Dr. Sarah Wakeman
speaker
484 appearances
2 recordings
2 series
first heard Jan 2025
last heard May 2025
Dr. Sarah Wakeman’s voice in public audio — every appearance, attributed to the second.
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Yeah. Yeah, I think empathy is really powerful. Those kind of things that we think of as soft skills actually matter tremendously.
Yeah, I mean, this is this concept of like enabling, which I think is nuanced. I would say at its core, it's really deeply problematic that for the most part, love and support are never going to be harmful. And when I talk to patients... Often the thing that caused them to ultimately engage in treatment was not some terrible consequence.
It was the idea that someone cared enough about them in a moment where they didn't love themselves very much and felt hopeless that someone was willing to sort of lift them up and believe in them. And it's these small moments of kindness. I'll tell you a story of a patient that we took care of in the hospital who was there for a really life-threatening infection related to their drug use.
And a year to the date after he was hospitalized, he wrote a letter to our team. And he said, you know, I'll never forget the moments you guys came in and just sat with me and talked to me. And he now sends an email every single year on the anniversary of when he got out of the hospital.
And it's those moments of humanity, of connection, again, that connection idea that often are the catalyst for change, the kind of hope and belief that your life could be better somehow. Yeah. as opposed to this idea of like increasing someone's pain and suffering. And that plays out in different ways.
So in families, one of the most effective tools we teach people is something called CRAFT, which stands for Community Reinforcement and Family Training. And it's very different than the like, people may have seen like shows where you're supposed to stage an intervention and tell someone all or nothing. But craft is very different.
It teaches people, first, how do you understand the science of addiction, family members? Second, how do you get support for yourself? Because it's really tough to deal with addiction in a family. And then how do you start to learn about consequences in a different way?
That if you're a parent and your kid is missing school because they're using, you don't want to cover for them and sort of reinforce their pattern. Right. But you also don't need to kick them out of your house, that there are sort of gradations of consequence that can actually help people change.
And one of the biggest sort of motivators for change is actually positive reinforcement of the behaviors you want to see. So that's been called contingency management in the kind of treatment world. You know, health insurance companies, lots of companies have figured this out, right?
So if you get money back because you joined a gym or you get those, you know, you get reimbursements for doing something that people want to see, people do more of it. It's true in human behavior. It's very true with addiction. But we often do the opposite.
We try to punish people into getting well instead of reinforcing kind of the healthy behavior, what we want to see more of, if that makes sense. Yeah.
Yeah, well, first, it is just so hard to be there as a family member or friend. So for anyone listening, I've been there. It's incredibly impossible. So have grace with yourself. I think that's a different decision you're talking about is at some point, you have to make a decision to protect yourself. So let's say you have someone...
in your home who's dealing with addiction who you know gets aggressive or stealing money or is you know causing trauma to the people living in the house at some point you may need to decide that for my well-being for the rest of the family's well-being i can't have this in my life right now that's very different than saying kicking them out is going to make them better
So the distinction there is that it's okay to protect ourselves. Sometimes we have to do that. And sometimes there's only so much you can do. But to not sort of fool yourself into thinking that the action is to help the other person, and that's okay. I think the other piece is, you know, at the end of the day, first of all, it's easier to be a treater. So I've been a family member.
I've been a clinician. As a clinician, I can truly be unconditional. So I'm going to be someone's doctor whether they continue to use heroin or continue to drink or don't. And there's something really beautiful in that. Like my engagement with someone is not premised on whether they make changes or not.
As a family member, that's harder, especially if you're a kid dependent on someone or you're in a marriage or a relationship. So you may have to make different choices. But I think at the end of the day, people don't change because of why we think they should change. They change because they think their life is going to get better in some way.
So the key then becomes figuring out, like, why might this person's life get better if they were to make changes to their alcohol or drug use? So it's a shift where you become sort of on their team instead of trying to drag them towards water, you know, drag the horse towards water. And there's this fascinating kind of human instinct that none of us like being told what to do.
So there's something called the writing reflex, which is it's really hard for caregivers. It's hard for parents because we love to tell people like our great advice and why what they're doing is wrong and they should take our like brilliant doctor advice. And this can be like telling someone like, don't you see what you're doing is causing harm? You should make changes. It can also be subtler.
It can be like lecturing someone or trying to educate them. But when someone shoves something down your throat, your instinct is to resist. It's just like natural human behavior, even if it's a great idea. If someone's like shoving an ice cream cone in your face and like, eat it. Even if you like ice cream, you might be like, wait, wait, I don't know if I want this ice cream.
And so the key then is not to sort of tell someone what to do. It's to understand why might they want to make changes. And so once you do that, then you all of a sudden realize, like, it just feels better. You're not trying to drag someone towards something.
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