practice. And now here she is.

    Ashley Loeb Blassingame (41:41):

    Yep. It’s incredible. It’s incredible. It’s incredible. Yeah, I have a very similar story and I got, got sober at 19 and hadn’t graduated high school and ended up going to college and getting a master’s and all the things, and with the ra I had a mental health wrap sheet, some of which was like truly laughable and my journey includes lots of gnarly medication and then that stabling out and then trying to go off medication and figuring out, okay, well I still need this and this, but I don’t need all of that. And so, you know, I think there’s this whole journey where you heal your brain and then figure out what it is that’s really going on and what things can support that. And in my journey I tried to go, I was really hoping to get off all of the meds and that wasn’t my story, which was hard for me to swallow, but I also did the work to try to figure out what made sense and what we came to was a lot fewer things, but just these foundational things. And I think one thing that I’ve heard you describe in all of this conversation is that there’s a good psychiatrist,

    Dr. Alison Tarlow (42:43):

    Find a good one. And when I say good, I don’t mean good like Harvard good, I mean somebody who is not going to just pigeonhole you as an addict with mental health issues that therefore needs to be on this lengthy list of heavy hitting drugs for the rest of your life. But it’s like there are so many psychiatrists who are not necessarily,

    Ashley Loeb Blassingame (43:02):

    They’re not willing to take you off,

    Dr. Alison Tarlow (43:03):

    They’re not willing to and it’s just maybe they’re not willing to spend enough time. Or the other thing is people get, you know, immediately if you struggled with addiction and you’re in recovery, you’ve sort of got this like letter and they’re like, yeah, okay. You know, it makes it very difficult to have conversations where you feel heard, but there are professionals, psychiatrists, psychologists, therapists who will do that, who will help you to advocate. And again, I think the most important thing that I like to share with people is don’t necessarily buy in to the labels that were given to you when you were ripping and running on the streets because that is not necessarily what is truly going on. And we may not know what’s really going on for a year or so until you’ve had a chance to like come back down a little bit to earth and let your brain have some time off from all the crazy drugs that you were giving to yourself.

    Ashley Loeb Blassingame (43:53):

    Well you are amazing and I am so grateful. Thank you that you came on the show and your expertise is so important to have out there. Thank you. Where can people get ahold of you if they want more information and they wanna talk to you more? I

    Dr. Alison Tarlow (44:08):

    Would say if you are looking for more information about me or about the facility that I work for, which is Boca Recovery Center, you can go to boca recovery center.com. We have a wonderful website with lots and lots of information that I personally work on to get information out there. So whether or not you’re actually looking for treatment, there’s a lot of just good information that you can find. We are on TikTok, we have big TikTok presence and you know, we’re also on Instagram and Facebook and all LinkedIn and all of that good stuff. But it’s Boca Recovery Center. We have three facilities. We have one in Florida, in New Jersey and in Bloomington, Indiana, our US facility. And we are a really family type of organization in that it is certainly not a factory. There are small numbers of people. I personally have built the clinical teams at all of our locations. The mental health component is so important, being taken care of emotionally, mentally, you know, in all ways so that you can get the foundation that you need to be able to go on to live a good, productive, healthy life in recovery is, you know, what we provide for people. Awesome.

    Ashley Loeb Blassingame (45:15):

    So yeah. Awesome. That’s wonderful. Thank you so, so much. Thank you for being,

    Dr. Alison Tarlow (45:18):

    Thank you for having me. This was great,

    Ashley Loeb Blassingame (45:23):

    Scott. Okay. That was a very helpful and informative conversation. As someone who is not a clinician, what did you hear or get out of that

    Scott Drochelman (45:36):

    As a certified dumb dumb <laugh>? I <laugh>. Well, first takeaway is I found her explanation about her talking about the difference between those micromanagement moments and the gut feeling moments. That one stuck with me, right? Because I, I think it’s a hard line probably for folks that are in that situation to be able to tell what’s the difference between micromanaging and gut feeling kinds of things. I don’t know, it felt kind of empowering to be like, no, at a certain level. Like if you really feel like there’s something happening, there’s, there’s an, there’s an conversation that can be had, there’s an appropriate way to approach that and maybe you have more to expand on kind of like indicators of when it’s time to kind of have that conversation versus when it’s time to kind of let the person struggle a little bit in the intent of like letting them find their way.

    Ashley Loeb Blassingame (46:27):

    I think what is missing from the conversation is the amount of gaslighting that parents experience <laugh> on a regular basis. And I, I was queen of the gas lighting party where, I mean, I would straight face tell them, I can’t believe you don’t trust me. Mm-hmm <affirmative> and that you are accusing me of doing this. Oh, you wanna drug test me? To the point where I convinced myself that the lie was real in order to embody the gaslighting basically. And meanwhile I’ve been doing drugs all day when the parent has that gut feeling or when the parent, when we’re talking about mic micromanaging, what happens is, in the case of the adult child, the parent sees a charge in the app and it says liquor store or whatever it is. And the kid’s like the adult child is like, I got a pack of gum, why don’t you trust me?

    (47:25):

    Meanwhile, your gut is telling you not only did they buy a pack of gum, right, not only are they acting strange, but there’s a charge at the liquor store, but they are going to shame you and lose their mind. And all these things, that situation and all its derivatives is the one that makes the conversation very difficult about the boundaries and the gut feelings and the micro man, the quote unquote micromanaging as a parent you’re seeing things, but the fear and the difficulty comes from the pushback and the flip out that you get from your alcoholic, but the alcoholic addict, whatever, is always going to protect the addiction because that’s how the brain is wired. It’s wired into our survival. And so we are always going to protect that. And so coaching parents in dealing with being told that they’re completely outta their mind, they don’t trust them. That is the place where people land, where they’re like, I don’t know what to do. I think that’s where the education piece, understanding what’s going on in the brain, understanding how what you can and, and how to react. These are all things you learn in a family program. In the family therapy. You get the education and you get training on how to show up for your child in a way that’s actually helpful to them. Do

    Scott Drochelman (48:52):

    You think you could have passed like a polygraph during that time with some of the things you were telling people?

    Ashley Loeb Blassingame (48:57):

    There are times where probably if I am convinced that what I’m telling you is true, if I convince myself what I’m telling you is true, then it makes my life so much more simple in terms of managing the feelings, projecting it, following through. Like, I, I don’t have to act as if because my brain actually thinks that that’s reality. I felt true outrage. I, I’ll never forget this, I had fucking p keystar, which, you know, sorry guys.

    Scott Drochelman (49:26):

    Keystar is a very good word. It’s an underutilized word. Let’s just say that.

    Ashley Loeb Blassingame (49:30):

    I, I dunno there, I think there’s a new term, but like, that’s the old school. I like it and clean pee up the wazo <laugh> and uh, and you gotta keep it warm. And my dad and mom were like, you are, I don’t remember what the circumstances were other than that they wanted me to drug test, urine test. I, honest to God, like I felt outraged that they would ask me like so offended and was like, fuck you, what, you know, <laugh>, like, I can’t believe this shit, whatever. And when I peed clean and I was like, don’t fucking come into the bathroom with me. Like, ugh, you perv what the, you know, whatever, you know. And then I squirted the, the p the advising bottle of pe right? And then I tested clean, dude, I lost my mind on them and was like I told you totally self-righteous and genuinely felt upset with them for challenging me. And was like, see, I told you I literally was loaded. I mean, what, like, I, I, I was literally using fake pee. I was ready for fake pee <laugh> I mean, it was, it was a premeditated situation. It was just, but I, I really would feel true outrage. And it, what it was was, first of all, I was using substances that made me a little cuckoo in the Kaa <laugh>. And second of all,

    Scott Drochelman (50:51):

    Let’s just string that together. I was keyring while using substances that made me cuckoo in the KAA while up the wazoo. Right. I

    Ashley Loeb Blassingame (50:59):

    Think that’s accurate. I think that’s accurate. I mean, it’s not, it’s not inaccurate, I’ll tell you that I had no ability to deal with any emotions and so I did not deal with them. And so what you get is they all are coming out all over the place. So whatever anger I have, right in that moment, I’m like, how dare you question me. <laugh>. Right?

    Scott Drochelman (51:23):

    And so you’re Wizard Wizard. Yeah.

    Ashley Loeb Blassingame (51:25):

    I, hundred percent. I think that that’s a problem. A few of it asked me, I probably would’ve said yes, <laugh>. But that outrage, right? Like I’m sure that if you go deep, like that outrage had so much to do with other things. So when I’m projecting that, and it’s, we’re talking about it being because they’re drug testing me, the truth is it, it had, it was outrage and pain about all these other things. Really what it came down to was like, you didn’t believe me about other shit. You don’t ever fucking believe me. But in this particular situation, I was still full of shit or urine, whatever you wanna,

    Scott Drochelman (52:00):

    And well, not full, it’s just about,

    Ashley Loeb Blassingame (52:02):

    I mean, not full. Yeah, I was just, I mean, not full, just like partial.

    Scott Drochelman (52:05):

    Well, I, I think, I love the way that Dr. Tarlo talks about pretty much everything and I would be interested in a team that she put together in helping me. So if you’re in the Florida, New Jersey, Indiana, Indiana area and you’re looking for help, that might be a good place to go to check out Boca Recovery. We are rooting for you this week, as we always are, every single week. We love to hear from you. If you haven’t checked out our newsletter and signed up for that change mail, there’s an opportunity there to just reply to that email and tell us anything that you wanna tell us. But aside from that, you can also reach us always@podcastlionrock.life, that’s Podcast Lion rock.life. And we love to hear from you. We love to hear when things are going well, when things are not going well, anything that you wanna share with us, because we wanna be in this with you and be a part of whatever healing and recovery looks like for you. Ashley, anything you wanna leave the people with this week?

    Ashley Loeb Blassingame (53:02):

    Yes, I do. I don’t usually do this, but Lion Rock Recovery has a family program and you do not need to have a loved one in treatment or sober or in our program, anything. It’s just you can just sign up for the family program. It’s once a week and they take you through the education. You get an individual session once a week on top of that group, and they walk through what you’re going through specifically and help you come up with the skills and the tools and the mindset that you need in order to actually be useful and supportive and helpful for your loved ones. So if you wanna get them into treatment or they’re coming home from treatment, whatever the circumstances, and they do a group with other parents who are going through the same thing, and obviously you get the individual session as well. It’s six weeks. It’s not super expensive. Insurance sometimes covers it. It’s called Family Matters, and you can do it from anywhere. It’s a virtual program and I highly recommend it. If you are struggling, please check that out. All right, everybody, have a wonderful week and we will see you next time.

    (54:08):

    This podcast is sponsored by Lion Rock Dot. Life Lion rock.life is a diverse and supportive recovery community offering weekly over 70 online peer support meetings, useful recovery information, and entertaining content. Whether you’re newly sober, have many years in recovery where you’re recovering from something other than drugs and alcohol, we have space for you. Visit www.lionrock.life today and enter promo code courage for one month of unlimited peer support. Meetings free. Find the joy in recovery@lionrock.life.

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