Pregnant and Afraid
Cindy is a mother of three who was using opioids during each of her pregnancies. She knew it wasn’t healthy for the babies, but she didn’t know how to safely stop. Fearing the doctors would notify authorities, Cindy was afraid to ask to help. Then one day, she made a call to a hotline. This led her to a doctor who gave her the support she needed, and now Cindy is in recovery and wants to share her story. Nzinga goes over some of the options available to pregnant women who are using and gives Cindy a call to check-in. She also shares a bit about how the pandemic has impacted recovery options–both the good and the bad.
Here are some other things you should definitely check out:
Support In Recovery. Get bonus content, discounts on swag, and more for as little as $5 a month! Go to http://lemonadamedia.com/inrecovery and become a member.
Here are some resources Nzinga mentioned in this week’s episode:
Dona International is an international group of doula’s. On their website, you can search by zip code to see if there is a doula in your area.
[00:02] Dr. Nzinga Harrison: Hey, everybody. I am Dr. Nzinga Harrison, and you are listening to In Recovery. I was super excited to have this podcast, and you heard me trying to put on my radio voice. But in reality, I am a physician, a doctor, a psychiatrist an addiction expert. I’ve been practicing addiction medicine for almost the last 20 years. More importantly, I’m a human before all of those things. I fill a lot of the same roles in my life as you do. I’m a wife, a daughter, a sister, a mother, a friend. And I want to use all of those roles to talk about how we look at addiction, how we treat addiction in an evidence-based way, how we treat people who have addiction better than we’ve been treating them. And so this show is a show about all things addiction. And when I say all things, I mean, not just drugs. So for sure, we’ll talk about opioids, alcohol, Xanax, amphetamine, cocaine. We’ll talk about all of that. But we will also talk about addictions that are not drugs. So food, sex, gambling, things you wouldn’t think about like exercise, work. So we don’t typically think of those as things that can be harmful to us, but they can become things that are harmful. And if we keep doing them, then that fits the definition of addiction.
[01:30] Dr. Nzinga Harrison: So here’s how the show’s going to work. Every week I’ll start off by telling you what’s going on in my world, from the shenanigans in my home life to the big things in my work life, and an overall view of kind of what I’m seeing in the world of addiction. Then from there, we’ll move into the part of the show where I answer your questions. If you have a question, you can send it in via email, phone, Twitter. Listen to the end of the episode for instructions. That’s how we keep you here till the end. Now, I won’t be the only person that you’re gonna hear on mic. Claire Jones, our producer, is going to join me each week. And she’s actually sitting across from me right now on Zoom, making sure I stay on track.
[02:12] Claire Jones: Hey.
[02:14] Dr. Nzinga Harrison: So, Claire, why don’t you tell us a little bit about yourself?
[02:18] Claire Jones: Sure. My name is Claire. I am a radio producer and have actually worked on a couple of Lemonada shows, including Last Day. So I’m really excited to be a part of the In Recovery team, especially because I also have some experience with addiction in my family and with some of my friends. But more than all of that stuff, like Nzinga, I am just a human person. I’m in my late 20s, which means I am constantly trying to figure out what adulthood is, and whether or not I’ve made it there. All while trying to minimize how awkward I am all the time. And I think quarantine is really helping. I think I’m really going to come out of this excelling as a social person. So you can tell I’m already doing a great job. All jokes aside, I am very excited to be on this team, and my role mostly will be to read Nzinga some of your questions, tell her about some of your voicemails and emails. And when the time is right, also read questions of my own. So I’m excited to be here.
[03:18] Dr. Nzinga Harrison: Super glad to have you here, Clair. Although I’m an expert in medicine and psychiatry and addiction medicine, not at all an expert in podcasts, so thank you for being on the line, keeping me in order. But last thing, guys, depending on the questions that we get from you, the show will be different every week. So there will be questions that have short answers. There will be questions that have long answers. So sometimes we could spend an episode going through a lot of questions. Other times we could spend most of an episode digging into one person’s story. Sometimes we’ll even be calling people back to hear directly from our callers. So now that you have the format, let’s dive in. This week, what’s going on in the news? I don’t have to tell you guys, it’s opioids, an addiction epidemic inside the Coronavirus pandemic.
[04:15] Dr. Nzinga Harrison: And these two worlds are colliding really like in a big way and causing a lot of struggle and a lot of hard times for folks. So if we look at what really has changed in addiction treatment, now that Coronavirus has come on, it’s overwhelmingly positive. So I’ll start with the difficulties that Coronavirus caused us, which was addiction treatment has overwhelmingly been in-person. And so when Coronavirus came and we kind of couldn’t go to clinics the same way, and we couldn’t go in person to see our doctors and our recovery coaches or to get methadone from the clinics, then there was a brief period of time where we really had an access crisis. Like folks couldn’t get to what they needed to get to. The beauty of it is that I think the industry pretty quickly recognized that we couldn’t accept that, that a lot of risk was coming for folks. And so we moved into virtual care. And laws have changed, laws that we’ve been advocating for years, like do I have to see a person face-to-face before I can prescribe buprenorphine or Suboxone for their heroin use disorder? The answer was yes, and that was a barrier and kept a lot of people out. Now the answer is we can get you started immediately.
[05:32] Dr. Nzinga Harrison: Other laws was like it was very specific what video platforms you can use to talk to people because of privacy of your health information, which is really important. Again, it was a barrier. That barrier has been removed. When we talk about methadone that is prescribed for opioid use disorder, you had to go every single day and there were like several months before you could be eligible for take-homes. Those regulations have been reduced so that people won’t have a gap in their methadone. So these are all great things. The last thing is that tele-health is like, man, exploding. So in different parts of healthcare where tele-health was like a future consideration that people thought might be a good idea at some point has become like the idea right now. And many insurances are even waiving the co-pays for tele-visits. So all of that to say, we are trying to get barriers out of the way. Like, just reach out, there’s probably a way for you to get seen, even if it’s virtually for right now. So the question that everybody asks after that is like, OK, is this going to last? And the answer is yes, some of it will last. So there is no way we can go back to where we were. But I also think we won’t stay where we are right now, which is just like so many emergency provisions that have opened it wide up. We’ll slide somewhere in the middle.
[06:54] Dr. Nzinga Harrison: And so I’ll actually lean on you guys to help me know what’s going on in your area. Send us in, you know, what you’re experiencing because we want to be advocating for us to be in the spot that makes sense somewhere in the middle. So jumping into the question and the story for today. At the end of Last Day, we were actually hearing from a lot of people asking about opioid use and pregnancy. And our first story is from a woman named Cindy. Cindy actually reached out as one of those Last Day listeners, but we thought her story really brought up some great questions about opioid use and pregnancy, MAT, so treating opioid use for medication and pregnancy. But also just Cindy’s story I think is so reflective of what so many people go through, starting very early, through life, and up through the addiction and into recovery. So tell us a little bit about Cindy’s story and then we’ll jump into some questions.
[07:56] Claire Jones: OK, so Cindy is a 34-year-old mother of three. She had childhood trauma because her dad was a drug user and abusive. She started using meth when she was 16 and then moved to opioids that were prescribed by her O.B. after she had a bad infection from her first pregnancy. She and her husband both got hooked on opioids, but Cindy was able to ask her doctor for help during her second pregnancy. And the doctor was amazing. She prescribed Cindy Subutex, got her a birth advocate, and she was able to give a healthy birth to her second child. Then after seven years of her being clean, she relapsed and got pregnant with her third child. The baby was born healthy, even though she had a hard time not using. Now, Cindy has been in recovery for two years, thanks to therapy and addressing her trauma.
[08:44] Dr. Nzinga Harrison: So I love that this story ends with Cindy in recovery for the last two years. And also that she emphasized that she thinks addressing that childhood trauma has really played a big part in her being able to stay in recovery. That’s huge. So, Claire, I hope you’ll let me make a couple of tweaks on your language. As you were telling that story, I heard a couple of things. And as our listeners get to know me, then they’ll know that I describe myself as language.-militant. And I think that’s because language matters, right? So a lot of times, even when we’re not trying to be pejorative, or send stigma, or pour shame on people, we accidentally do it with the words that we use. So I wrote down two things. And listeners, I hope you’ll start listening to yourselves and start listening to others as they talk and feel confident enough to raise your voices on it. But so, Claire, you said after seven years of being “clean.” And I just over the Zoom call gave Claire my motherly look.
[09:49] Claire Jones: Yeah. When you say it like that, I understand immediately.
[09:53] Dr. Nzinga Harrison: Right? And so the connotation there is that while she was using, or to put it in medical terms, while she was suffering from the symptoms of the illness that she had, we’re calling her “dirty.” So we’re gonna stay away from clean and dirty. Some alternatives are “while she wasn’t using” or “she’s in recovery” or “her illness is in remission.” Tons of different ways we can say it. But if you’ll — I’m just asking the listeners kind of to put their conscious mind on not saying clean and dirty. And then the other one was actually a lot lighter, but when you mentioned her dad, you said her dad was a “drug user.” Sounds kind of like an indictment. It makes it seem like that is the only identifying feature of him. And so I like to lead with the human being and say the person has or the person did or the person was experiencing. And so rather than like he was a drug user, he also had addiction or he was using drugs, to separate the symptoms from the identity of the person. So I hope it was OK that I made those tweaks.
[11:04] Claire Jones: Yes, that’s amazing. Thank you. There’s a part of this email that you said really stood out to you that I actually want to read. And this is what she said. She said, “I want women who have used while pregnant, or who have children, to not let that shame control their lives. That is what leads to failure. I hope you can use it and it’s helpful. I’ve always wanted to share my story, but I’ve been too nervous to. Thanks so much for reading.” Why was that part the most intriguing for you, Nzinga?
[11:30] Dr. Nzinga Harrison: It hit me in my heart. Like I just absolutely, one, loved that she found the courage and was gracious enough to share herself with us. Like, that is a very difficult life story that you just told us. And we being kind of like the larger culture, community, pour so much shame on people. It really should be us that’s making it easy for her to speak up. But all of the feedback that folks get, like, you used while you were pregnant, you used I.V., like, you don’t really have pain, right. Like all of the elements of her story is kind of the collective stigma just bearing down on her to keep her silent. And I agree so much with her is the shame that leads to failure. We have this idea that it’s the addiction that leads to failure, or it’s the drug that leads to failure, and we have made these illnesses so much worse. And so many more people have died that didn’t have to die. You can hear I’m on my soapbox right now because of the shame that we’ve put on people. And so, like, it is on us to start peeling back that shame, to make it easier for people to tell their stories. Because it’s the stories of people, when we see ourselves in those stories, that automatically generates our compassion, but also our motivation to like figure out a different way for people. And so that she overcame what is clearly a very tall barrier, I thought it pointed to just the resilience and awesomeness of her as a human.
[13:49] Dr. Nzinga Harrison: So many questions come out of Cindy’s story. But one of the big questions is how do we start peeling back the stigma to help a pregnant woman who is using be able to raise her voice to ask for help? And so part of my job as a medical doctor is to answer the question: if I’m using, or if my partner is using, or if my daughter is using, and she’s pregnant, what kind of help is there for me and how do I get to that help? And so kind of the question that’s inherent in that, that I hear from pregnant moms, or from women who are intending to get pregnant, who want to get pregnant but have an active drug use history, is are the medications that are used for, in this case, opioids safe while I’m pregnant? The first answer to that question is yes. So there are really three different medications that we use for opioid use disorder. You’ve heard of two of them, I know for sure, maybe the third. So the first is methadone, that’s the oldest medication that we have for opiate use disorder. That’s where the most evidence and the most data is in using in pregnant women, just because we’ve had it around for a long time. The second is buprenorphine. So you heard actually Claire refer to this earlier as Subutex. So, you know, every medication has a generic name and a brand name. So, for example, we all know the brand name of Tylenol. The generic name for Tylenol is acetaminophen. So buprenorphine is the generic name, Subutex is one of the brand names. So we have methadone, we have buprenorphine. And then the third one that you may have heard of is naltrexone. Each one of these medications work differently.
[15:45] Dr. Nzinga Harrison: So when we talk about how the brain works, opioids bind to this specific place in the brain that we call a receptor. So you can think of it like there’s a lock and that lock is the receptor and then there’s a key, and that key is the opioid. Whether that opioid is heroin, whether that opioid is a pain medication, like a morphine or a fentanyl or OxyContin, all of those opioids are the key that can turn this lock. And when opioids turn the lock in the brain, it sends a whole chemical and electrical reaction through the brain and the body that treats physical pain, but also treats emotional pain. There are some keys that turn the lock all the way, like totally unlock the door, the door flings wide open. You get the whole message: no pain, no physical pain, no emotional pain. Methadone is one of those keys. We call it a full agonist. So an agonist is something that helps you seeing your entire message. Methadone turns that key completely. That means it can very quickly treat opioid use disorder, but that also means you can get high on methadone. And that also means that the most deadliest side effect of opioids, which is stopping your breathing, is a serious risk with methadone. This is the reason methadone is so tightly controlled. So the reason you have to go to a clinic every single day to get a dose when you first start is because the overdose risk for methadone is actually substantial.
[17:26] Dr. Nzinga Harrison: It’s also the reason why we have to increase the dose so slowly. So you’ll see when people first start methadone, it can be a month, maybe even a couple of months before they’re on the methadone dose that actually keeps their cravings away and actually keeps withdrawal away. But we have to increase that dose slowly so that we don’t accidentally stop your breathing. That’s methadone. Methadone has been shown to be safer in pregnancy than heroin. Right. So every time, and this is in all of medicine, every specialty, but specifically talking about it here in addiction, what we’re always doing — there is no intervention we have in terms of medication that doesn’t come with some risk. So it is always a decision point between what is riskier. And in this case, the decision is between heroin and methadone, the answer is methadone. With all of the regulations around it, methadone is a safer choice than heroin. So, yes, if the only access you have is to methadone, please, you, your loved one, if you’re thinking about getting pregnant, go to a methadone clinic and start methadone. It will help reduce and or eliminate any withdrawal symptoms that you’re having from the opioid that you’re using. And it will also reduce all of the other risk that can come along with using an opioid or being addicted to an opioid.
[18:57] Dr. Nzinga Harrison: The next medication that got developed is buprenorphine. And so buprenorphine also turns that lock, but it only turns that lock halfway. So it’s what we call — remember I said an agonist sends the full message — buprenorphine is what we call a partial agonist. So the key still goes in the lock, but it only turns it halfway. And this reduces the risk of buprenorphine substantially. It would be extremely difficult to take enough buprenorphine to overdose and stop your breathing. And for this reason, there’s not as much regulation around buprenorphine. So typically you can go to a doctor’s office and when you’re first starting out, you can get a one-week supply and then pretty quickly move in to getting your buprenorphine prescriptions monthly. And there are different types of doctors that can prescribe buprenorphine for you. And so when we go back to that same risk-benefit analysis, clearly the answer is easy: is buprenorphine safer than heroin? That’s a no-brainer. Is buprenorphine safer than the OxyContin that this person is addicted to? The answer is easy. Yes, buprenorphine is definitely safer and we would choose buprenorphine. The question is in pregnancy, is buprenorphine safer than methadone? And so those studies have started to come really probably about the last five or six years. And it’s a little bit not black-and-white, of course. It’s a little bit gray. So in short, buprenorphine has been shown, after the baby is born, that the baby will have less withdrawal symptoms. Just like when you’re using, and you suddenly stop using, and your blood level falls, then you develop an opioid withdrawal syndrome, then when babies are first born, the same thing happens. Because they were getting that opioid supply, whether it’s heroin or pain pills or methadone or buprenorphine, that was coming through the placenta to the baby. The medical evidence shows that the neonatal withdrawal syndrome from buprenorphine is not as severe as the withdrawal syndrome from methadone. So in that way, you would say buprenorphine is a safer choice. The reason I say it’s gray is because buprenorphine doesn’t have as much regulation around it. And part of the reason methadone works so well is the accountability of having to go every single day and get that dose. And so for some women, the severity of their illness will be such that they need that accountability of the daily dosing. If we could get the accountability of daily dosing for buprenorphine for that woman, I would choose buprenorphine over methadone. Because I don’t have to worry about the overdose risk. I don’t have to worry as much about the little baby after the baby is born and the withdrawal syndrome that they’re going to have.
[22:02] Dr. Nzinga Harrison: And then the other medication that I said, vivitrol, naltrexone, we actually do not recommend in pregnancy, very important. You’ve heard of a medication which is called Suboxone. Suboxone is a combination of buprenorphine — so that partial agonist — plus a medication called naloxone. You’ve heard of it. The brand name is Narcan. That’s the reversal drug. When you put that combination together, Suboxone is actually the favorite medication for non-pregnant women because the naloxone reduces the chance that you abuse the Suboxone. But for pregnant women, we do not recommend naloxone for that baby. So that was a lot. The high-level summary is that there are two choices that are safe for use in pregnancy, methadone and buprenorphine. If a woman has access to buprenorphine, and she can establish a relationship with a treatment provider that can be very close, really be also providing the other services that are necessary to treat an opioid use disorder. So medication is not a magic bullet, right? So we need therapy, we need counseling, we need to address trauma. We need to take care of depression and anxiety. We need our birth advocate to help make sure that this mom who has an addiction is not experiencing unnecessary stigma and discrimination that’s making pregnancy scarier and harder for her. If we can get that whole wrap-around, buprenorphine is my recommendation. If buprenorphine is not available in your community and in your neighborhood, you don’t have any way to get to it, the only thing you can get to is methadone, than methadone will always be my recommendation over whatever opioid that woman is addicted to.
[23:52] Claire Jones: Wow, that was such a helpful answer. I mean, that just provides me with such a better in-depth understanding. I think another burning question that I had after reading Cindy’s email was what compelled her to talk to her second doctor about her addiction, especially after having such a negative experience with her O.B.? And how did she sort of feel like that was a safe person that she can confide in?
[24:18] Dr. Nzinga Harrison: Yeah. So after we got Cindy’s email, and you kind of sent me that question, we called her back. So why don’t we listen to the check-in that we were able to do with Cindy?
[24:34] Dr. Nzinga Harrison: So Cindy, so nice to meet you. Thank you for coming on. I really wanted to start by saying thank you for sending your message in. Just talk me through how it was developing that trusting relationship with the second doctor after the not-so-good experiences you had had before that.
[24:54] Cindy: With my second one, I just — since I was taking opiates, I had a huge fear of them taking my child. It was just — took like months to finally do it. And I lived in California at the time, and they had a phone number you could call. And I was like, well, maybe I’ll call them, it’s anonymous. I can get some information on where to go or where to start. And they weren’t very helpful. But the fact that I took that step to make that call anonymously made me feel — and I didn’t hear any judgment, they just didn’t have any resources at the time that they could send me to or something. It was so long ago, I can’t quite remember what the hotline was for. That little step made a little bit easier to, like, tell someone, like a nurse or whatever. And so I think I’d emailed the doctor and she was like, yeah, we can discuss this when you come in. And they act like it was like me telling them, hey, I have diabetes. Like, they were not surprised. They were not, you know, mad or anything like that. And it was a very good experience from there on out.
[25:53] Dr. Nzinga Harrison: So, Claire, that was so great being able to talk to Cindy, like I continue to just be amazed at the courage it took her kind of to send her story into us. It makes me want to touch on a bit about the stigma that surrounds addiction kind of in our culture and in our belief system. I always say I want us to get to the place where you could be in a bar and say, “I’m not having a drink because I have alcoholism,” and that engender the same kind of understanding and support that it would be if you said, “I’m not going to eat this piece of cake because I have diabetes.” Or even to take it the next step, if somebody said. I’m not going to go in that smoky place because I’m a breast cancer survivor. Like immediately everybody would rally around that person and be like, “oh, my gosh, breast cancer is such a scary illness. Like, great for you for fighting it. So happy that you’re in recovery. What can I do to support you?” And we don’t have that same orientation for people that have addictions, especially substance addictions. But this is true — like, you couldn’t say, “I’m not going to go past that movie theater because it triggers my sex addiction.” Like the eyeballs that would fall on you would just be heavy and immediately burst you into flames. And so when we can get to the point where our knee-jerk reaction is the same as I’m not going to do that because I’m in recovery, or I’m in treatment for breast cancer, then I think we will have made so much progress in the right direction. So I just really can’t thank Cindy enough for helping to push us in that direction. Because it does start with the courage to raise our voices. So I loved that. And then there are a lot of questions I know that you had, and also some questions that I heard in her story that I have often gotten from folks over my 20 years of practice. So why don’t we jump into a few of those?
[28:04] Claire Jones: Yeah, that sounds good.
[28:11] Claire Jones: Hey, In Recovery listeners, Claire here. If you’re enjoying the content on this show, we’re happy to report that you can get more of it. We have exclusive bonus content for our listeners who want to pitch in some money to help us make the show. For as little as $5 per month, you can sign up right now at LemonadaMedia.com/InRecovery to get bonus content, discounts or free swag and other membership benefits. We greatly appreciate any financial support you can pitch in. Seriously, any amount helps us bring you this content in a financially sustainable way.
[28:58] Claire Jones: OK, the first one that I have is pretty simple. What exactly is a birth advocate?
[29:02] Dr. Nzinga Harrison: Oh, OK. Great question. So many people have heard of a doula. And so a doula is a type of birth advocate. It’s basically a non-medical professional who is your person. So a birth advocate’s job is to make sure they help you advocate for your needs, and to have an understanding of the health system so that as you move through it, you can have a safe emotional, psychological and physical experience through your pregnancy and any interaction that you have to have with the healthcare system throughout that pregnancy. I had actually not thought about recommending birth advocates for my pregnant moms with addiction. Like, if a mother brought that to me, I would help her get connected, but hearing Cindy’s story really makes me think that I might proactively start talking about that with my pregnant moms.
[30:00] Claire Jones: What does it cost to have a birth advocate, or how do I know that that is something that is an option for me or is something that I can access?
[30:07] Dr. Nzinga Harrison: Great question. So there’s actually a huge movement to get birth advocates to be covered by insurance. And different insurances are taking that up at different times. So the first thing you can definitely do if you have Medicaid or Medicare or other private insurance is call the number on the back of your card and see if they cover doula or birth advocate services. If they do, they’ll have a provider directory that they can point you to. If they don’t, you can always pay for a birth advocate out of pocket and the expense will be relative kind of to what your own situation is, but there are definitely different price points. And so one resource that I like is actually DONA International. This is actually an international group of doulas that kind of, you know, advocate for quality and effectiveness of doula and the difference that they can make in a woman’s birth journey. And they have a directory on their site that you can search by zip code. So first check your insurance, and then you can try DONA International.
[31:21] Dr. Nzinga Harrison: I want to touch on a question that may have come up for a lot of listeners, which is — and I’ll ask this question in the most stigmatizing way. How can a woman who’s pregnant keep using? Because that’s really the way we think about it, right? And so one thing I say is I don’t want you to judge yourself if you develop that question, or if you had that reaction. Because we’re all kind of being raised in this same kind of thought process and they get embedded in our brains and so they can come up automatically. So I don’t want us to judge ourselves for asking the question that way, so much as to recognize this is the emotional response that I’m having to this story. And be able to ask myself, what is that about? And so the question, why do women keep using when they’re pregnant? We know from the literature, we know from surveys, I know from my 20 years practicing psychiatry and addiction medicine, that getting pregnant is one of the most effective triggers for a woman seeking to get abstinent from drug use. Immediately upon getting pregnant with a pregnancy that the woman decides she wants to take to birth develops the motivation, how can I stop using these drugs? When we look at the way drugs work in the brain, there’s this specific system and it’s called the dopamine pathway. It used to be called the reward system. It is now called the motivation pathway. Dopamine is the chemical that drives that pathway in the brain. And look way back kind of evolution, the whole point of the dopamine system was to let you know “this will keep you alive. This will help you survive.” So when you look at the natural things that cause a dopamine signal in the brain, it’s food, it’s water, it’s sex and it’s nurturing. So we need food to survive. We need water to survive. We need sex for our species to survive. Some will argue we need it individually as well. We definitely need nurturing. So all the studies show you take a newborn, whatever, baby, human, baby monkey, baby dog, baby whatever, and you separate it and you don’t give it any nourishing and the little baby withers.
[33:46] Dr. Nzinga Harrison: So we all need food, water, sex and nurturing to stay alive. And for the species to stay alive. The problem with drugs is that they tap that same pathway. And in your brain, the importance of a signal is purely how much dopamine does this one thing send? And so the studies show these drugs tap the dopamine system in a way that is just like thousands of times larger than food, water, sex or nurturing. So when I talk to people about the biology of addiction and I say, “did this mother — and I’m doing air quotes ‘choose’ heroin over her unborn baby?” Not in the sense that you think. Heroin generated a dopamine signal that said, “I am the most important thing for your survival.” And then it sends a loop to the part of your brain that makes plans and controls your actions. And it says make sure we never go without heroin because heroin is essential to our survival. And purely by the fact that heroin can send a dopamine signal that is thousands of times bigger, like, think about you hug your baby, you get a dopamine signal from that and it’s a light bulb and it goes, ping! We need to love this baby to survive. And then you use heroin and it’s the brightness of the sun, what signal is more important, the sun or the light bulb? And so while we say like this mother chose drugs over her unborn infant, what it really is the size of that dopamine signal chose drugs.
[35:30] Dr. Nzinga Harrison: And the way we undermine the size of that dopamine signal is by increasing the dopamine by nurturing. Wrapping our arms around her, getting a support system in place, getting a birth advocate to stand up for her when she can’t stand up for herself. But we’ve done the opposite, right? We kick you out, we isolate you, we put you on an island, and then there’s no nurturing dopamine signal. So, of course, heroin’s signal is bigger than that. So really, I want you when you feel yourself have that emotional response, because you’ll get it, because we all care for the baby, we’ve been taught to less care for the mother. So that’s where I want us to get to, where we have the same amount of kind of reflexive compassion for the mother as we do for the baby. But when you get that emotional response, just remind yourself: heroin’s dopamine single is like a bastard, right? Like it is. It is the worst and really hard to overcome. And then just think about something less serious for yourself. Like you say, “I’m only going to eat one cookie.” Well, that cookie gave you a dopamine signal and that dopamine signal was like “you should eat another cookie.”
[36:39] Claire Jones: My life in quarantine.
[36:40] Dr. Nzinga Harrison: Totally, totally. I’m like, you know, more than halfway through my family-size Oreos pack. And I’m like, “I’m not gonna eat this whole pack of Oreos,” but I am. You won’t judge me for because it’s Oreos and that dopamine signal is way smaller than heroin’s dopamine signal. So that’s the reason why. Two-part answer to that. Neurobiologically, it’s a setup. But also, when we feel ourselves have those stigma later reactions, we don’t have to judge ourselves for that, but we do have to put our eyeballs on it.
[37:12] Claire Jones: Yeah. One of the things that you said during that that I thought was really interesting is how, if you have a birth advocate, that can really help with you, sort of handle your own shame that you feel. Or if you have a doctor that is comfortable enough for you to be able to talk to them about what’s going on for you, that can be really helpful for you to deal with your shame. But how do you know how to trust a doctor? How do you know that they’re not going to judge you? And I think that was the thing with Cindy, too, that was so fascinated by her story. It was like part of it had to come from her, right, of being like, OK, I feel like I’m ready to talk about this. But also, part of it had to be about having this sense of I can trust this person. So how do you know how to trust a doctor?
[37:54] Dr. Nzinga Harrison: Part of it, you can feel it. So you’ve all, just like any relationship with any other person, you can feel a person actually cares about you. Even like people say, doctors visits are so short, you can tell in the first minute of that appointment if this is a person that cares about you. And so I think this is really what we heard from Cindy when she first called that hotline. They didn’t even have a specific resource to give her, but she got off of that phone call and she didn’t feel judged. And so part of it is if you don’t feel that judgment, then what I ask you to do is take the risk. I recognize if you feel the judgment, it might be too much to ask for you to take the risk. But a lot of times we’ve had so many experiences that are bad, we carry that experience forward into this current relationship, even though there’s a person there that you can tell really cares. And so if you can tell that person cares, take the risk.
[39:00] Dr. Nzinga Harrison: All right, everybody, that brings our first episode to an end. Before we leave, I just want to say living in a pandemic is hard. It’s hard on everyone in so many different ways. So if you’re really struggling during this time, I really just want to encourage you to connect. Reach out to someone you can trust who can be a source of support for you. Even though we can’t be in the same physical space as our support system, there are ways that we can get in the same emotional space, and right now that is just hugely important. If you need resources either for support system or otherwise, check out the show notes. We’re gonna drop some links there for you and hopefully that can be a help. Thanks so much for listening to the end of the episode. I hope you’ll listen again next week, and even more, I hope you’ll subscribe to the podcast. This felt great to me, but I would love to hear your opinions on how this first episode went. So if you want to send me your opinions, you’ll send them to the same place that you would send your questions. Let me ask Claire to tell us how you should get that done.
[40:17] Claire Jones: Here’s what you can do. You can send us an email to InRecovery@LemonadaMedia.com. You could also record a voice memo on your phone and then email it to that same address. You can call us and leave a voicemail at 833-453-6662. Or you can tweet @naharrisonmd. If you’re leaving us a question, we want to hear a couple of things from you. We want to know your name if you’re willing to share it. We’d love to know your age, where you’re from, and a little bit of context for your question. It could be a short story or it can just be a little bit about yourself, but we want to know a little bit about you.
[41:13] Dr. Nzinga Harrison: Thanks, Claire. And with that, we are done. You are listening to In Recovery with me, Dr. Nzinga Harrison. And remember, we are all in this together. Hope to talk to you next week.
[41:30] Dr. Nzinga Harrison: In Recovery is a Lemonada Media original. The show is produced by Claire Jones and edited by Ivan Kuraev. Music is by Dan Molad. Jessica Cordova Kramer and Stephanie Wittels Wachs are our executive producers. Rate and review us and say nice things. And follow us @LemonadaMedia across all social platforms, or find me on Twitter @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help destigmatize addiction together.