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"Never the Same" is an interview-based podcast exploring how different work streams intersect with suicide prevention, career development, and life lessons. The title draws inspiration from Heraclitus' quote, "No man ever steps in the same river twice, for it's not the same river and he's not the same man," reflecting the ever-changing nature of life and personal growth. Each episode features conversations with guests from various fields, highlighting defining moments and shifts in thinking. The podcast aims to uncover new insights for suicide prevention while offering broader perspectives on personal and professional growth.
Tony:
Today, the Never The Same Podcast really earns its name with a different kind of episode. One that was really meaningful to me and I hope it will be to you, too. The topic is: How to address suicide concerns with a friend or family member who uses substances. It was a really wide ranging conversation with several different perspectives represented.
Most importantly, Jack Stem and his daughter, Kim were part of this conversation, they have Lived Experience in this area and shared their wisdom and perspective. I was also joined by two close colleagues, Dr. Ken Conner, who's a faculty member in emergency medicine and psychiatry at the University of Rochester, and Rica Hutchison, who is a faculty member in Public Health Sciences at the University of Connecticut School of Medicine.
In this episode, we have kind of a free discussion about the steps that you can take to start a conversation about suicide concerns with a friend or family member, how to ask directly about suicide in a way that's sensitive and comfortable, as comfortable as it can be, and how to respond when someone does share their concerns. The release of this episode coincides with the release of an online training resource for concerned friends and family members that we developed in collaboration with the University of Rochester Recovery Center of Excellence with funding from the Health Resources and Services Administration.
Just a word of caution, both suicide and substance use are sensitive topics, and we don't shy away from the hard things about them. So you can decide for yourself if this is an episode that you wanna watch or listen to. If you do decide to listen to it and find it upsetting, I hope you'll seek support and there'll be links in the episode description on places that you can get help.
Why do you think it's important to have a program for concerned friends and family members?
Jack:
Boy, how long do you have for that answer? It's a long one. I know in my own case, nobody seemed to know what to do. As my addiction progressed, I'm surrounded by healthcare professionals, surgeons, anesthesiologists, nurse anesthetists, pre and post-op nurses. I was clearly in trouble and nobody said a word to me. And I think the bottom line was that they had a sense of what might be going on, but they didn't know what to say, so they didn't say anything. And after I accidentally overdosed and was taken to the hospital that I worked at, I finally realized that I had to tell the truth.
You know, I'd been hiding it for six months, seven months. And, so I paged one of the guys that I hung around with a lot, he would happen to be in the hospital that night, and he came up to my room and I'm trying to figure out, how do you start this conversation?
And he walked in the room and I just said, "Bob, I'm addicted to fentanyl." And then I kind of cringed waiting for the, “Oh, you piece of, you know,” and that's not what he said. He said, "Oh, thank God," which I thought was really an interesting response, and I said, "What do you mean?" He said, "Dude, we thought you had AIDS or cancer," 'cause I'd lost like fifty pounds in five months, I wasn't eating, you know, and my personality was changing.
And then I was kind of angry when he said that. I'm thinking, you thought I had a fatal disease and didn't say anything to me about it, what in the world? And I just, I really think it's because they didn't know what to say, they didn't know what to do. So having a resource where somebody could look it up online
and find a process, I think is an important thing, yeah.
Tony:
Yeah, I find that myself that sometimes just, just, even though I, you know, work in suicide prevention and spend all day, every day kind of thinking about this, I find myself at a loss for words sometimes. Not knowing what will be sort of the right thing to say to that particular person.
I'm wondering for you, what kinds of things have been most helpful when somebody wants to broach this topic with you?
Jack:
Well, twenty nine years into my recovery and being a counselor for twelve years and being a peer assistance advisor for eighteen years, it's, for me, it's just, I just say it, you know? And if I suspect somebody's struggling with something, I say, “Hey dude, you know, what's going on, man? You're not you, what's going on?” And I think they know they can trust me. I know my clients find it helpful that I'm in recovery. They feel like they're not gonna shock me. They're not going to be able to hide things for the most part. For me, I just bring it up. “Something's going on with you, you're different, you're not talkative, what's going on? Let's talk about this."
Kim:
Being in recovery myself, over the years, I've learned through trial and error that, like my dad, the best approach is just to be completely open with who I am from the beginning. And I think over time, I have found that people respect me a lot more. People on the outside watching, they sense something's going on, but everybody is afraid to either offend, offend you, or... I'm trying to think of how to word this. I've had a couple friends that I've been concerned about and even having going through it myself, I still am, I was hesitant to say anything because what if I was wrong? What if, what if they're just, you know, going through some temporary situation, are they gonna shut down? Are they going to now find a better way to hide it from me? You know, are they gonna shift their behaviors so that I don't notice anymore? I just think it's important because there's such a fine line between being proactive about it and then kind of tiptoeing around the situation, if that makes sense?
Tony:
It does, yeah and when I've worked with families before, what you just described is, you know, I feel like is a very common experience. I think you're giving words to a very common experience. Feeling like, with a person who has problematic substance use, people often feel like they're walking on eggshells.
Kim:
Right, yes.
Tony:
And that anything I say might make the person distance more from me.
And then if you're worried about suicide on top of that, somebody's distancing could be really dangerous. So it's a really, it's a really hard problem, so this this idea of kind of tiptoeing, yeah. Wonder what others have experienced around that?
Jack:
I think one of the things that you're afraid of, you talked about distancing if you approach the subject, one of the things that I would worry about when Kim was struggling was if I say something, is she going to use that as a reason to go use?
So maybe she's got some clean time, but I'm starting to see some things that are kinda, okay, she's sliding here, what's going on? And if I say something, is she going to shut me down, isolate and use more? And when you use more and you're isolated, that's a risk if you OD. You know, I got lucky when I OD'ed, she found me. So it was just one of those things where my higher power definitely had something else in mind for me than being dead, and so, yeah, so I'm fortunate, I'm grateful.
Tony:
Yeah, me too.
Kim:
When you do finally approach somebody with your concerns and you decide to speak up and let them know, like, hey, I'm noticing changes in your behavior, I'm really worried, you know, I love you, and I just, you know, what can I do? I think it’s, with suicide and addiction, it's almost the opposite of what a logical response would be. So I think if somebody is set on, you know, they're starting to move toward suicidal ideations, they might be more inclined to act normal, act extra happy, because they don't wanna set off any red flags.
And I know for, in one instance, in my personal experience, I did decide to finally confront a loved one about my concerns and immediately after it was, I'm doing okay now, you know, you pointed it out to me and I'm happy now and I've got things back on track and I don't realize, and that was almost a little bit more concerning to me, as opposed to, you know, yeah, you're right,
I need to, I need to double down on my efforts and asking for help.
Tony:
Yeah, thanks, and we'll be talking a little bit as we go about the, a kind of a three step process that the online program suggests, just as a way of giving you something to hang a hat on.
Nothing is as easy as one, two, three when it comes to these kinds of problems. So you almost don't wanna say there's a three step process 'cause it sounds like it would be a lot easier than it really is. But, I think, you know, we have found that when people have something memorable to go to that can give you just that little extra boldness to be able to stick with a conversation when you're still feeling, still feeling concerned.
Rica, I know that this program grew out of some research that you helped lead, looking at what's out there in the field for family members. Would you talk about that?
Rica:
Yeah, so the research was really interesting. We were trying to look at programs that offered support for loved ones who were concerned about a family member, whether that's involving the family member they're concerned about or something just for them. And we found a lot of different community-based programs, online supports and resources, and a lot of them focused on like communication and coping skills and strategies to help support the family member. But one of the things we found was, despite them having concerns about their loved ones substance use, there wasn't a lot of focus on suicide risk or overdose prevention. And so that really kind of led us to wanting to create this online learning module, to have a resource that not only talks about your concerns of substance use, but also, you know, that there is an increased risk for suicide and overdose, and how can we help give resources or language and supports of how can you talk about that with your loved one?
Tony:
I guess that's the definition of silos, right? That the idea is that, you know, there's, that suicide is in some kind of a mental health silo and substance use is in its own one. And often programs that are focused on one are not necessarily focused on another. So I appreciate that kind of really showed that out there, there really wasn't enough kind of bringing those two things together. Yeah, we've experienced that even in services where, you know, people sometimes will feel like they're getting a message that in a substance use setting, your suicide problems don't belong here. And then in a mental health setting, sometimes getting the message like, well, your substance use should be taken care of elsewhere. So I think there's a lot of good movements happening to bring these together and appreciate that you, you know, kind of showed that here and that we're, you know, with the University of Rochester Center of Excellence kinda trying to, you know, equip people to kind of cross these things. Ken, so you study suicide and substance use and, you know, how they interact. Could you talk a little bit about that overlap and what you've learned over your time studying?
Ken:
Sure, yeah, I mean, the experiences from the literature, from research, but also from talking to lots and lots of people who have attempted suicide and shared their story. I think substance use drives suicidal risk in a couple ways. One is just the throes of addiction, the grind of addiction creates risk, disruptions in family relationships, finances.
One's life can really be under threat with substances and that creates a daily struggle. Secondly, you know, the substances themselves can be a real player. They can be a chronic player, they can, like with cocaine addiction, create withdrawal states that are very uncomfortable and distressing.
With heroin addiction, people are really just struggling to feel normal, they're not getting high anymore, they're just trying not to be sick and that's very difficult. With alcoholism, much of the risk comes into play with, during intoxication is a very high risk time, so the substances themselves play a role in risk.
And then people with substance use problems are not protected from any of the other things that any of us could get into trouble with suicide risk from, whether it's depression or divorce, or relationship difficulties, et cetera. So all of the things that drive risk in people without substance use disorders can also be there in people with them. So it's kind of a, it's a two-headed monster, the substance use problem itself creating a difficult life. And then people are people and people with substance use disorders are not immune from all of the things that drive risk otherwise, such as depression, et cetera.
Tony:
So in those circumstances, what have you seen, either what you know from the literature or from your own, you know, experiences, what have you seen help, you know, bring people out of that? What helps to, you know, what helps people in those difficult situations?
Ken:
Engagement in a recovery process can be lifesaving. Whether that's self-help, whether that's treatment, or whether that's making a decision and walking toward, making steps toward recovery, whatever that looks like. And addressing the mental health issue or the suicide related issue, directly. You know, people with substance use disorders who are depressed, people with substance use disorders who are in a really difficult relationship, they wanna be able to talk about that. They don't want to just hear, “Oh, if you just sobered up, that'll be fine,” that’s kind of flippant and a blow off, so they wanna be able to talk about those things.
And traditionally, there's been a problem with substance use providers saying, “No, we're just gonna talk about substance use, everything's gonna get better if we do that,” but the person's real life is there to be dealt with. So I think really an openness to take on what's happening with the person, addressing the substance use needs to be part of it, but their pain, whether that's physical pain, emotional pain, relationship pain, that those things need to be honored too and addressed.
Tony:
Hmm, I wonder if that's a helpful message for friends and family too, right, because you, I mean, when you see who's really struggling with alcohol or other drugs, you know, a natural thought would be like, “Well, if you just stopped doing that, you'd be,” if you just said...
Jack:
Just say no.
Tony:
But yeah, but I wonder if it could be a helpful reminder for family, that, well, yes, that probably would have, you know, probably would help, like you said, but, but it doesn't mean that this is not still a whole person and who has their, you know, other sets of concerns and goals and hopes and a whole set of things. And then talking about those things instead of always harping on the substance use, I wonder if that could be a helpful thing for friends and family. I wonder if you have any, guys have any thoughts about that?
Jack:
Well, the thing that keeps going through my mind is that there's underlying all of this is one word: stigma. You know, you don't talk about this, if I do talk about it, I'm angry. If you, like you said, if you just stop using, everything will get better.
Well that, you have no idea how many times the person has said, “This is the last time I'm doing this, I'm gonna quit, I have to stop,” and then three or four hours later, they're doing it again. And that makes–that made me feel like I am really weak. I clearly don't love my family enough to stop doing this because if I did love my family, I would stop doing this.
Now that I know all the brain changes that go on and how it changes personalities and makes you impulsive, of course you can't just say, I'm gonna quit and that's the end of it, right? So it's, but nobody wants to talk about it. So I think stigma underlies an awful lot of what's goes, for mental health, for suicide, for substance use disorder, that's a tough thing to deal with and it's hard to change that.
If you read comments online, let's say there's an article, well, with Matthew Perry, some of the responses that people have after you read the article, you're going to, "Well, he asked for this, he did this to himself. What else did he think was gonna happen?"
And it's like, I was taking pain medication 'cause I had a chronic pain condition. I took them appropriately for quite a while. Whatever triggered the addiction portion, I didn't ask for that. You know, people say, well, you chose to be an addict. No, I choose to take the medicine. I choose to use the medicine or drink the alcohol. I did not choose to become addicted.
That's hard to overcome, that's really hard and it makes you not wanna talk about some things sometimes, which is for me, sober support is key to my recovery. You know, I have to have people who know what I'm going through that I can contact when I'm struggling, who will take the time to talk to me and kinda guide me through things.
'Cause when I'm stuck in that situation where something's going really bad, I have blinders on. I see one solution and I need that consultation from these people in my home group. I can't tell you how many times I've gone into a group and said, "Well, here's what's going on. This is what I'm thinking about doing." And I look around the table and people are going, What's he...? That's the dumbest thing I've ever heard of, what's he?” It made sense in my head, but when I get the feedback, I can start to see there's twelve different ways to deal with this, not just my way.
So, for me, that support is key 'cause they get it. They know what I'm going through 'cause they've been through it.
And with Kimberly, I, you know, I found out how codependent I was. I always liked to think that I wasn't, but, man, I wanted to fix her in the worst way. And when she wouldn't follow through on things, I was angry and I felt like I failed, which made me wanna push her even harder, which is the worst thing you can do, you know.
So yeah, I've learned a lot over the last twenty nine years, it's been an interesting ride.
Tony:
I suspect a lot of families could relate to that. In fact, I think some people who are searching online and may find this online program will be in that spot. I think it's very hard not to be and I think we, you know, just as I think people using substances can be stigmatized, so can, you know, family members. Their, you know, their anger is understandable.
And, you know, I think we can't, you know, kind of say, well just, you know, don't be so, it's kinda like, don't be angry. Well, you know, sometimes there've been real hurts that have happened, but this is where suicide, I think, is such a bottom line issue. Even where people are hurt or angry with a family member. They care about their lives, they don't want them to die.
And in my experience, many families do, even when they will tell you they've given up, still have sort of hope that the person will come back around because they do care about them so much.
Kim:
Piggybacking off what my dad was saying is the way the brain works. I think that after watching him help people over several decades, and I've referred a lot of people to him who have family members that are struggling with addiction and they're worried and they don't know how to approach it, and all they know to do, the only options they know about are what they've seen on TV, what they've seen online.
And I think one of the most important things that makes my dad's approach so unique, that helps people so much is explaining the biology behind addiction and suicide and mental health. You feel worthless, like I totally relate to feeling like I was broken, there's something wrong with me. I've always felt that way since I was young. Why can't I just get it together? And, you know, it's like, what am I missing that everybody else figured out?
I just like, I don't understand why my life is so like, is so chaotic all the time. And I've learned that my brain just is different than other people. When people finally hear the way the brain processes work, it clicks to them, like, I am not a bad person, I'm not stupid, I'm not worthless, I'm not a failure.
This is why I'm acting the way I'm acting. You know, it's, I don't think enough people realize how powerful the brain is. And so it's, it just, it gives people a sense of comfort in knowing that there's not anything wrong with them.
Tony:
Thanks. Well actually you started to share some things that can be helpful frames and things, and maybe that would be good to walk through some of the steps that can be helpful.
I think we've talked a little bit about, okay, this is a hard situation. It's hard for the family members, it's hard for the person who may be struggling with their substance use, it's hard. And hopefully it's also clear that nobody around this table thinks that you should be able to solve this, you know, in a week or in a day or with one magic question, right? I think everybody wishes there was. In fact, sometimes when people will call and are like, “What do I say?” You know, if there was just one thing you could say, you know, I would give it to you.
But it's not that easy, but at the same time, I think it is important to know that there are things that we can do. And our close colleague, Kristina Zurich, always reminds us, you have a lot to offer. Every person has a lot to offer to the people that they care about, and that person still has a lot to offer. The first step is to start the conversation. And so let's talk about what that involves. What does starting the conversation involve?
Rica:
Well, I think one of the things it involves is being compassionate, right? Like, showing that you care, sitting down, facing the person you're speaking to, finding a private area so they feel like they can open up to you about what's going on. So maybe not when the kids are running in and out of the room, but you know, they're off at school, you're able to sit and talk with them and honestly asking directly. Like, it's seems very taboo to a lot of people of like, oh, if I ask if you're feeling suicidal, that's gonna make you suicidal, right? But that's not the case.
Tony:
Or you're really mad at me.
Rica:
Yeah, or you're gonna be mad at me, you're gonna think I'm judging you, you know, like we have all these preconceived ideas of what they're gonna think if we ask this. But really the best thing you can do is just ask them directly.
Say, you know, like, “I'm concerned about you, you know, you've had a lot of stressful things going on, like, have you, you know, been thinking about killing yourself?” Like asking directly and honestly and stating, you know, that you're concerned and you just wanna hear what's going on for them.
Jack:
One of the little tricks I learned with my kids that I'm hoping that they pick up on is, I'd take them for a ride in the car. We used to just love to ride in the country and play music and sing along with the music, but then I would ask a question or make a comment and they would tell me things that if I sat them down and said, "Hey, tell me about," there's no way they'd tell me, right? So it's kind of fooling them, it makes them comfortable, and we're not really, we're not really talking about this, we're just talking about it, you know?
So I think sometimes that seems to work pretty well. “Hey man, how you doing and what's going on with the family?” And, “I've been a little worried. Let's go get some coffee or let's have lunch.” My best friend in recovery, he and I have lunch every Tuesday and we just talk about what's going on in our lives. You know, he did anesthesia for as many years as I did and then more.
He is the blueprint on how you do recovery. He did everything that was suggested. I'm the blueprint of how not to do recovery 'cause I was gonna do it my way. And eventually I learned after a lot of heartache and loss, and my way doesn't work. I have to have that help. I have to have those folks who can give me a perspective as to what's going on that I don't have and I have to trust them, yeah.
Tony:
What else about starting that conversation, any thoughts?
Ken:
Trying to get in the right space is helpful. So, finding a time when you can be patient, when you can listen, when you can not be emotionally reactive or loud or over expressive. Getting in a calm place yourself and in a direct place yourself. As Dr. Hutchison was saying, asking directly, bringing it up directly, but with compassion.
“I'm worried about you, I've been concerned about you, you know, can we talk about what's going on, how you've been feeling? You seem to be suffering, you seem like you're in a lot of pain. It's hard for me to see you like that. I would like to talk to you about it. I would like to see how I could help. What could be done?” Allowing space for the person to answer.
Allowing space for them to answer in the way that works for them and not becoming over reactive to it or sort of needing to get in there with your own thing again, but leaving some space in the conversation so that they can also express how they're doing.
Tony:
Yeah, I find that hard myself. I'm one of these people when like I'm anxious, I'll kinda talk more.
And so it, I find that I'll ask a question and then if there's not an immediate answer, I can ask the second one, you know, but I think it's being patient is, that's really good advice. One, you know, one other, I love the way you put that, Ken. Of like so many different entry points, like I'm concerned about, I wanna help, those things. I think sometimes people need like a little ramp into the question.
I think you really haven't asked about suicide unless you use a word or close to the word suicide, like suicide, end your life, kill yourself. I don't think you've actually asked, but sometimes we do need a little ramp into that.
And one thing that's sometimes been helpful for me when I'm feeling like, well, maybe I'm getting some vibe, like I don't wanna, or I'm feeling intimidated myself, is to start with, “Well how bad have things gotten for you?” And then, “Has it gotten so bad that you've actually had thoughts about ending your life?” You know, kind of easing into it a little bit with a question like that. I wonder what you all think. Are there other kinds of questions or ways of approaching it, especially Kim, like when you feel that, like you're tiptoeing or walking on eggshells?
Kim:
Yeah, I think that what's worked, what's always worked for me and helped me to open up to people is to feel of service, is to feel useful. And one of the approaches that I, so one of the approaches that I use often with like my kids, you know, I have an a seven and a nine year old and they're not always gonna wanna tell me things 'cause they think I'm gonna get mad at them, and so one of the approaches that I use is I come to them and say, you know, I'm having a really hard time, I'm feeling this type of way and I'm struggling with this or that, what do you think I should do? Do you have any thoughts for me?
You know, and then it's, it kind of, it doesn't put the spotlight on them, but it kind of sparks the conversation that they start sharing how they're feeling and it kind of leads into almost like what my dad said, it tricks them into talking about their feelings and what's going on with them.
I think that it's such a vulnerable feeling to have somebody come to you and ask you about it 'cause these are such intimate, you know, sensitive feelings already. And so if the other person is being vulnerable with me, I'm gonna feel so much more comfortable being vulnerable with them. Like, they're not gonna judge me because they're struggling with something too.
Tony:
Well, that's brilliant, I hadn't really thought about that. In other words, some, you're really kind of talking about your own struggles or vulnerability and getting the person's advice about those things. Yeah, and we have a vision statement at SafeSide Prevention about seeking towards a world in which every person is respected, connected, and giving to others.
And I think that part that you just talked about is, you know, you're putting somebody in a position instead of being the one who's supposed to be getting help all the time, maybe you can help me with something. And kind of, you know, remembering that that person, and this is probably true for anyone, anybody who themselves has struggled know that you still have a lot to offer even in the midst of the depths of your own struggles, but people don't always, don't always recognize that.
Yeah, I wonder what other kinds of strategies, you know, there there could be to what we call starting the conversation? Any other thoughts about that?
Rica:
Well, I think that's the nice thing of it is like there is no one right way to start that conversation, right? Like, you know the person who you're trying to have this conversation with, you know your relationship where they might feel comfortable talking to you.
You know, I think it's really following the path of what feels most comfortable in an uncomfortable situation, you know, of, like you said, that on-ramp of maybe starting with some maybe easier or more vague questions just to understand how they're feeling, what's going on for them before getting into asking a more direct route of it, right?
But I think there's no one way you can do it, no right or wrong answer of how you start a conversation. It's really, you know, like, you know your daughter, you know, when does she like to open up? What types of things make her feel comfortable?
Tony:
And some people might be the other way. I can think of some people that, especially one person who I've talked to before where if I were to tiptoe around anything, he would be like out of the conversation. I need to be super direct and you know, like, or he will call me, you know, he'll be like, if you wanna ask me if I'm using, why don't you just ask me that?
You know, so there's different, there's many different ways, and I think it's, you know, you can do that too, because I, and I think sometimes especially, you know, people have used substance don't really like, sometimes don't like people to be, they want you to be direct and straight like you've described too, Jack.
Jack:
Well, I think the other thing is that, and I think this is an advantage that those of us who have lived through this, the "lived experience person,” I can share exactly what I was going through. You know, listen, I saw the end of the world coming. As far as I was concerned, I was gonna lose my career, probably gonna end up divorced, a very good chance I'll get arrested, I might have to do time, my family's gonna be embarrassed because of my actions. If I was dead, they could explain my death any way they feel like and move on with their lives and they wouldn't be held down by this anchor, right?
Because that's how I saw myself, I was an anchor. It was a really impulsive thing. I mean, I never thought about it until that moment and then I went into the hospital and I was gonna do it. And somebody interrupted me before I could follow through completely, which I was grateful for. But it's one of those things where if I can share my experience, maybe they feel a little safer.
Tony:
And we all have experiences, right? I mean, you don't have to be having the exact same experience as somebody else to share your experience. I mean, like, who has not been in a pretty desperate situation, you know? Who hasn't felt like, oh, well we know that of all people in the US, up to twenty five percent of people say at some point in their life, at some point in their lives, they've seriously considered suicide.
So, a lot of us have had those kinds of thoughts or been, so I think it's saying, and I'll sometimes, one thing, as human beings, we are very, we're really geared towards, stories. I think you're a very effective communicator in some ways 'cause you're a storyteller.
Jack:
In more ways than one.
Tony:
Nobody can spin a tale like Jack Stem. But, I'll sometimes say, can I tell you a story? And it's like, we're so wired for that, that almost everybody, like will, you know, physically or emotionally lean in when you say, can I tell you a story? And then sharing something about yourself and putting yourself in that vulnerable position, like you were saying, Kim, I think that can be really, a really powerful way of doing that.
The second in these kind of steps that are laid out in this online program, which as we said before is available and we'll have the link if people wanna check it out, available in the episode notes for this podcast. So it's Start the Conversation, and then it's Ask sensitively and directly, and we've been talking about that a bit. And then the third is to Respond. Could you maybe, Rica, do you wanna share a little bit about what's included in that idea?
Rica:
Yeah, so I think back to Ken's point, right, of like, when you're having this conversation of listening. So a part of the responding is really listening to what they're saying, to not listen to react to them, right? So you were talking about the emotionality piece of it, of like keeping calm, keeping eye contact with them, validating their feelings, right? What they're feeling and what they're experiencing is real to them.
So it's not minimizing what they're feeling, but acknowledging like, this is serious for you, right? I'm gonna, “Thank you for opening up to me,” right?
“That's gotta be really hard,” you know, telling them like, “I appreciate you talking to me about this, I care about you so much, I want to hear more about what you're going through.”
So really taking the time to explore a bit more about, you know, “Now that you've shared this really monumental thing you're going through, that was really hard to be vulnerable, like, I would like to hear more, take your time.” You know, like really engaging in the conversation with them.
Tony:
Right, and because as a family member, a very natural instinct is to be like, “How could you think that? Why would you do that? What about your son? What about your brother,” right? I think that's like a natural, you know, kind of thought and way to go. But that's really interesting, that part of the response is thanking, thanking the person and validating their experience, yeah. I don't know if you were about to say something about that.
Ken:
It's true that twenty five people, 25% of people in the US have seriously considered suicide, so that, you know, that's why we're talking about it. It does, it does happen. But the good news is most people with substance use disorders don't attempt suicide. Most people with substance use disorders who attempt suicide don't die. So the odds are in the, the odds are in their favor. The odds are in the substance users' favor, the odds are in the family members’ favor of getting through the crisis. And that's, I think there's a lot of hope there. In terms of responding, I think recognizing if there's truly acute risk, so...
Tony:
Could you say what acute risk means?
Ken:
Right, there's a concern that the person could attempt suicide, today, in the next few hours. And so, are there signs that the person's in dramatic trouble? Perhaps they're intoxicated, which can be a really key thing to pay attention to, but also do they have access to a lethal mean, and are they seeming to be in a place where they're thinking about suicide in and of itself?
They're seriously considering it, they're talking about suicide. You think that they're on a path to that, maybe planning it, giving away possessions, other things that might indicate acute risk. And so our response to acute risk, you know, needs to be more robust perhaps, more active in terms of getting the person help or staying with the person and getting, and helping them move through that crisis versus a general concern a person has about someone.
That– “You seem to be struggling, I know addiction's beating the heck outta you, and even beyond that, you feel like, it seems like to me you're suffering more than I've seen. And I know you and your partner are struggling and all that's gotta be weighing on your mind.”
So those are more chronic risks, where there's not necessarily an acute emergency, but you do want to broach that topic of suicidality and talk to them. So, sort of what is the situation here? Is it real acute, is it red hot or is it, boy, there's a downhill slide here that I'm recognizing and I wanna talk about with the person?
Tony:
Okay, well, let's actually break some of that down. I mean, you said a lot of important things there and maybe we can all talk about those things a little bit. So one thing that you were making a difference between was something that's sort of there, ongoing maybe, but it doesn't, you're not, doesn't seem like today, and then something that really where you're worried about is today.
So let's maybe, and then there's another circumstance where the person and Kim, you brought this one out before, where the person says, they say is no, but maybe I'm still worried. So let's think about maybe those three scenarios. No, but I'm still worried, yeah, I have, but it doesn't seem like it's right now, and the circumstance where like, oh gosh, you know, I’m really worried. And we'll break down some of the words that we're talking about there. So let's start with that like, no, but I'm still worried.
What kind of thoughts do we have about that?
Jack:
One of the red flags for me is when somebody has clearly been depressed, they're really struggling emotionally, and all of a sudden everything's great. They're happy. And it seems like in my past, I would struggle with something and there were no really great options, but I finally picked an option and there was a sense of relief. Okay, I got a plan, I'm gonna follow the plan.
And I think sometimes when they've been down for such a long time and they're really struggling and people are giving them a hard time, maybe they just got fired and it's kind of like all of a sudden they're happy. And it's, oh, have you decided that you're gonna?
Tony:
Well, that's a hard situation. People bring that up a lot. So it's like, well, gosh, one of the signs might be somebody doing better. I always find that difficult because like, what are you saying? Oh gosh, you know, you look like you're doing great. Are you thinking about killing yourself? I think it can be really hard.
One of the ways that I've found to ask in that circumstance is to say, hey, you know, you look like you're doing really, but is that how you're feeling inside too? That way we're not like questioning or, you know, 'cause it can be very, or sometimes you're just so glad the person seems better that you just wanna like leave that alone.
Jack:
Right.
Tony:
But I think being able to sort of say like, “Hey, just checking, like is that how you're doing inside too?” Yeah, I don't know. Kim, you kind of brought that up before, the person kind of seeming like they're doing better or they try to reassure you. Do you have ideas about, you know, that situation? But you're, part of you is still nagging, you know, a nagging part of you is still worried.
Kim:
I'm of the mind that, I've kind of learned over time to go with my gut. I think, like, you know, as stated before, everybody's different and it's one of those things where I ask somebody and they say, “No, I'm fine,” but I have a gut feeling that maybe it's not, usually I have that gut feeling because I know them so well that, you know, I've kind of seen the baseline, if that makes sense, their baseline. So like, you know, and if I still have concerns because I'm like, okay, you seem like you're doing really well, but not in a normal way for how you typically act, you know, it's kind of one of those things where it's like, I don't know, I just come out and say it at that point. I don't really have a good answer.
Tony:
Yeah, we have another expression, 'when in doubt tell the truth'. And you know, if I'm still worried, I could just say like, maybe even saying like, you know, “I know you said you're okay, but like part of me feels like you're not.” That's just telling the truth. And I feel like most of the time people can take that in pretty well. I mean, they just know you're just saying what you're feeling and they can still say again, “No, no, I am fine.”
Kim:
I think that, you know, by just alerting them that, hey, I am paying attention because I think that, you know, it's at that point, hopefully you've gained that person's trust enough that it's like, okay, they're seriously noticing my behavior, you know, I really can't hide it at this point. Hopefully it's at that point they'll open up to you just from being honest, you know?
Ken:
I think it's a both, and. The person says, “No, I'm doing better, I'm doing...” “Oh, that's great, I'm so glad to hear you're doing better. At the same time, you know, you've been struggling for a while now and recovery or feeling better has fits and starts. And so, you know, it's probably the case that the rough times are not over. It's probably the case that you could struggle again, so let's talk about, let's talk about how I can help or how I can stay connected to you until the feeling better part is longer lasting, and we can both feel like, yeah, okay, this is really enduring and it's a, you know, it's a different situation,” as an example.
Tony:
Yeah, that's helpful. Before we move on to the second situation of yes, but maybe it's not immediate, I think one thing would be like, I think important to mention because there could be friends or family members who care about somebody who's just not a talker.
This past year we conducted several different listening sessions with people with lived experience who hesitate to get help in crisis. And one of the, one person who really stuck with me, he said, "You know, I just don't like to talk about things and I go to a crisis center and first thing they wanna do is talk." And it's true, I hadn't even thought about that. You know, being a psychologist, you just think, well, talking, I mean, isn’t that what everybody wants to talk, right?
Or listen, talk about feelings and stuff. But he was just like, “That's not me.” And, you know, so how, I guess maybe one thing I think is important, how do we make room for people who that's just not their mode to feel better, is to talk? You know, maybe we're all here around this table because we are processors or talkers, so maybe we're not the even best people, you know, that's why we listen to people like that guy I was talking with.
But what about that? How do I make room for, you know, this person who’s just not gonna, that's just not their mode?
Jack:
I had a supervisor when I first started in counseling who said, I am a storyteller, right, I am a talker. And she said, "Have you ever heard of this thing called therapeutic silence?" And I said, "No, what's that?" And she says, "That's where when your client doesn't really wanna talk about things or isn't talkative, you just kind of say, “Yeah, I understand what you're saying, and then don't say anything.” Because the silence kinda gets a little heavy and then they feel like they have to fill it in. And she said, "A lot of times they fill it in with nothing, but a lot of times they give you some leads too." So yeah, I have learned to use that a lot more. “I understand you don't wanna talk about this now, and that's okay, you know,
I'm available anytime you want to. Why don't we just spend some time together, we'll do whatever, you know. The ping pong table's open, let's play some ping pong.” But give them that opportunity to know that you're not ready to talk now, but I'm gonna be ready when you are, just let me know, yeah.
Kim:
I agree. I actually don't consider myself a talker. I tell people close to me all the time, you know, I'm only a phone call away if you have some, if you need to just talk or vent or anything like that. My dad says that to me all the time, call me if you need to vent. That doesn't help me really, at least I don't feel like it does. Sometimes it's when I feel–when I'm talking, it almost just like pushes me deeper into the problem, I feel like, and sometimes I just need, I need to get out of myself. I need to get out of my head.
And so I'm glad that you brought that up because it isn't always, you know, I never used to call my sponsor to talk things out when I was struggling. It was kind of one of those things where it's like, I don't really wanna talk about this because it's bothering me so much I need to get away from it, I need to escape it.
Tony:
Well, thanks for sharing that, Kim. And maybe you also provided part of a way of supporting when the person doesn't wanna talk, which can be to offer just help, you know, or be of service or assistance to the person in some other way. Like, you know, can I look after your kids? Can I, you know, do you need any, you know, I know how to fix things, do you want me to, do you need anything helped around your– I personally don't know how to fix anything, but if I did, this would be one of those things I would offer is, you know–can I just do something for you?
You know, I had a family therapy– I know we both have a family therapy, actually all three of us have a family therapy– a family therapy supervisor who said the first rule if you wanna be helpful to families is to help.
And meaning like, be helpful in a way that they need help, not like, because you have like an approach or something that you need to bring to the table. So the first step if you wanna help people is to be helpful and maybe that can be a thing or even just to say maybe, “You know, I you're not much for talking about things and that's fine, I still, you know, wanna be around you. And if it ever, if you ever did though get to this, a place where you are really thinking about suicide, I know that you don't like to talk about stuff, but please tell me.”
You know, just making a genuine plea for that and honoring, though, that they may not be wanting to like process things or vent as you put it, Kim.
So let's then talk about that next kind of scenario, which is we said there's, the person who says no, but maybe I'm still concerned, and then there's, a person who says yes and, but it's not right now, but it is a kind of more of an ongoing concern. What then? I mean, how do we approach that respond kind of step when it's not right now?
Jack:
Well, I think you said being helpful. My brother-in-law is, he just does things, right? So I have terrible arthritis in my knees and I have a hard time getting around, and the steps on my back deck were falling apart. There's no way I was gonna fix that. So one weekend after I had one of my treatments and I was just kind of sleeping the whole weekend away, I come out on Sunday and I got new steps. He just came over and fixed them. So I called him up and I said, "Hey dude, thanks," you know, he said, "Oh, that's no problem." He says, "What are you doing?" I said, "Why?" He says, "Because I'm making some goetta, why don't you come over and help me make some goetta and then I'll send some home.”
So he helped me and then he invited me over to maybe even help me more. And I didn't think about it in that therapeutic way, but I guarantee you he wasn't thinking that, he was just being Tom, you know. But I thought, when I went out to open that back door, it was like, what the heck? I didn't hear the saw, nothing, so yeah. And so I think sometimes that might be the way to get in, is just say, “Hey, I noticed you got a problem over here in the yard, I've worked on that a little, how about if I come over and give you a hand?”
Tony:
I don't wanna take us down a rabbit hole, but you have to say– what's goetta?
Jack:
Oh, goetta? It is pin oats and usually pork, onions, and you cook them all together and then you put them in these little bread pans–
Kim:
It's amazing.
Jack:
And you cool them in the refrigerator and you slice them up and fry them up with your eggs on Sunday morning. Ooh, it's good. Do you know what scrapple is?
Tony:
I think I've seen scrapple.
Jack:
It’s similar to that, I think scrapple is a little more gross. But the goetta, oh man, and Tom makes a mean goetta, man. When he says he's got a batch, it's like I gotta get some.
Tony:
Goetta?
Jack:
G-O-E-T-T-A
Tony:
Goetta, yeah, yeah.
Jack:
I think it's an old German...
Tony:
Yeah, but that is pretty cool. I mean, he did something for you, then said, come over and now we're gonna have more. And maybe and, but like, although he was not being like strategic about it, I mean it can be something. And I think that for some family members especially where, maybe I can think of, I'm thinking of example in my head right now where the family was really clear about not wanting to maybe give the person any more money or material things 'cause there had been some hurt around that previously. But something like that where you can still give to somebody in a different way or do as, as Kim was suggesting before, ask their help for something might be a way.
What else around this idea of like, okay, this isn't today, but it can, but still it's, this is a concern? Yeah, Rica you've been thinking about it?
Rica:
Yeah, I think it's continuing that conversation more, right? Like understanding, like saying like, I know it's not happening right now, but like when it did come up in the past, like what was going on for you, right? So like, trying to look for like “triggers” or like scenarios that make this come out more without it feeling like, hey, we're having a therapy session right now. You know, like, just trying to understand when this has come up for you in the past, like, what was going on? How can we recognize, you know, maybe when this is coming up again for you, right? So if it's a finance thing, maybe you were in financial trouble last time it came up. Right now you're in an okay financial space. But like, if that comes up again, you know, I don't know, like holidays are coming up, maybe you overspend for holidays, maybe you're concerned finances might come up again, like, how do we kind of make a plan for that? How do we be aware of like, okay, like things might start getting bad again?
So I think trying to understand some of the signs that it could go bad again and some of the like more stressful moments in their life and thinking of when it could happen again in the future. And what's the plan to either, talk to me about that, talk to someone else about it, what other, you know, supports and resources can help you when that stressful time starts to come back?
Tony:
You made me think of something in this Framework that we use even just to, even to teach therapists or peer workers, we have this concept called Foreseeable Changes. And what it means is that I wanna be thinking about like what's one or two things that could if they happened, really throw this person off? And it could either be asking that person or just kind of thinking about those things and then if they did happen, kinda knowing that I might reach back out. It look like you were about to say something before.
Ken:
I think that one would be to say, kind of the same thing– “I'm glad you're not in a place today where you're, you know, you're thinking of suicide. I mean, that's great. I want you to know that if you ever get in that place, you know, you can call me anytime of day. I want to help in that situation. And also, there's this new thing–988–call that, there's a person who's trained to help people in that space will want to talk to you and can help.”
So I would try to make a plan with them about if the chips are down, if you're in a different place than you are right now, “I want to be a resource for you.” And in addition to that, I would say, “But still, I mean, it's great that you're not gonna, I mean, that, you know, you’re not gonna, but let's face it, you're not in a place that you want to be or that I want you to be. I mean, you're, you know, you're drinking a lot and it's really, it's, you know, it's doing a number on your life, and I can see you're struggling and that you're not as happy as I've seen you, you know. So, you know, is there anything I could do to help you with that? I mean, could I drive you to a meeting or could we try to make an appointment together? Or could we spend more time together, you know, sober time together and just stay connected more, you know? Is there something we can do to address that? 'Cause I think that's a big to big factor in your struggle. You know, I'm not a doctor, you know, but as your friend, that's how I see it,” so that could be part of the response.
Tony:
Super helpful, yeah. And maybe there's also asking permission to continue the conversation. I think permission asking is way underrated in general. Saying to somebody when you say, “Okay, can I ask you something that, you know, I've been thinking?”
Okay, you know, and maybe the person says no, and you have to, you know, kind of be okay with that because if you ask permission or like could we talk about this again? If the person says no, then probably if you brought it up again, they weren't gonna be too open with you anyway. So you don't really lose much if they, if they said no, you were already probably not gonna get very far. And if they say yes, well now you have a way back in.
And they probably also feel respected that you're realizing this is ultimately their choice about whether they wanna talk about this or not. Well, let's think about that third scenario we were talking about in this Respond section, which is, what about if it's, you know, the concern seems to be pretty immediate? Your use was acute, like meaning, it's soon.
You're worried that this person could actually take their life today. What are the things we should think about there? What are the ways, the things we say, things we need to do? It's such a scary, such a scary situation.
Ken:
There's good research with alcohol intoxication that while people are intoxicated, especially at high alcohol levels, that their risk increases dramatically. And that when somebody sobers up, it's not like everything's okay now, you know, all their problems went away. But when people sober up, by and large, they're no longer acutely at risk.
So if I was super worried about somebody who was frankly drunk, and I had reason to believe they might act on that, I would want to think about, what can I do to make sure this person isn't alone and this person has some support until that point when they're sober and they can think straight and we can talk about things? So that would be a priority for me in that situation.
Tony:
Yeah, oh, that seems hugely important, yeah.
Jack:
Well, you know, if they're acutely intoxicated, they're a heck of a lot more impulsive as well. You know, one of the things I teach my clients, I said, I learned this in my anesthesia training. Your brain grows from the bottom up, and when you put them to sleep, it goes to sleep from the top down.
And since the prefrontal cortex and the frontal lobes are involved in decision making and impulse control and all that, when I start pushing that Pentothal, you know, they used to call that truth serum. I push just enough to get you groggy and then ask you some questions and it's amazing what people will tell you when that happens, which means they don't have that ability to say no.
So, as Ken said, if they're intoxicated, that's, to me, that's really scary because they're not in control. You know, that impulse pops up, they're gonna act on it, which is a scary situation.
Tony:
So what do we do? I mean, so that, it sounds like your one idea is, well, maybe if you can just bide your time and stay with the person maybe or until they are sober, then you, there's kind of, it may, that there's a natural almost way that that might pass, so it's kinda staying with them.
Ken:
Or make their situation safe.
Tony:
Yeah, talk about that.
Ken:
You know, it could be car keys, could be a firearm, could be access to medications, you know, make their situation safer so that they become less lethal, you know, in a sense.
And so, you know, it's good for somebody who's in that space not to get in the car and drive away. It's good for them not to have access to do that or to do that. It's good for them not to be near a firearm or to have access to one. And so being around or arranging for others to be around or somehow for there to be a presence beyond the person can be really helpful. And also making their environment safer can be helpful 'cause, you know, suicidal risk is, it's such a tragedy. Suicide is such a tragedy because overwhelmingly, the person in their life is not suicidal, but they were at that moment. And so if we can get people, if we can help to get a person like this through that moment safely, that could save a life or at least prevent a suicide attempt or, you know, a real difficulty.
Rica:
And I think going off of that, like in that moment, you don't have to be the only person to keep them safe, right? Like, there's outside resources, so you'd mentioned 988, right? So that's the national hotline. You can call, you can text, you can chat online and it'll connect you with a trained clinician who will help talk through what's going on in your situation, you know, understand what is happening in the moment, try and maybe deescalate things if things are a bit stressful, and then maybe talk about, you know, what are the next best steps of support?
You can also contact local mobile crisis units. There's over 3,000 of them in communities around the US and these are trained clinicians who will come to wherever you are. So whether you're at school, you're at home, you're at work–anywhere, they can come out to you at your home and they'll talk to you, right? They'll understand, “Hey, what's going on? I wanna listen to you, I wanna understand how you're feeling. How can we help you, you know, feel better? Is that us sitting with you until you sober up a little bit? Is it, you know, setting you up with an appointment to talk to a therapist somewhere? Like what are the next steps? You know, is it getting you to a meeting,” right?
Like, there are trained people who can come meet you in your community, somewhere you feel safe. And obviously, there is always the other option of bringing someone to an emergency department. There's, you know, definitely pros and cons with that. I think part of it is the safety piece you talked about.
If you feel like you can't remove things that will not keep them safe from the home, that's one option to, you know, make sure that they don't have access to that and there's other people there helping to keep them safe. But also not everyone in the ED, in the emergency department, is necessarily trained in the same way a clinician is to really sit with you, listen to you, make sure you're not alone. To help deescalate the situation and maybe not make you feel as like isolated, right? So you're not sitting in a room alone, your possessions taken, waiting to talk to someone, kind of having that like, stinky thinking time, you know, just by yourself, but you can have other resources and supports that can meet you where you're at in your home and find ways to kinda make you feel a bit more safe and comfortable during such a stressful time.
Ken:
I thought it was really interesting when you said about calling 988 and getting coaching sort of in real time, what an interesting idea. You know, a person who's really intoxicated, they're probably not gonna call or maybe even benefit that much from a call in the space they're in. But a family member, boy, they could, that person might be able to help you calm down, might be able to help you problem solve, you know, they have a lot of training, you know, so you don't have to keep track of all the things I should be thinking about. They can keep track of it for you and really prioritize, okay, you're worried acutely or immediately about their risk, let's think about that. Have you thought of this or have you done…?
And so getting that coaching, boy, that could really be powerful in trying to get through a situation like this. I could see how that could really be interesting and valuable.
Tony:
And that wouldn't be unusual because there's been research about this, about how many of the calls to a suicide and mental health line are from, they call them third party. So there was research conducted at Columbia University by one of our colleagues, Dr. Madelyn Gould, about that on the phone lines. We also conducted some of that about crisis text lines too. And a good number of those are third party, meaning the friends and family who are calling in for that coaching.
It can be challenging in that situation too. It is often helpful to say, you know, I'm, you know, I'm calling about my brother. I realize that you can't do everything to help my brother, but I'm asking really for help for myself. That will also give that person more leeway to be able to say, okay, I'm here to help you in that situation as well, yeah.
While we're talking about it, you both, Ken, you and Rica both mentioned about, you know, safety, and I think it's probably an important moment to talk about the safety of the family member trying to help too. You know, you're trying to keep car keys from somebody and we'd have to say, I think I would say a couple of things about this.
I mean, one is you wanna do these things to the extent that you can do this in a way that's safe for yourself too. And ultimately you're not responsible. Of course you're gonna feel responsible, but you're not responsible for this person and what they might do. And you're not, shouldn't be putting yourself in a situation, you know, especially if that person is, you know, intoxicated or high to be in a dangerous situation with them. You know, that should never be the case.
The other thing I think we probably ought to mention is that that is the place where the police can also be involved. You know, as well as other people, right? Like, I think you may have mentioned this, like–don't do this alone. You know, this is not a time to keep it to yourself. This is a time to get anybody in your community you can pull in, and sometimes the police.
Now for, it's not, not everybody, you know, feels comfortable with police and there's, you know, it's a whole topic unto itself about, you know, what different communities and race and all these things come into play with whether the police feels to be a safe option for you. I will say that there's much more training and awareness going on among police departments about mental health issues, substance use, but very hard things still happen, dangerous things still happen. So we just wanna just sort of, I guess, say that out loud too. That we're not naive to that and we don't have all the answers to that, but it's real for people.
Rica:
And I think that can also be a benefit of like calling 988 or using mobile crisis is those types of services kind of have their own procedures in place of like, especially with mobile crisis, right? Like if you call the clinician and then you say like, you know, they're intoxicated, they're trying to leave or like, I can't keep them safe, they have a gun in their hand or something, you know, they have procedures for saying, okay, that meets the threshold of we're gonna help you call the police, right? So it kinda takes the decision out of your hands in a way and has a professional saying, this is the best next step that we think for you to, you know, involve the police or call 911 or whatever, right?
So I think sometimes as a concerned family member, a friend, it can be really hard to like know what is the right moment to make this call and what might be, you know, the person you're concerned abouts feelings or reactions to this. So I think having an outside support or resource who is trained and kind of knows like what is that threshold, what is the point of when we should, you know, go and open door A, B, or C for next steps, right, can be really helpful to make sure that they're making an informed choice, that you're making a choice that will help keep the person you care about, safe in the most appropriate way.
Tony:
Yeah, and I can tell you, I used to sit on the training and standards committee for 988 and I can tell you that a lot of thought and hand wringing and research is going into how to appropriately, safely involve police or emergency services. I don't, I’m not saying that they necessarily have everything figured out, but I will say that a great deal of thought and care, including hearing from people in different communities with different lived experience about that. So, you know, the problems of society are very real, but there is a lot of thought going into that at 988 about how to pursue equity, safety, you know, justice for people who call in.
Ken:
Whatever actions you take, they need to be taken in the context of what is your relationship with the person and who is the person? So this, you know, “I'm a mom, this is my son, he's twice my size and he's been violent toward me, okay. I love him, I'll do anything to prevent him from attempting suicide. At the same time, I can't be taking an action that could result in him being violent toward me. He doesn't want that, I don't want that. I don't wanna sort of just say, ‘Well I have to do this,’ you know?”
And so, you know, that's the beauty of it being a loved one. You know them, you know what your relationship with them is. You know what, you sort of inherently know what is the boundary of what I can do in this situation that that person will tolerate even while intoxicated? And so this isn't a person I could take their keys from 'cause that's just not gonna be safe for me, versus this a person I've done this before with, and we've been there before and they understand that I'll take this action if I'm really scared and they're intoxicated, and we've sort of even negotiated that maybe. You know, it's a different situation. So yeah, I think you need to act within your relationship and within how close you are and who the other person is and that's a really key point, Tony, yeah.
Tony:
Yeah, thanks. Jack and Kim, thoughts about this situation, this, you know, really scared kind of event when it's very, it feels very immediate? What are your thoughts about that?
Kim:
Quite frankly, if they're intoxicated, obviously they're acting erratically and their inhibitions are lowered or gone. A, you know, I'm not gonna be able to tiptoe around their feelings because you can't deal with irrational people, rationally. And B, I honestly don't care if I make them mad at this point, you know, or like offend them at this point, they're not gonna remember it the next day. And if they do, it's kind of one of those things where I've set my hard boundary with them.
That was another thing I wanted to mention is I think that setting up a plan like you guys mentioned earlier with somebody saying like, “Okay, if you get back into this place, you know, what should I do or how can I help you?” I think another important thing is to also set boundaries for yourself 'cause when you have no boundaries, that's, you know, that's co-dependence and that can only make things worse.
I think that, you know, just like children crave order and consistency, so do adults. Especially people, I know for myself, people that have substance abuse problems, mental health, you know, like depression, anxiety, I need consistency too. It makes me feel better when I know what to expect if, you know, A happens, B is going to be the result. So, you know, it's like, “Okay, well if I start seeing these red flags and I get uncomfortable, I just want you to know like, this is what's gonna help me. I'm gonna need to, you know, call your sponsor, I'm gonna need to call a hotline or something because that's what I need for myself in order to, you know, be safe in this situation.
So I just, I think boundaries and assertive, you know, directness in that, in what you need as the loved one, because it is, I think that it's always so much focus on what the person in distress needs. What do you need, what can I do, what, blah, blah, blah, blah, blah? But we forget that we're involved in the situation too and it's affecting us and it's forming how we handle situations. And so it's, I think that the loved one of the recovering person or the person, you know, considering suicide also needs to be considered as well, because it is, it's a dynamic kind of a thing.
Ken:
We're not talking about typical intoxication. It's fairly rare that somebody becomes intoxicated and they become acutely suicidal. This is not what we would typically expect. So if you have, if somebody in your life who has a severe drinking problem and they become intoxicated, not irregularly, it doesn't mean you would take these actions necessarily, certainly with the view of preventing suicide. Typically there's something else that would trigger you to worry about them.
The most common scenario, honestly, with suicidality and intoxication is a sudden disruptive argument with a partner, a relationship partner. That tends to be a very common trigger in people who are intoxicated to harm themselves. So if you, if that scenario presents itself and you have reason to believe it's the person who's been depressed or has attempted suicide in the past or may go there, that that might be a situation where, boy, I wanna pay more attention to this, to this event than I would normally do and I'm gonna try to be present or try to get some additional coaching now 'cause I'm not sure about this one.
Tony:
Well, we have covered a lot of ground here today and you know, Jack and Kim, I really appreciate what you have shared and taught us here today, and Rica and Ken, all the wisdom you've shared from your research and experience and participating in this program. So, maybe just wanna open it up to, you know, anything else that you wanna share or leave with people who are viewing this or listening to this who, you know, who maybe are in one of these situations, either struggling themselves or have a family member or friend who is? So, let's, yeah, love to hear what you have left to say.
Rica:
Sure, I think the biggest thing is when you're worried about someone you care about, whether it's a family member or a friend is not losing track of yourself, right? So it's making sure you're taking care of yourself during this process. It's very easy to let your emotions take over, to kind of feel hopeless and helpless, maybe not eat right, sleep right, exercise right?
But self-care comes in all shapes and sizes. I like to tell people it doesn't take much to take care of yourself in little ways every day. This could be as much as like, I'm a mom, so drinking my coffee while it's still hot in the morning, right? Like, that can be a piece of self-care. Or taking a hot shower. It can be calling a friend, cooking food, right? Like your, you said that your brother invited you over to cook, right? Like, those can be little things of self-care. And what you need every day can look different, right? Sometimes we need a 45-minute exercise class, and other days I just need five minutes to go cut a bouquet of flowers from outside.
So I think making sure that while you're concerned about your loved one and you're taking time up in your day to check in on them, make sure they're getting help and support, not forgetting about that for yourself.
You're still a person too. You're going through a stressful and challenging time because someone you care about is using substances, is maybe, you know, feeling suicidal, like that's really stressful and emotional for you, so making sure that you're able to find ways to take care of yourself.
Ken:
I would say that suicide is always a shock. Suicide attempt is always a shock. Nobody has a crystal ball. And honestly, in all humility, we don't know how to predict suicide. We don't know how to do that. And so, and I've, you know, I've lost patients to suicide. And I think that at the end of the day, we only have so much power, we only have so much control.
It's ultimately not our decision. And it's important not to blame oneself, it's important to have perspective. And just like I was doing my very best with those patients and my team was and we were concerned about them, but, you know, it went the way it went.
And it's important to realize that we have limitations, we have only so much power and control and that we're not to blame for what happens, no matter what happens. And I said the good news before, and I'll say it again, even if things go terribly wrong and a person attempts suicide, usually they survive. And usually we have more opportunity to support them and they have another chance. And so it's, even suicidal behavior is usually not the end of the road for a loved one. And with that can be real opportunity to think about what the next step is.
So, you know, just understand that all we can, all any of us can do is the best we can do, and we're not in the business of predicting, we don't know the future, only God knows that.
Tony:
Thank you, Kim.
Kim:
I actually completely agree with what both of you just said. I think that what I've learned is the most important part is to realize that the, if you're a loved one of somebody who's considering suicide, they are not the whole pie that's getting, you know, eaten here. I think that we're all pieces that are put together and not forgetting that you are important too, you need help too, you can't isolate and, you know, you should call for help so you don't have to do it on your own. I just think that, and then setting those boundaries like you said.
Tony:
Thank you, and Jack, we'll give you the last word here.
Jack:
The thing that keeps running through my head is that when you understand that a disease process typically affects a specific organ in the body. So if I have high cholesterol and I block off one of my coronary arteries, I have a heart attack. If it's a major heart attack, I don't function the same way I did prior to the heart... Maybe I was a marathon runner, now I can't run marathon 'cause two-thirds of my heart muscle is dead.
So when you change an organ, you change the way it works. And the one thing that kept coming through in my head is the brain's an organ, we don't understand a lot about it. We're learning a lot about it, so the things we've learned in the last thirty years are amazing. But all of these chemicals that we put in our body as substance use or misuse alters the way the brain functions. And when you alter the way the brain functions, you alter the way the person functions.
That's not them when they're under those, the influence of those drugs, that's not them. That's this person that's altered. And if those changes are longstanding, it can take a long time to recover from that. And there's a lot of crazy things that happen in the interim as they try to get into recovery from that. And one of those is, I'm hurting to the point where death is better than what I have here.
I think we have to be patient. I think we have to have boundaries. I think we have to let them know we love them and we will do whatever we can to help them not do this, but realize that in the end, regardless of the outcome, it's not our fault.
Tony:
Well, thank you, thank all of you. And, you know, we'll make sure that there's a link to the online resources in these episode notes. And, you know, hopefully they'll be of some use to people and if they can check them out. So, thank all of you for the conversation and really grateful to have had it with you.
Jack:
Thanks for having me.
Rica:
Yeah, thank you.
Ken:
Thank you.
Kim:
Thank you so much for inviting me to participate in this.
Tony:
Thank you, Kim.