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Q&A on Co-Occurring Disorders with Dr. Randall Stenson, MD conducted by Chelsea Bagias, Psy.D. and Chris Woodyard
published in Empowerment Magazine.

INTERVIEWER: What would you consider the greatest risk in the life of the patient with co-occurring addiction and mental health challenges?


DR. STENSON: Such individuals face a number of challenges but perhaps the greatest risk would be a preventable, premature death. When diagnosis is delayed and treatment not provided, risk factors such as suicide, accidental death, and illness development significantly increases. An individual’s quality of life can be significantly improved with proper diagnosis and treatment.


INTERVIEWER: What things would you consider as most important to add to the patient’s lives to increase resiliency?

DR. STENSON: Becoming a partner and meaningful participant in the individual’s treatment can greatly add to an individual’s resiliency.  Knowing that their treatment team understands the many challenges they face can be internalized and applied to the day-to-day coping skills and resiliency.


INTERVIEWER: If you were to ask a patient further down the line in recovery what had the most impact on their success, what information would you pass on to individuals still in more difficulty stages of recovery?


DR. STENSON: Learning to accept and cope with discouragement and demoralization is often a key element in moving through the stages of recovery. Recognizing that one is not alone with these feelings and experiences is very important.  It is interesting how often acceptance breeds hope and optimism. Realizing that such symptoms as low energy are part of an illness and not part of the moral weakness can assist a great deal in making gradual improvement.


INTERVIEWER: What might be some of the main ways the media and society at large misjudge individuals with co-occurring disorders?
DR. STENSON: First of all, painting such individuals with the same brush is a common misjudgment. Lumping individuals together and drawing simplistic conclusions is common. Each individual is unique and deserves access to an individualized treatment plan. Demonizing or vilifying such individuals is a sale’s or scare tactic used by the media who might have other agendas. Viewing individuals on Social Security disability as lazy, manipulative, and a risk to the Federal budget would be such an example.


INTERVIEWER: What kind of information may be helpful to the families of individuals experiencing co-occurring disorders?

DR. STENSON: Organizations such as the National Alliance for the Mentally Ill (NAMI) can provide a wealth of support and information to such families. Programs such as Al-Anon can be very helpful when codependency issues are central themes. It is important to understand that each of these organizations may not have a complete understanding of individuals with co-occurring disorders and that incorporating components of each may be necessary. Information at the SAMHSA website is more specifically tailored for families dealing with co-occurring disorders. At C.O.R.E., we either attempt to manage both the substance abuse and mental health needs of our clients or assure that they have access to the required community resources.


INTERVIEWER: What has been your personal background in dealing with addiction and mental health issues among loved ones?
DR. STENSON: One advantage of society’s more open information exchange is the realization that most families are touched in some way by individuals with substance abuse, mental illness, and co-occurring disorders.  When close friends or family members have requests for help or are in need of an intervention, I do my best to assure that appropriate direction is provided.

INTERVIEWER: What local services can you identify that would be beneficial for family members or patients dealing with co-occurring challenges?

DR. STENSON: At C.O.R.E., an individual must first suffer from opioid addiction to be eligible for services. We work hard to treat each patient with respect and to help them deal with this very serious illness and co-occurring disorders. The third Wednesday of each month at 11 a.m., I conduct a workshop open to anyone interested in opioid addiction and related problems. Patients, family members, friends, staff and community members provide very positive feedback of the utility of this workshop.  The historical and scientific background to our treatment model is explained and patients are encouraged to hold their heads high and to become strong advocates for their treatment to hopefully improve future access.  In achieving our goals, we often are in close communication and cooperation with county ACCESS, community hospitals, and many other community based organizations and resources.


INTERVIEWER: What roles do medication, psychotherapy/counseling, holistic treatment and spirituality play in recovery from co-occurring issues?


DR. STENSON: This question underscores the importance of an individualized treatment plan and approach. Patients at C.O.R.E. are encouraged to see themselves as the ultimate expert in their disorders and treatment. Excellent care requires that the treatment staff maintain an open mind regarding the treatment needs of each patient. In the field of opioid addiction, our field forefathers suspected that patients suffered more from a deficiency than from a toxicity. Subsequent research and experience has largely supported this concept. Methadone and buprenorphine have proven to be excellent medications to treat this deficiency and are often life-saving, life-altering medications. The medications effectiveness must be supported by quality interventions addressing the therapy, counseling, spirituality, and other needs brought to the table.  Each individual’s “story” must be told and needs addressed. Holistic concepts are great, can be very helpful and meaningful, but too often hype, misrepresentation, poor quality control and related factors can lead to scams. It is important that treating staff stress the importance of good communication about various products that are promoted as holistic, organic, herbal, etc as some have no foundation in science and are financial scams. Wellness oriented life-style changes that include nutrition, exercise, and stress management are very positive and important.


INTERVIEWER: Do you feel additional supports such as AA, NA or other meeting groups are helpful in aiding recovery?

DR. STENSON: These programs are incredibly important and sadly, too often, under-utilized. Frequently, patients on normalizing doses of methadone or buprenorphine report unpleasant experiences at AA/NA when their treatment was shared. This is gradually changing as more AAs and NAs gain awareness of the highly effective, non-conscious altering effects of proper dosing of methadone and buprenorphine. We encourage our patients to become familiar with brochures such as, “The AA Member-Medications and Other Drugs” (page 5, point 3 states “No AA Member Plays Doctor”) and NA’s “In Times of Illness.” In that all our patients have doctor directed, highly researched and effective treatment, they can meaningfully work the steps and participate as sponsors, sponsees, secretaries, treasures, greeters, coffee monitors, birthday chip presenters, etc. Hopefully more participation will occur in the future as these points are more generally understood and accepted.


INTERVIEWER: Is it always necessary to completely cut out contact with triggers for either relapse or increased self-criticism?

DR. STENSON: A good offense is often related to having a good defense. It is important to take a careful inventory of triggers and have an active plan to eliminate or avoid as many as possible. It is also important to understand that triggers can be unexpected or even subconscious at times (a TV scene, an odor, a sound, etc) so impossible to completely cut out. I work to help individuals anticipate these likelihoods and have a craving coping strategy in place. This often includes the reality that intense craving usually lasts about 10 minutes. By building a time frame, not only does craving often fade but the individual then acquires more impulse control skills and ability to think through the entire consequences should one give into craving. This becomes part of a process of re-sensitizing oneself to the enormous consequences of relapse, including the real possibility of accidental death.

DR. STENSON: This important because the benefits are is often overlooked in treatment planning. With opioid addiction and mental illness, the reward mechanisms of the brain are often impaired, either as a consequence of the drugs of abuse or underlying genetically determined causes. Developing or rekindling hobbies, interests, and related positive pursuits assists the treatment therapeutic talk and medication interventions. Initially, the reward of mending a hold in a pair of pants or reading an article may not compare with the high of a drug, but over time, such positive activities grow in pleasure and become much more meaningfully integrated into long-term success.


INTERVIEWER: With all the talk about the biological nature of addiction and mental health, can people still recover even if a LOT of family members have long histories with addiction, mental health concerns, or both?

DR. STENSON: Absolutely, especially if you define ‘recover’ in a broader sense. A paraplegic may not “recover’ the ability to walk but they certainly can ‘recover’ a deeper appreciation of life, themselves, and lead a full life. The same analogy can be applied to co-occurring disorders. Many times over the years, I have had patients who have come from the worse of genetic and social backgrounds share that they feel these have heightened their sense of meaning and appreciation of life. Sometimes overcoming or coping with the biggest adversities has the greatest rewards. A number of staff -
persons over the years have emphasized this point and many become highly effective counselors.

INTERVIEWER: If you were going to recommend a family member for treatment what are some of the things you would want to assess or identify before you start?

DR. STENSON: A simplistic answer would be to start with the most urgent issues (i.e. suicide or homicide risk) and move to other symptoms or behaviors that are creating distress, serious problems, or role functioning interference. It is important to have a sense of the individual’s insight, motivation, and exposure to previous treatment. Substance abuse often includes a high degree of denial and may require an intervention with loved ones or persons most involved and affected by the family member’s disorder.


INTERVIEWER: If someone has no insurance or lacks adequate coverage will that rule them out of successful recovery?

DR. STENSON: The ingredients to “successful recovery” are sometimes mysterious and hard to define. Many timers over the years, I have recommended to a patient, friend, family member, etc to attend 7 to 14 meetings a week for AA or NA, which costs nothing. With mental illness, participation in local NAMI meetings is open and free. Being in the presence of others who are dealing with similar problems who are motivated to help themselves and others often leads to successful recovery.


INTERVIEWER: What is the most influential character trait among individuals who maintain long-term recovery while also having happy lives?

DR. STENSON: Perseverance and an ability to stick with a tough challenge certainly help when one is dealing with the difficulty illness of addiction. I also like to remind patients that channeling or redirecting their inner rebelliousness can also be very helpful. Often times, this characteristic relates to a sense of not being heard or understood. In the presence of others that do listen and understand, this characteristic can become a positive energy used to achieve long-term recovery and living a rewarding, happy life

INTERVIEWER: If I’ve had multiple relapses, will I ever be able to find the right combination that will work for me?
Some of the patients who have had the most meaningful and rich recoveries were our most difficult patients, with many relapses or persistence of drug abuse patterns. I preach often to not make prognostications as one never knows when the light will go on and the right combination occurs that facilitates recovery. Many, many individuals with long-term successful recovery had many relapses prior to their more lasting recovery.


DR. STENSON: Ignorance and lack of good knowledge is the biggest danger. Often the most impaired individuals know at some level that they need help and are not completely hopeless. They often are very sensitive to insincerity or lack of knowledge and can easily be turned off when being helped by someone not knowledgeable of the unique challenges of substance abuse and mental illness.

INTERVIEWER: What are good ways to prepare for the changes that may occur after I have made needed changes to support my recovery?

DR. STENSON: Change is hard for human beings, including all the people that are connected to the individual. One must prepare for the reality that others may want to, need to or unconsciously stress the recovering individual by having a hard time adjusting to a new, recovering person. One may find out who their real friend are. It can be a lonely journey at times, especially if not connected with healthy supports. Sometimes a person who is viewed as a “black sheep,” may continue to be treated that way even though they are working hard, making positive changes, and doing well in their recovery. Many humans feel better about themselves when someone close to them is the identified problem. When the person with the identified problem improves, others may be forced to look more honestly with themselves an have a hard time doing that. Have a toolkit of stress reducers or stress coping devices. Such things as relaxation breathing exercises, physical exercise, hobbies, special interests, trustworthy and supportive friends, etc all become important considerations in preparing for the changes. 

Q&A on Co-Occurring Disorders with Dr. Randall Stenson, MD conducted by Chelsea Bagias, Psy.D. and Chris Woodyard


Chelsea Bagias is a doctor of psychology currently collecting hours as a psychological assistant (PSB 36064 and PSB 36074). She is supervised in a local private practice by Rosa Di Lorenzo Psy.D. (PSY 24148) and at C.O.R.E. Medical Clinic by Randall Stenson M.D. (G-25548). Chelsea has a passion for working with people experiencing intense challenges and believes all situations can find more peace and joy in life.

Chris Woodyard graduated from the school of Health Sciences in 1981 in Wichita Falls Texas on Sheppard AFB, as a Psychiatric Technician. He worked as a Crisis Counselor & Crisis Case Manager at Solano County Mental Health for 13 years. Shortly thereafter, Chris moved to Sacramento and worked with adults with Co-Occurring disorders in Private and Non-Profit agencies for the past 13 years. He attended The Breining Institute in 2004 and graduated as a Certified Alcohol & Drug Counselor. Chris is presently working at CORE Medical clinic as a Mental Health Counselor and Buprenorphine Program Supervisor. Eventually Chris would like to open his own restaurant and provide healthy, tasty nutritional meals such as Chris’s Minestrone Soup.

Dr. Stenson graduated from the first class of the UC Davis school of medicine. After being awarded a Regent’s Scholarship as both a UCD undergraduate and medical student, he completed his residency training in psychiatry at the UC program affiliated with the Sacramento Medical Center, where he was also the chief resident. He served 2 years in the Air Force under the Berry Plan, directing both an outpatient and alcohol program at Sheppard AFB. His subsequent professional career has been primarily related to community mental health and substance abuse. He was the medical director of San Joaquin County Mental Health between 1984-2006. He is the owner and medical director of C.O.R.E. Medical Clinic, located at 2100 Capitol Ave in Sacramento, which treats individuals suffering from opioid addiction. Dr. Stenson conducts a monthly workshop on opioid addiction the third Wednesday of each month at 11:00 a.m. at the clinic which is open to anyone interested in learning more about opioid addiction and treatment.
published in Empowerment Magazine.