UNDERSTANDING SUBSTANCE ABUSE AND MENTAL ILLNESS WITH ROSITA BARSALLO

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Rosita Barsallo is a Puerto Rican/Peruvian woman first-generation born and raised in New Jersey. “I received my Bachelor’s in Criminal Justice and my Masters in Forensic Psychology. I am also a Gunnery Sergeant in the Marine Corps Reserves which I have been serving in for the past 15 years. I have also been working with non-profits in the substance abuse/mental health field for the past 6-7 years”, she tells us.

In this interview, we speak about the correlation of Substance Abuse and Mental Illness.

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You work for a nonprofit in LA treating Substance Abuse and Mental Illness. Tell us more.

I have worked in a few non profit organizations across  Los Angeles County that addresses substance abuse and Mental Illness in various communities. When I worked in Santa Monica with Ocean Park Community Center (now called the People’s Concern)  , I worked as part of a multidisciplinary mobile unit contracted through the Department of Mental Health (DMH) helping the homeless population all through Service Planning Area (SPA) 5. I worked as a case manager helping the severely mentally ill homeless individuals in those communities get access to care and supportive housing to get off the streets. We also followed up with them once they are housed to make sure they have the skills needed for healthy living on their own and are remaining connected to their services for long-term success. The program I worked with primarily focused on the client’s hierarchy of needs and placed an emphasis on finding housing for our clients first. If a client’s immediate needs and basic living needs were taken care of, such as having a safe and stable place to live, the hopes was it would allow them to focus on their other needs which fall in to substance abuse challenges and mental illness. It’s hard to try to work on your coping skills and improve your mood when you live on the streets and worry if you are going to be attacked in the middle of the night or when you don’t know if you will have enough to eat for the next day.

When I worked in SPA  6 with Shields for Families, I worked in both Outpatient and Residential substance abuse treatment settings. I worked as an Associate Professional Clinical Counselor providing direct services (individual therapy, group therapy, case management, etc) then I progressed to working as a Program Manager overseeing the staff at these programs and services being provided to the clients. We had a variety of different referral sources but one of the biggest referral sources was from the Department of Child and Family Services (DCFS). We helped our clients who had DCFS cases work on reducing substance abuse,  assist them in improving their parenting skills and to work on their long term sobriety with the hopes of being reunited with their children. At this agency, our substance abuse programs worked very closely with our DMH contracted programs and services to ensure we were providing additional care needed for clients with co-occuring disorders which is commonly found in the substance abuse world. This agency had a strong focus on the family system and in providing services to the family as a whole when possible. They offered services for the youth/adolescent through substance abuse and mental health programs and also worked with young children especially those impacted by the DCFS system and impacted from parents who struggled with mental illness or substance abuse. They did a good job in making sure no one was left behind in needing services within a family unit. They understood the value of making sure the family unit as a whole was supported and had the resources they needed to succeed.  

I later transitioned to SPA 7 where I currently am working with the Los Angeles Centers for Alcohol and Drug Abuse (LACADA). I assist with the Quality Assurance (QA) department, overseeing the QA staff at each of our sites. I ensure services are being provided appropriately to clients and that documentation is compliant in accordance to our contract requirements. We provide a number of services to include Medication Assisted Treatment, Outpatient and residential services, as well as Recovery Bridge Housing options for temporary housing while clients are completing their treatment with us. We work heavily with court ordered clients who were identified as being a good candidate to complete substance abuse treatment in lieu of doing jail time. We have court liasons at multiple courthouses across Los Angeles and have good working relationships with the courts to better advocate for our clients as they progress through treatment. We also have a fairly large medical team who work closely with our clients to facilitate any medication needs, provides physical assessments and medication assistant treatment services. The medical team is a very important part of our agency due to the number of physical health issues our clients tend to have due to neglecting their overall health while on the streets or while in their addiction over the years. I am fortunate to be apart of an agency that has a good variety of resources and services that we can offer the clients in our communities to address their needs holistically.

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What services are provided by your team?

In summary, we provide medical assistance treatment (MAT) which provides medication to help people addicted to alcohol or opioids curb their cravings. Examples of these medications are Vivitrol, and Suboxone. We also provide inpatient and outpatient substance abuse treatment for adults and outpatient services for youth which consists of Therapy, Individual Counseling, Group Counseling, Family Therapy, Case Management, recovery support services, Recovery Bridge Housing (RBH) which is a form of temporary housing for clients enrolled in outpatient treatment but do not have a place to stay; along with other types of services. We are funded through Substance Abuse Prevention and Control (SAPC) and a variety of different grants which allows us to provide these services to our clients at little to no cost to them through certain insurance avenues. We do accept clients without insurance who are eligible to receive Medi-Cal and we help them apply for it. We also assist undocumented individuals who need care but do not have insurance. We connect those clients to MyHealthLA which helps undocumented people get access to care.

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How did you get to where you are today?

I initially went to college thinking I would become a police officer. But I found myself being interested in the psychology/sociology aspect of it and wanting to be a part of the change to prevent crimes from happening rather than reactively responding to crimes that have already happened. I wanted to be more proactive and help individuals before it becomes a problem. That’s why I chose to get a master’s degree in Forensic Psychology because I wanted to challenge myself to work with more difficult populations and populations that tend to be more complex. That is the same reason I chose to join the Marine Corps when I was 18. I wanted to join the military and when deciding which branch, I asked which one was the toughest. I knew that if I didn’t at least try, I would always be left wondering if I was able to make it through the toughest- and now I know I can.  When people say they don’t want to do something because it is hard, or challenging, those are the activities I am more drawn to. I like to develop skills that are unique and that there is a need for. If I know there are people not willing to do it, then I know there is a need for it even more.

What drew you to focus on addiction and mental illness?

Mental illness and addiction is something I have always been interested in. For example, why certain people have more of a propensity to develop certain issues than others. Learning and understanding the cause of these issues may help us better find a way to prevent it and mitigate the effects of it. I feel like a lot of crime, trauma, addiction, and hurt around the world stems from others being hurt. Similar to the saying of “Hurt people, hurt people”. I want the hurting to stop for our communities. To end the cycle of both self-hurt and hurt to others.

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Can you describe the stigmas faced by minorities when they seek help for addiction and mental health issues? Do you think the stigmatizations are specific to certain minorities, or is it a broad issue?

Stigmas are a very real issue in our communities. I have seen more of an effort over the years through the media to assist with destigmatizing getting help for mental health/ addiction needs, however, we still have a long way to go to break the cycle. Since I’ve worked primarily with underserved and minority communities, I mostly come across individuals who are hesitant to access services or who struggle with acknowledging they have a problem due to stigmatization as a contributing factor.  I don’t believe stigmas are specific to certain minority groups but I do believe they can look different between each other. But stigmas have always been there and not just in minority communities but in all communities. We just see more of it in certain cultural groups than others. Some clients don’t want their family to know or be involved, others don’t have family at all. I have seen how stigmatization has contributed to individuals having feelings of shame or a sense of failure when discussing the impacts of their addiction/ mental health on their lives and on the lives of those around them.   De-stigmatization can help individuals better acknowledge that addiction is a real disease and mental health is a necessity for every human being. There is no shame in getting help.  Struggling with any one of these issues doesn’t mean failure in the human sense because no one is perfect.  

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Do you use motivational incentives with your patients?

At the agency I now work with we currently don’t have any motivational incentives at our programs. However, when I worked with the mobile unit to engage with homeless individuals to access mental health and housing resources, we would offer them gift cards to food establishments such as subway, and McDonalds, we would also have snacks and water to offer them during our meetings, etc. in order to motivate them to engage in our services and work towards their housing. Aside from challenges with their mental health and substance use, many don’t want to seek assistance due to a lack of trust in “the system” and have had people who tried to help in the past that never followed up with them or who wasn’t able to help. Also, many of them have their own homeless community that takes care of each other and they don’t have a need to gain housing where they have to pay rent and follow rental rules/guidelines. When I was working with those individuals, incentives were a huge help in getting our “foot in the door” and establishing a better trusting relationship with them.

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What prevents patients from seeking mental health and addiction treatment?

Stigmas play a role in making someone hesitant to seek help. Other factors include: financial ability to pay for services; child care for individuals who come from a single parent home with limited outside support to be able to attend treatment; legal ramifications for those who are undocumented or those who have criminal background or those who still live a criminal lifestyle; transportation to the treatment centers; lack of insurance; and a lack of overall knowledge of outside resources available to them to assist them overcome these various barriers. All these can deter people from getting the help they need.  There are many programs that understand these fundamental barriers to individuals accessing care and treatment and they work with individuals and families to offer support and resources for people who need them.  Many people just don’t know about them.

How do you handle stressful situations?

Self-care is a key word in this field but also very difficult to be consistent with. This field is definitely a “giving” field and the staff openly and willingly give themselves and their time to helping individuals in needed. Far too often does that come at a cost to those providing direct services. This causes high turn-over rates at agencies, high staff burn outs, and at times, low staff morale. What I have found is that focusing and building a solid team helps the individual staff. Frequent check-ins also help because sometimes we don’t know how far gone we are until someone else points it out.  You can’t take this job and succeed long term all on your own. I rely on my team heavily and understand when to delegate, pay attention to changes within my teammates, and be able to make adjustments or provide additional support as needed, because some days I’ll be “off” and not at my best, and I know my team will be able to support me when if times comes. A lot of this stems from my military background and I believe my leadership skills and strong team mentality has definitely helped me through these challenges and stressful periods of my life. The military has its own challenges and stresses, but providing this type of work, typically at non-profit agencies with challenging populations and limited resources, is a battlefield in and of itself.

Can anyone become addicted? Or is it just people with certain personality traits?

The quick answer is that there is no certain personality trait that causes people to become addicted to substances. The answer is a lot more complex.

The long response is, some research points to arguments of “nature vs nurture”. The idea is that some factors or traits are genetic and individuals can have a predisposition to obtaining a certain traits or conditions. On the other side, their environment can “nurture” certain behaviors or certain behaviors are learned from their environments. If someone has a family history of alcoholism, that person may have a predisposition to becoming addictive and it places them at a higher risk but that doesn’t automatically mean that they will fall in the same path. Other factors would have to be taken into consideration. Factors in their environment may cause someone to have more of a propensity to engage in certain behaviors. Such as someone who is raised by a parent who has difficulties managing their emotions in a healthy way. The child may or may not learn to manage their emotions similar to their parent/guardian but that doesn’t necessarily mean they are incapable of it or that they will have a “problem”. It may be that they haven’t learned any other way to manage their distress yet until they are exposed to other types of environments.  Another example can be, if someone is expose to trauma or large amounts of stress and they struggle with managing those levels of distress, someone may have to develop adaptive or survival techniques that may or may not be healthy or helpful to them in the long-term.

So the answer to that question is a little more complex and depends on many factors. (Keeping in mind that someone can be addicted to a wide variety of things not just drugs/ alcohol). This is because not every individual is the same. Since humans are very complex creatures, the causes of mental health conditions and traits can vary and depends on the individual’s history, genetics, and life experiences. In reality, I’m not sure we have the science yet to know the full truth behind how it all comes to manifest

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What are the main challenges that your patients face?

Housing. Since I primarily work with individuals with low socioeconomic status (SES), finding affordable and appropriate living arraignments can be difficult. Especially in Los Angeles where the homeless population rate is very high.

Not enough resources/treatment options for our low SES clients. I’ve always struggled with finding appropriate programs and facilities with enough “beds” to be able to provide services and treat our clients.  It’s almost like a sick game of musical chairs and it often leaves our most in need, struggling to get consistent care. If you look at all the amount of people currently in the streets or who are at below the poverty line, there is a high need of services for those communities to be able to access care at little to no cost to them. There can never be too many substance abuse, mental health, or housing programs out there because the need is so high and the supply is so low. We make do with what is available to us. We are very grateful for the resources we do have. But, in my experience, some legislation, and the lack there of, that address the needs of our communities, only place a bandage on an open bleeding artery and we have been struggling to stop the bleeding for a long time with the limited resources we have as a whole.  Policies and politics play a large role in programs and funding for certain resources for our communities. All I can say is- Vote. Voting and knowing what you are voting for is very important for all of us.

What recommendations can you make for people who are trying to help others who are experiencing this type of crisis while in long-term recovery?

I would say my best advice is to Listen, Guide, and Stand-by.

Listen- If you know of someone experiencing challenges with substance abuse or mental health.  The best advice I can give is just to listen. I feel people tend to forget the effectiveness of just being available to actively hear someone out and allow them to share their thoughts and feelings without the need to give an advice or say something in return. There is a saying I heard of when I was in school to become a therapist. I’m not sure where it came from but it is “be comfortable with the silence”. Some people feel an underlying pressure to say something in return or to give advice that may or may not have been asked for. Although there may be times when that is needed, I have found that if I sit in the silence with them, it gives them the quiet space to actually hear and understand what is going on in their mind and in their thoughts. Just because someone is silent or crying doesn’t mean there aren’t thoughts running in their mind. There may be thoughts that are begging to come out and are waiting for the right time.

Guide-After to someone, you would be better able to figure out what they need. And for people not familiar with this field, I would say maybe point them to resources available to them or guide them to where they can get the help they need. Depending on your relationship with the person, it may be helpful to walk them through the process with them.  If someone has never reached out for help before, it can be a scary and intimidating thing. Having a familiar and supportive friend to help them through, can be helpful in making sure they follow through with that help.

Stand by- I want to make sure I also address the need to set healthy boundaries. For individuals who are struggling with chronic challenges of substance abuse and mental illness, it is very easy to get others caught up in their crisis and in their cycle of it. I have seen people with good intentions to help eventually become enablers. I have also seen people who want to help their friend or loved ones start to feel their own mental health being impacted. If you are able to listen and guide them in their struggle, I would say make sure to know when to step back and stand-by. Remembering the saying that “you can lead a horse to water, but the horse has to drink from it”. Even with coworkers in my field, I have had to remind them that we can’t be more invested than they are with their success. It will eventually drain us when they aren’t following through or taking the necessary steps they need to get better. All we can do is be there to support them and allow them to take the rest of the steps on their own. I would suggest knowing your limits and know that its ok to look out for yourself also. Knowing when to ask for help yourself can model healthy behaviors to others around you.

How are substance abuse and mental health connected?

When substance abuse and mental health disorders are present we call that co-occurring disorders.  Sometimes people use drugs in an attempt to manage mental health issues that they haven’t been able to manage on their own. Sometimes we see chronic substance abuse impacting someone’s mental health over periods of time.  For some people, their mental illness gets exacerbated or worsened when they use substances. When trying to figure what came first, at times I can figure it out and other times it’s not so clear. But what I do know, is that often they feed off of each other. One thing is for sure, we can’t treat one without the other. We have to address both in order to get long term success.

Does the feeling of addiction ever go away?

That is hard to tell since I don’t have a personal experience with addiction, but in my professional experience, recovery is a lifelong process. I have heard and seen individuals with 25+ years of sobriety have a slip or relapse. It is important to constantly be aware of your triggers and actively taking the steps necessary to reduce your risk of relapse. Triggers may evolve, change and the intensity of it may decrease over time but I’m not sure they ever go away. Again, I don’t have a personal experience of substance abuse but from my professional experience, that is what I have gathered.  It’s important to frequently practice self-care and mindfulness for all things in your life, including recovery.

What is the most rewarding part of the work you do?

Since a lot of the work we do is in a short amount of time, the successes I see are small but those small successes make a world of difference to those individuals and that is most rewarding. I usually don’t see clients after they leave our programs. So I typically don’t get the chance to see the long term effects, but I can only hope it’s beautiful.

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How do you want to help moving humanity forward?

I would like to continue helping the community in the substance abuse and mental health fields by giving those without a voice, the space they need to grow and become the best versions of themselves. Some people forget that behind the substance abuse and the mental illness, there is a human being just like any one of us who needs some extra care and attention. Some people see the homelessness before they see a young adult who left home because of sexual abuse. They see the addict before they see a father, they see a person with schizophrenia before they see someone who previously ran their own business. I want to bring back the image of humanity to them.

As far as my next steps, I actually have been feeling a need to start focusing on our survivors and victims of human trafficking and the unique needs and assistance they require to regain their lives back. Hopefully one day I can open my own wellness or treatment center for these underserved communities and become another resource for people who need it. I hope that it can shed a light to the devastating things that happen “in the dark” and make people more aware of the things that are happening in the shadows of this county. Maybe that will help this field get more resources needed to finally “stop the bleeding” and give everyone a chance to heal and stop hurting one another.

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