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Welcome to the NOCE Dose Opioid Crisis Unplugged. The NOCE Dose Opioid Crisis Unplugged is a concise and insightful podcast offering a deeper dive into the realities faced by professionals combating the opioid epidemic. Join us as we reconnect with expert panelists from our listening sessions, providing a behind the scenes look at their work and insights into the pressing issues of prevention and diversion, harm reduction, opioid use, treatment, recovery and reoccurrence prevention. Welcome to the NOCE Dose brought to you by the Nevada Opioid center of Excellence at nvopoidcoe.org. I am your host with the NOCE, Bianca D. McCall, going behind the scenes of the front lines, having courageous conversations with those who support the opioid response programming in Nevada State. And today's show, it's a special one we are all set to debrief after the latest the greatest no Sponsored listening session. And joining us today is Dr. Krista Hales, a licensed alcohol and drug counselor and intern supervisor based in Las Vegas, Nevada. With a doctorate in behavioral health from Arizona State University and over 15 years of experience in substance use treatment, she's developed innovative programs for individuals with substance use and co occurring disorders. Dr. Hales is deeply involved in Nevada's behavioral health landscape, serving on key councils like the Governor's Behavioral Health Planning and Advisory Council and leading initiatives such as the Recovery Village at Las Vegas Pride and Narcan at night. The good Dr. Hales is passionate about highlighting the lived experiences of, diverse communities and she's here today to share her invaluable insights on the NOCE Dose podcast. Let's dive right in. Dr. Christa, how have you been since the listening session way back in 2024? And if I can ask you what's been the most profound thing that's come from the listening sessions? What's really landed for you?

I think I've made some new connections with community partners that haven't come to the forefront before that were part of that listening session that was really cool to be able to get the word out, and make some new connections.

No, absolutely. it's funny. Not funny haha, but funny just the way that the world works in these communities, in Nevada communities specifically. it's funny that connectedness and making new connections seems to be kind of like the theme, that we've heard a lot of. We've gotten a great response from those who joined the listening session, those that were, that were listening in the audience there and then also with the panelists, everybody's kind of saying the same thing. It's really just to have a platform to where we can come together and connect seems to be what, is the major takeaway for a lot of folks that join in. And going back to kind of my first question, Doc, how have you been? I mean, we've seen a changing of the year. We've seen some pretty, like milestone events that are, that are going on in, in our communities in Nevada, for our state, and then also nationwide. And so how has that all kind of affected you, affected your motivations and your intentions in starting a, brand new year and, and knowing what you know, and having the connections that you've made through the listening session?

Yeah. So right now, obviously with, the change nationally and locally, politically, a bunch of stuff happening, I think now is when a lot of us start getting a lot louder about our advocacy work, as well as gearing up our programs for the year, setting those milestones for our staff and for the clients that we work with. you have more and more people that are seeking access to resources because you have that New Year, new Me kind of mentality and those New Year's resolutions. So people that are finally ready to get the help that they need. so this is busy time. So it's. It's pretty much like gas pedal to the floor now for a couple of months at least. Getting all of those pieces in a row.

Yeah, yeah. No, and thank you for that. I mean, so much is. So much has happened. Right. So much has gone on, to where the listening session, you know, it seems like it was forever ago, or it might have been forever ago. And you mentioned, with the New Year, the turning of a new year, New Year's resolutions and things. And so I read that New Year's resolutions, they name it the, Gosh, what is the name of the day? It's January 10th. They say that this is the day that most like 80% of New Year's resolutions are actually, done. We're ready to give up and walk away by January 10th. And I'm going to find the name of that day, what they actually call it, for us to all just kind of walk away and abandon our resolutions. Right. And really that comes down to kind of like a, disruption in our motivations. Right. And our intentionality, to create change. And so for you, Doc, I'm wondering, have you seen that like, as of January 10th, people are no longer Kind of, kind of wanting to look at better tomorrows and wanting to make these changes. Have you seen that extended? because of some of the other things that have been going on, whether it be locally, here in Nevada or nationally. have you seen that extended. And then, you know me, I always want to start with. It starts with us. Right. And so for you, where's your motivation? What motivates you to today? well, after, the 10th of January, what motivates you to. To continue to. To fight this good fight with it.

Being a, political year, so to say, without getting deep into politics, I feel like we probably made it past the 10th this year with a lot of people still keeping their goals in line, because I think they really want to see what happens over the next couple of months, with the shift in things and, and how that may change, like our everyday life, so to say, for a lot of people. so I think we'll see a little bit longer of those New Year's resolutions or, or advocacy work and that type of thing. for me personally, like, I do this on a daily basis professionally, but it also hits home. I got into this profession because of a history of substance use in my family. And I lost two family members to suicide via overdose. And so, I also have two children that are on the autism spectrum. So my life revolves around a behavioral health focus, so to say. And so that's kind of my motivation. Like I cannot support anyone in my family, I cannot support my kids, I cannot support my community, unless I'm giving my best version of myself to, to them. so I have to take that self care time as well, and know that there's so many people in our community that are still voiceless. And I have a platform that I can be a voice for them until they get to a point that they can advocate for themselves. So that kind of keeps me going on a daily basis.

Yeah, no, thank you so much for sharing that and being vulnerable in some of the challenges. Right. That, that you have to overcome just personally. Right. And also understanding that that may translate, to, you know, more challenges, even professionally. Right. And so, and this is something that you talked about during the listening session. You mentioned that one of the most significant challenges facing the substance use disorder and the treatment workforce. Right. Are concepts, and management of time. Right. and for a lot of us, having multiple things going on possibly, in our personal lives that, again, have some impact on, our professional experiences, and a lot of us Feeling, like we're stretched thin. Right. And there being a need for more professionals and perhaps greater and more diverse representation and transparency. You also mentioned during the listening session, and you described the value of psychological safety, characterized by that sense of belonging and quality relationships and confidence and, even to make mistakes in our professional spaces. I want to ask you, Doc, does that really exist? Does psychological safety really exist? And how do you propose that we as a workforce, pour into ourselves during these seasons and overcome the, challenges that are, presented to us in our personal professional lives? And how do we muster up the energy and desire to reconnect in our workspaces?

The biggest thing for me is learning to say no. I struggled with that for a very long time because I was very much that student that came out of school that was gung ho, that was going to save the world, that was going to make this big, drastic difference. And I quickly realized that I'm only one person. And while I am only one person, I can still rally those around me to make the impact that I want to make. so learning to say no and being realistic about things, that's something that, I've come to terms with probably over the last 12 months, is pouring my energy into the things that need my energy and deserve my energy versus spreading myself thin. And so, there's projects and things like that that I very easily could have jumped onto or volunteered my time to. but that would have meant that the projects that I already had wouldn't have gotten my full attention. And so, being realistic about that time is super big for me.

Yeah. And, okay, so being realistic. Right. Being real. and I happen to pride myself on saying, you know what? I'm perfectionist. Yes. And I'm all these things, but I'm also. What's rooted in that perfectionism is being a realist. Right. I'm constantly looking at, taking, personal inventory, taking inventory of the resources that exist internally within me and then also environmentally, what do I have access to in my immediate spaces and environments now, having that type of mindset. Right. Being realistic to your points of, just being realistic about what we can do, where we need to pour into ourselves and things like that. I would argue, Doc, that that requires us knowing ourselves. Right. Knowing ourselves and accepting ourselves, even the areas that we may need, to challenge, you know, challenge the status quo, to challenge some of those patterns and things. And I really appreciate it that you brought up, the subject matter of unconscious bias during the session because. And you Shared that, a mere 17% of individuals experiencing substance use problems. Right. Successfully complete treatment and a much lower percent. Right. For historically and intentionally marginalized communities. And so will you please speak to your approaches and ensuring cultural responsiveness in the treatment of substance use disorder and considering the unique experiences of people who are using opioids.

So with this one, it's super important and it's hard when we push peer support and lived experience and things like that. I think it's important for individuals working with this community to take themselves out of the situation and value that unique experience that that client brings to the table. no matter what cultural aspects are involved there, whether it's race, whether it's gender, whether it's, sexuality or anything in between, poverty, any of those things, we have to take ourselves out of their. That situation and almost put ourselves in their shoes so that we fully understand what exactly it is that they're needing to be better versions of themselves. and also not giving them the same expectations that we would put on ourselves. I think that's. That's hard is like we would say, well, if I was in your shoes, I would. I'd be checking into detox tonight and I'd be doing X, Y and Z and. And that's not realistic for the majority of people. And so, being like, competent in that sense that I use the example of when I'm training for harm reduction. it was actually a client in one of my harm reduction classes that gave me this scenario, and now I've used it in every scenario since then. But if you had a leak in your house and you called a plumber, you'd want that plumber to show up with their entire truck full of tools, extra parts, whatever it may be, so that once they diagnose the problem, they have whatever might be the right tool to fix it. If that plumber only shows up with a wrench and the problem needs an extra fitting, it needs a screwdriver or that type of thing, then that person's probably never going to call you again to fix their problem. So I think that's kind of when you come into a situation, like, you have to come from a standpoint that, like, here's all the tools, here's all the resources, let's diagnose it together and let's figure out what's going to be best.

Yeah. No, I love the plumber analogy. And also, I got to tell you, the mic drop for me was when you asserted that we have to teach people how to Be comfortable being uncomfortable. And I love this, I think it's a great segue into the conversation of that being kind of the centerpiece. Right. Or the cornerstone rather of treatment, for people that are using opioids is the teaching them to be comfortable being uncomfortable. And that takes us out of kind of this static binary, way of looking about treatment. It's not somebody is cured, but no, there's a continuum. Right. It's a living person and a living recovery journey. and so I love that it was a mic drop for me and I'm just wondering if you can kind of expand upon that and let us know. How do you do that? How do you teach people to be comfortable being uncomfortable? And how does that approach change for you, when you're working with people across the lifespan? Right, because how much is a young person expected to be uncomfortable right before it makes us uncomfortable? Right. Or an older person or circling back to the cultural appropriateness and responsiveness, you know, throw trauma in there, you know. So can you, can you paint that picture for us of what a normal range of discomfort looks like while we still honor the differences and the unique pain histories of the people that we're working with?

So I think this question's kind of double edged sword. there's no normal range of comfort in my opinion because it, it is case by case scenario and our backgrounds and, and our current situations shape what we're comfortable and uncomfortable with. Our personality differences and things like that. Like throwing myself under the bus. I'm very uncomfortable when I don't have control of a situation because I'm very type A planner personality. And so the instance you throw me in something spontaneous, I am completely uncomfortable. And, and that's not to say that like I'm an introvert because I'm an extrovert 100%. but if you put me in a scenario where I have no control, I'm uncomfortable. But that's not to say that the next person that walks through the door would be uncomfortable in that scenario. So I think it's sitting down and really gauging where their comfort zone is and what feels uncomfortable for them before you dive into it. Like you want to have a game plan for what that uncomfortability looks like, whether it's physical, whether it's mentally, whether it's financially. and this is kind of where I typically delve into the eight dimensions of wellness with people and kind of gauge where are your high points, where are your low Points because then we know that there are low points and those dimensions are probably going to be where they're uncomfortable because that's where they've made the least amount of progress. but until you kind of get that balance in those eight dimensions, you're always going to be uncomfortable and you kind of have to case by case it to get people to where I like to say their wheel of wellness, is balanced out to where it would roll and they'd make forward progress. I also like, I'm a big analogy person if you couldn't tell. I, I, I, I've heard, I've been told numerous times throughout school and so forth that the, the best therapists are in therapy themselves. And so I've been in therapy, and my therapist told me once you have to shed a few tears to water the seeds and, and you're not going to get growth without it. And so it was like, oh, okay, like I get it now. There's going to be times where we have to step outside of our comfort zone and do some things that are going to be pretty hard, but in the end like you're going to get this amazing garden out of it. so it's, it's, it's a short time frame teaching them that like you only have to be uncomfortable for a short amount of time and then you're going to see this growth that you're going to be so proud of yourself for getting through that uncomfortability, and helping them visualize the long term versus that short term uncomfortableness.

Yeah. And thank you so much for that. And since your areas, one of your areas of expertise is again, in the behavioral, health and strategies and treatment. Right. you know, you're talking about some things like when you say gauge and I'm thinking about what are the metrics, how do we measure, you know, whether or not somebody's uncomfortable and then behaviorally, what if somebody is Again we talked about lifespan, with age being a factor in their abilities to express, being uncomfortable. Right. But also thinking about emotional development. Right. Doc. Where maybe sometimes, and I use the term regressed, you know, begrudgingly because I, you know, operating in earlier stages of development. It doesn't necessarily, for me, it doesn't necessarily imply a regression but a return, an intentional return to an earlier stage of development. Right. And with trauma and things like that, there's a reason why we're going back to these stages where there's some things unhealed and so when you say gauge and for somebody that perhaps has returned to an earlier stage of development, has a difficult time expressing their, their their level of comfort right as they're engaged in treatment. What have you seen? that, that helps us as a, as a treatment provider or professional or or a peer, you know, in the space. What are some things that could help us to identify and say oh this is, this is a pain point or this is a, this is an issue of comfort. and here's how I can meet that person, where they are, if that makes sense.

So I'm a big believer in body language. your body's response is always going to be very genuine to a situation. Whereas mentally you can train yourself to respond in various ways. So I'm a huge proponent of like paying attention to body language. I also really focus and harness in on building trust. And so that may mean like having unconventional sessions with individuals. Whether that's we're not gonna sit in the counseling session normal chair like where there's kind of an authoritarian power struggle sometimes maybe it's, it's sitting on the floor in the beanbags or V doing the first session via telehealth so that they're in an environment that they're comfortable in. having conversations to really just get to know who they are so that those pain points almost kind of naturally reveal themselves through conversation. I've worked all across the lifespan. I've worked as young as 12, 13 year olds and then I've worked upwards of elderly in their 80s. and I think trust is kind of that one thing that's a genuine theme between all age groups. that if, if you're reading their body language and adjusting your body language and, and your tone of voice and things like that to match their energy or taking them to places and, and either whether it's visualization or doing things like empty chair, that type of thing, so that you can get them to a space where they are comfortable, starting to release and then being non judgmental as those things come out. letting them have their time to share on their comfort level and providing that active listening and that safe space for them to just be genuine. Those, those pain points naturally reveal themselves.

Yeah, the non judgment piece is so important because oftentimes the way that discomfort is expressed is through resistance. Right Doc. And so if we are engaged in the treatment process with someone who is using opioids and we're seeing resistance. We're met with resistance. A lot of times as professionals or providers, we look at that resistance as. It's a huge problem. And there's perhaps some unconscious bias, perhaps some judgment going on, about whether or not this person really wants it or they're ready and all these things. And so, when you say non judgment, I, see that as being so such a significant piece in all this. Especially when we talk about level of comfort and discomfort being expressed by, oftentimes by resistance. Right. I want to ask you just anything. Is there any kind of, just that, that one thing, right? Like if, if, you know, we all hope to, to be able to reach at least one person out there, right. And hope that our message resonates with, with just the one person for that, that person, your person, Doc, that's that may be listening to this episode today. Is there something that you would hope that they would take from. Whether it's something that you, you maybe didn't get to say during the listening session or in today's episode, with regards to behavior and treating the behavioral approaches and treating people who are, using opioids, is there one thing, what is that message that you would hope that that person would take from you in your message today or from the listening session?

My message would be both for providers and advocates, so professionals as well as those who are maybe struggling. And I think it's. Don't let one bad experience deter you from continuing to either help or continuing to seek help. Because I know personally that that's, that's what hit my family was a couple of bad experiences ultimately cost two family members my life, their lives. And it was because they thought that this is how it was going to be everywhere they go and everyone that they asked for help. And that's not the case. Like there's bad apples everywhere. and there's gonna be bad experiences because unfortunately we're not going to be able to get everyone on our side. That's just the reality of the world. but there are so many people out there that are doing good things that will get you access to the care and resources that you need as well as if you're a professional that maybe had a bad experience helping someone, like, don't blanket that experience over the next person that comes in and wants your help because it. They. There could be compounding factors there that, that they had their unconscious, bias before they came into you. You now have an unconscious bias that you're going to carry on to other people and, and all that is is going to continue us taking two steps backwards instead of steps forward. So I think that message just wraps up to, like, do not let one experience dictate whether you continue asking for help or you continue offering help.

Yeah, no, I love that. and it resonates with me. I'm one of these people that I don't accept the answer no very well. I always think, not right now. Not right now. Right. So that's what resonates with me is it's being able to push through, some of those challenges. Right. And to see yourself overcoming these, these challenges or overcoming adversity, and being able to continue on with your goal. And it's especially. I, believe it's especially, you know, there's a positive outlook, depending upon who you have around you. Right. The team that you have around you, who you're working with. Right. And that connectedness going back to, to what you said, you know, you took, really landed for you, from this listening session is the connectedness. Right. And so, Dr. Hales, will you let everybody know, how can professionals in the opioid treatment spaces connect with you? And what can they connect with you on? What can they call you for? But how do they find you? How do they have a conversation like this or continue the conversations with you? where can you be found, Dr. Hales?

Yeah, so right now I'm currently with Roseman University. I'm always available via email, so, that's probably the quickest and easiest way to get a hold of me. but I serve on all of these communities, so usually it's a quick search and you can find my name too. LinkedIn is always an easy way, to connect. I pride myself on liking being a hub, so even if it's not a problem that I can directly help solve, I probably know someone that can. So I have no problem with anyone reaching out to me, with whatever it may be. I have a vast experience. but that's not to say that I've done it all either. So, I'm always easy to connect with. And like I said, I, I won't stop things with me if I don't know the answer. The answer is just going to be like, no, I don't know. Sorry, good luck. it's very much going to be like, no, I don't know. But either I can ask this person or I can connect you with this one. I love helping people make those connections.

Oh, I love that. And when you let us know what your email is and then we'll also, make it available to those on, our platforms and our pages and things like that. But will you say your email for us?

Yeah, so it's Khalees H A L E S at, Roseman Ah Edu.

All right, thank you so much. And Dr. Hales, thank you so much for joining us today and sharing your incredible insights on trauma, on addiction, on holistic healing. Your work is truly inspiring and we're grateful for the impact that you're making in the lives of so many. Thank, you to everyone for tuning into this episode and if you found value in today's conversations, be sure to subscribe. Share this, leave a review or a comment and stay connected with us for more inspiring stories and impactful discussions. Until next time, take care and be well. Thank you for listening to the NOCE the Opioid Epidemic Unplugged. We hope that you found this episode compelling and informative, and we ask that you please share this episode with your friends and your colleagues. And if you want to learn more, please visit our website@nvopioidcoe.org the Noso podcast is brought to you by the Nevada Opioid center of Excellence or no. NOCE is dedicated to developing and sharing evidence, informed training, and offering technical assistance to professionals and community members alike. Whether, you are a care provider or a concerned community member, NOCE provides resources to support those affected by opioid use. Funding for this activity was made possible in whole or in part by the Nevada Department of Health and Human Services Services DHHS Director's Office, through the Fund for Resilient Nevada.

CASAT Podcast Network. This podcast has been brought to you by the CASAT Podcast Network, located within the center for the Application of Substance Abuse Technologies, a part of the School of Public Health at the University of Nevada, Reno. For more podcast information and resources, visit casat.org.