 meal. And we have people who are handing out the question cards. If you've got a question that you'd like to ask and have answered, you may bring it up to the front and we will do our best to make sure we answer as many questions as we can. We will stop by 7.30 so that people have time if they want to go to the Hillstrom or if they want to take a little bit time and walk slowly because it's a lovely evening before they head over to Christchapel for some wonderful music. So we've got a few more people coming in. This is wonderful. When Scott and I were coming up with this program, we decided that we wanted to have people who are on the front lines, people whose professional work brings them into fairly regular contact with people struggling with addiction. We knew that in our own backyard we have some incredible experts and they are up here on the stage tonight. And I would like to welcome and say hello to Tricia Frederick, who is my colleague here at the college. She is the intervention specialist. So she works with our students who have perhaps found themselves with a certain high level alcohol or drug infraction and she also helps students who may come to her voluntarily. So that's an incredibly crucial role on this campus. And she'll be moderating the panel tonight. And if I may, I would like to ask each panelist to introduce him or herself beginning with the immediate person on my left, Dr. Bob Gazola. And with that, I'm getting off the stage. Thank you. Hi. And Peg mentioned that this is a panel of experts. I'm the one who is not an expert. I'm a family practice doctor here in town. And I do deal with many patients with addiction and do as best I can to help guide them. But as we'll talk about here, it's sometimes a struggle. In addition to my work as a family practitioner in St. Peter, I also am a supervising physician of the health service on campus and a gusty alum. So have a lot of guest Davis connections. Hi. My name is Alison Crabill. I am the presiding judge in Nicollet County. So my work with and I'm also the presiding judge of the Nicollet County Drug Court, which has been in existence for approximately six years. And my work is always after the addicted individual has come into contact with the legal system and have been charged with a crime and are facing usually prison sentences. And as I, when I started 14 years ago, before that I was a public defender. So I defended these individuals and before that I was a prosecutor. So I prosecuted these individuals. It's kind of being a lawyer is like being schizophrenic. You can go either side, right? So in any event, what I realized when I started is what kept me in business were drugs and alcohol. And that is 90% of the courts work involves drugs and alcohol and people suffering from addiction. And I was tired of sending people to prison and I heard about drug courts and I went out and visited some drug courts and was determined to start a drug court in Nicollet County, Brown County and what one county. And to my left, Detective Groko, most police officers don't like drug courts, but I found a great supporter with Detective Groko. And again, thank you, Judge Crabill. As she mentioned, I'm Matt Groko. I'm with the St. Peter Police Department. I'm a detective there. Coming in contact with addicts is what Judge Crabill referred to as when they come into the system to her for about 10 years, I worked as an undercover agent investigating narcotic crimes. And it really didn't occur to me roughly the first six or seven years, but thereafter when there was a discussion about drug courts, there's certainly resistance from law enforcement, as Judge Crabill might have mentioned. And the resistance is that law enforcement uniquely has a position when it comes to people violating the law and that's jail or prison. And through my experience work in narcotics, I began to change and I certainly changed when I became a member of the Brown and Nicollet and what one county drug court team and that change was very simple. Having done all of those investigations and incarcerating many people in prison, it occurred to me that many of them were getting out. There's many programs that are available in the judicial and the Department of Corrections and the systems that they offer. And within a year or two, these individuals are back on the street. And I began to think that we were more educators than enforcers of law enforcement. And what I mean by that as educators is that we educated them on how not to get caught. And it really became challenging for us and that challenge also provided much more level of severity and danger to the undercover agents because they knew what to look for. They knew what to look for and counter surveillance. They knew what to look for in our agents that were purchasing drugs undercover. And I really began to change when I became part of the drug court team and then taking on an additional role in conjunction with being a detective and becoming a support and compliance agent to all of the addicts that we have in drug court. So that too is very challenging. It has taught me a lot and I'm glad I'm leading in that direction because I think we have a lot of people that we have changed through drug court and many more to come. Thank you. My name is Walter Lockhart. I'm a United Methodist pastor and I'm serving two churches in South Minneapolis. Walker United Methodist Church and Simpson United Methodist Church. Both of these churches work intentionally with our neighborhoods and invite people in to be a part of our community regardless of where they happen to be. And a big piece of my work is working with people for whom the church has become their community of support. Many of them have burned through all of their bridges of their family and friends by the time I get involved with it. And one of the things that I have the honor of doing is walking with people hopefully before they get involved in the criminal justice system but often times while they are going through the criminal justice system to be an advocate and to work with them and to help people find healing and wholeness recognizing that the dual diagnosis is the norm recognizing that human beings are complicated agents and we can't be defined by just an event that has led us into criminal justice or a diagnosis that we have this addiction or this mental illness that there's a larger holistic piece. And my ministry has spent a lot of time working with people who are trying to integrate those pieces together and have been in South Minneapolis for 10 years now and enjoy new challenges every day. So thank you. I'm Barb Carlson and I am a licensed mental health and chemical health professional in the state of Minnesota. I've been in private practice in Mankato for almost 10 years and I deal with people in a number of different aspects as they are coming to grips with mental health and chemical dependency issues. Oftentimes I will be one of the initial contacts they make doing chemical use assessments to try to provide or refer them to the appropriate level of services that they need and oftentimes after they have completed a treatment or a residential mental health program when they return to the community I will provide individual therapy for them support for dealing with reintegration into the community getting their way through the legal system if they're on probation. Oftentimes I work with individuals on one-on-one basis there and I also do family assessments for individuals who have become involved in the legal system either through mental health chemical use or whatever and may or may not be running into legal issues having their children removed from the home for example and trying to provide and recommend services that will reunite the family in a healthy manner. Thank you. Thank you. The route that we are taking tonight is Judge Crable has prepared a case study for us which she will walk us through and then we would ask the panelists to please share their insights and how they might work with this client and walk them through the process of addiction and recovery and how they might support this person. So Judge Crable? Well I should start by saying that the case study that I prepared you said a client and the interesting thing about all of us here is we will all see the same person in different capacities to Dr. Gazolla she will be a patient to me she will be a defendant to Officer Groko she will be either an arrested individual or an inmate a parishioner and a client so there's so we all see the same person but each time we see them they have a different title and we all were emailing each other about this and I said it's pretty easy to come up with who we can talk about because we all know this person very well she's we're going to say this is a fictitious person but she could fit hundreds of people that I've seen she's 30 years old she's male dependent by male dependent I mean that she does not feel any self-worth or self-esteem unless it is in a sexual nature or if she's in a relationship where someone is they don't even have to treat her well but she feels needed or wanted she is suffers from post-traumatic stress syndrome because she possibly suffered well she did suffer some trauma whether it be sexual or physical abuse or neglect but at some point in her life she did suffer trauma she is delivering drugs that her boyfriend sold so she didn't sell the drugs but she uses drugs and part of the way that she stays in the relationship is her boyfriend supplies her with drugs but she takes all the risk so the boyfriend sells behind closed doors and she delivers she is at times been suicidal and she also seeks medication whenever she can't get drugs so she will harm herself in order to be able to go to dr. Gazola and say I need pain medication and for all of those that you would that work in this field you know this person and you know her very well because we see weekly over and over I see the same thing so the initial thing would probably be her initial contact would probably be detective groco because he's done the surveillance and he is going to make the arrest and we make the arrest simply based on intelligence arrangements that are undercover or an informant would do to contact her boyfriend so it's a telephone call it's a meeting we see it very much the individuals that are very involved in selling want to buffer themselves they don't want to have direct contact with me or one of my agents or anyone that they do not trust how you gain trust in this environment is that you use the drug with them certainly as undercover agents we never use any drugs so it gets to be very difficult but when we say to them we are not going to use any of your drugs but we want to purchase them and sell them to make more money that elicits that response with the girlfriend I can't count how many times the girlfriend has come to our meeting spot I can't count how many times they are arrested and how so similar these stories are to this broken individual did I recognize that initially when I was starting these investigations no I didn't it was one of those instance where we now have the girlfriend and now we want the boyfriend is the abuse so significant that the girlfriend is not going to tell us about the boyfriend absolutely but there are ways to there are investigative pass that we take to get to the boyfriend but this girlfriend now depending on the amount of drugs that she bought to us the amount of drugs she might have sold previous to us is looking then to a presumptive commit once she is presented to judge Crabill court up to 86 months and very often it is a first-degree charge that carries that offense and many times that's what they're incarcerated for so the individual shows up she is arrested many times she doesn't talk simply out of fear for her safety and often times there's not a statement but we already know the answers anyway and so we continue that investigation but she is incarcerated she is now waiting for her first appearance within a certain time period and then she ultimately sees drudge Crabill and before she's been arrested she's seen dr. Gazella perhaps you know I guess in this scenario Allison was talking or judge Crabill I'm sorry was talking about self-injuries to to allow her to come in and have justification for getting opiates narcotics and I would say that that is we see that perhaps not as frequently with obvious injuries but it's more the back pain stuff that you really can't see you can't objectify you have to take patience at their words and you know it's it's an incredibly significant challenge as a as a provider because there are people perhaps some of you sitting here who truly have needs for medications to help with chronic pain or acute pain but there are also many people who will abuse that's that trust with their physician and it's not just about pain meds we have the same thing as was already discussed a bit this afternoon with stimulant type medication for ADHD and similar sort of learning issues and also employment issues I mean there are adults who come in saying that they have a need for treatment for their ADHD and it's simply you know like like with the back pain which is very very much a subjective complaint you know ADHD is a subjective complaint too I can't do a blood test and know how much pain you're in I can't do a blood test and know that you have ADHD but yeah these are real problems that I face each and every day and there are providers out there who have a lower threshold for writing those prescriptions I fortunately am not one of those but we still see this and you're he's very correct I shouldn't have said self-injurious because that is not the norm it's happened but it's not the norm but if you would see the young people that come into my courtroom that have carpal tunnel what do you call those braces I had carpal tunnel so I know what this is and they're in so much pain they are just gonna die if they don't get something for it and I'm suffering for it or I had incredible back pain and they're young they're 20 years old 19 20 and they have incredible pain and I often wonder how much pain they actually have they are not opiate deficient but they want you to believe they are you know yeah and the other thing that's interesting about when Dr. Gazolla sees them I can't talk to got Dr. Gazolla I can't with my drug court people and I should explain drug court is a diversion program after in Nicola County it's after the person has entered a plea of guilt to whatever charge they had then instead of sending them to prison we do what's called the downward departure and that means that those people don't go to prison they're put on probation the condition of their probation is that they successfully complete drug court drug court is usually an 18 month program where the individuals are tested three times a week randomly for drugs they have to appear in court every week they get visits by Detective Groko once or twice a week they get visits by their probation agent all random and by the police department different officers they have a curfew they we expect things and when we get them they're complete they don't have a job they're completely broken by the time they graduate they have to have employment or be in school they have to have been free from chemicals for a period of 90 days at least but usually it's over a year that they've been free without any violations of the drug court rules and we operate with sanctions and incentives sanctions can be jail the empirical data data and evidence-based research shows that jail is not very effective as a sanction it's more doing things like making them write a paper about why they are not getting up in time for work and they have to present that it's different things than we try to find creative sanctions and incentives we don't have much money to operate so we can't give like a hundred dollar gift cards if you've been sober 90 days but we have a bag with $5 gifts in it and every so often I'll say you really did a good job this week why don't you go and get something out of this gift bag and if you would they don't really care about the gift they care about the fact that they are recognized to get the gift they have to see me as I said once a week and again the evidence-based practice says if I spend five minutes with them their likelihood of success is much greater and it's because I think the judge becomes the parent and we are I know their children's names I know everything about them and as much as I can and they also know that they're being watched all the time in recovery there's a a for those of you that are in recovery you'll know this there's a saying fake it till you make it and that means that you pretend that you're in recovery when really you're just really wanting to use until you get over the hump and that's when we see the people start to really become much more you know they're in recovery and the and I said I can't talk to dr. Gazolla and say I know that this woman is med-seeking because he can't tell me that he's seeing her because of HIPAA so what we are doing now is having our drug court participants sign releases that say yes we can talk to dr. Gazolla and we give them little cards that they have to present to the doctor that says I'm in drug court and I'm an addict so that we are trying to give him that information that he couldn't get otherwise that's just a fill in the blank so now I know during this woman's journey she's seen you too and through throughout all of this and you made the statement that it was the drugs and the alcohol that keep you in business and the reality is is that we at least have some systems to deal with the drug and the alcohol but the fact that she was abused which is why she is in a bad relationship and has probably chosen somebody particularly bad in relationship I spend more time dealing with sex addicts than I deal with alcoholics because the alcoholics can go to AA or Hazeldon depending on what they need and what their resources are but the whole broader piece of this woman's life is the pieces with that end up getting laid on my plate and I'm sitting there and saying but what you know and and and trying to put together the pieces to where she follows through with the drug issues that she has to deal with but in there to be any chance of having a whole life she's got to deal with the relationship issue and that is an entirely different piece and that's not something that the court's going to tell her that she has to do that that that is one of those pieces that she has to be led to and I end up spending more of my time on the front line dealing with these issues on the other pieces and the other parts of the addiction and the other parts of the brokenness because there are even fewer resources you talk about how few resources you have for dealing with the drug court there are even fewer resources for dealing with people who don't know how to be in a healthy relationship and those resources get even harder after you've burned bridges and grown or grown up in families where you have no models of relationships if you grow up in a family that your parents are not still together and you've watched both your mother and your father have poor models of relationships you don't have any grandparents who had good relationships all of a sudden we're dealing with a whole chunk of our world where nobody has a good model for the relationship and until those issues and those abuse issues are dealt with how is this woman ever going to get to a point where she believes in herself enough to maintain sobriety and to find the wholeness so that's the piece that as a church if we're lucky either she has grown up with somebody who's had her in church somewhere and she has a relationship or more likely she has a friend who comes to church and that's how I get involved because the person is in need of help so they call in the pastor because I am free counseling and unfortunately I am not in a peer reviewed situation nor am I trained to be a counselor so the best thing I can do is to refer and that is the piece that comes in the table from for me with this person and that doesn't go on for 18 months that goes on until they leave town right most often and when you refer you refer to when I refer I refer to anybody who I can and hopefully somebody as qualified as the person on my left and what Sir Lockhart is saying is absolutely right. Addiction is much more than the secession of the use of the chemicals because if a person doesn't feel worthwhile and feel valued and what I often tell them is you have to learn to be your own best friend because that's the person that's going to be with you 24 seven for the rest of your life if you don't like that friend you're not going to treat that friend very well sounds somewhat simplistic but a lot of addicts have lost that component to themselves along the way either through trauma bad relationships neglect and abuse as a child there's many many reasons for it and until they really are mindful and learn to be mindful of their own feelings because many of them also along the way have lost the ability to recognize their own feelings within themselves and where they are at at any given time during a day a week a month and if they really have lost that key component of functioning called their inner self or their inner child it's too easy to become very frustrated overly stressed seeking something to replace that empty core and it's just too easy to reach for a quick fix whether it be alcohol or drugs or to remain in a relationship that really is abusive and unhealthy simply to have someone there so oftentimes when I'm working with these individuals I said I will either see them on the front end and do a chemical use assessment which oftentimes then goes right back up the line to judge Cravel and I will recommend things that they need for their chemical health their mental health family support oftentimes these people as Mr. Lockhart said have burned their bridges they don't have a support system which is an essential component if you're going to get into recovery from addiction and stay there and so once services are undertaken I may not see these individuals for a period of time and then later on when they have completed treatment and some of the other drug court steps and things and sometimes even while they are going through drug court the individuals will come back in for individual therapy and we will start working on these other components to strengthen them as a person oftentimes I will see people I have had some people that have completed drug court and are still coming in usually I will start seeing them weekly then as they progress and they become stronger their self-esteem kids comes back they've redeveloped their sense of self-worth we start spacing out their appointments two weeks a month sometimes two or three months but oftentimes it's a long process it can last up to two years I've had some individuals that still come back periodically just for what they call a checkup and I've seen them for three or four years maybe once every six months maybe once every nine months so it's a long process and it's something they have to work at day in and day out and I think it's clear why we have such a diverse panel up here now as we can see there are many complex issues that the addicted individual needs to address and the avenue for which that begins can vary quite greatly any other comments I just have one other thing I'm going to put that ball back in your court because sometimes some of the people that I see in court who are addicts also have diagnosable mental health issues it's we we call that co-occurring disorders so they have mental health issues that need treatment and sometimes that treatment needs to be through pharmaceutical pharmaceutical products and and so that gets very tricky because if they need the medication and I'm saying you can't take any drugs I can't say if Dr. Gazola says they need this I'm not an expert in that I'm not going to say you can't take what your doctor prescribed so we do a dance together and those releases of information because you know you have to talk about how you have to give non-addictive depressive medication or antidepressants sure sure and I was gonna make one other comment that I maybe Trisha had already said but we also want if you guys have any questions I think there are some yeah I don't know someone collecting them it'd be nice so we can get those up here anyway yeah there's you know depression anxiety bipolar disorder PTSD there's all sorts of diagnoses that would certainly warrant therapy and you know fortunately there is a lot of pharmacotherapy that is non-addictive and you know I mean I try so hard to avoid those medications that can send a person down a slippery slope and this afternoon they talked about Xanax is one of those medicines that was fairly often abused and you know there's other ways to treat anxiety beyond pharmacotherapy and certainly beyond those addictive benzodiazepine type meds and and that's always a focus that I have mean you know yeah there is SSRI type medication there's there's norepinephrine type medications you know one thing that gets overlooked often and helping people with a lot of these issues is taking good care of their physical being and exercise can do so much if you can help somebody get to that point where they can take better care of themselves physically they feel so much better about themselves mentally and you can accomplish a lot so and something else I try to do when I'm working with people is to educate them about symptomology of mental health issues and how to recognize when symptoms may be in the infancy stage for example and like doctor said some of the things that you can do either exercise good diet getting more sleep relaxations sometimes I will suggest people get massages for example there's a number of things and lots and lots of people are just not aware of how they can control their own symptoms oftentimes especially when they are not a severe and then they don't have to resort to medication right away and a lot of times it's just simply educating people about those things because lots and lots of people like I said get out of touch with themselves and they don't know how to recognize what's happening even within themselves until it's really gotten to be a serious problem great we have a few questions here two are specifically for judge Grable I didn't mean to put you in jail I'm sure you were innocent I apologize okay do you require or sentence assumed addicts to alternatives to AA including women for sobriety smart recovery yes I well I will tell you that our drug court requires that and even when you're not in drug court on probation if it's a chemical issue that got you into court that you will have to attend support meetings and I constitutionally cannot require someone to go to a certain support meeting because of the first amendment and so I can't say you have to go to AA or NA because those are spiritual based support groups I don't care what support group it is as long as it's effective and you go and it is productive just as long I think that the statistics show that a chain the chances of staying in recovered recovery are 70% greater when you are in a recovery support yep population as long as you're going to have a sponsor have someone some way that you're actually interacting with other people in recovery your chances of recovery success and recovery are enhanced by 70% thank you one other question here that I think would be great for all of the panelists to address is how do you personally handle the emotional labor of the work to do this okay I guess I'll start since they're all looking at me you know as a family practice doctor one real benefit I have for most of my patients is a relationship you know certainly there's always that first visit with any patient but with most patients that I see I've seen them for months for years and there's that trust that has been developed and you know with that you do get more emotionally connected certainly but I think it becomes you know you're you're advocating for them not just because you ought to but because you care and you want to see them get to the other side of this and you know it's pretty it is incredibly rewarding when you when you do help someone get to the other side see a whole new person walk in that door and and I think it's maybe that hope and I'll say even expectation of of accomplishing that of reaching that that just makes it so worthwhile and makes it not laborious that he also runs a lot if you can't tell by the way you do right oh yeah that's a really difficult question for me because I don't know that I do very well in that area the stress that comes along with I guess the best way to explain what a judge's job is that you live other people's misery there is very few times that people are coming to court because they're happy and and so usually it's because the only time that something is happy is if someone's getting adopted otherwise there is conflict and there is pain and you see broken people and children that are abused and it's a it's a hard job my outlet is I have three beautiful daughters who are not using drugs or alcohol who do well in school who I have to go see cross-country meets and run across golf courses and you know my family is really what when I go home I really try to say I'm gonna make dinner now and I'm gonna have an ice-center with my kids and we're gonna talk about other things but otherwise I don't know it's I don't know if you can separate either yeah you know I've been thinking about that it's a very good question and and I try to correlate a detachment phase and I really only came up with next January 16th I'm going to Cancun so yeah yeah so and and as I sit here and think more about that I'm getting text messages approximately five of them from our drug court participants I hope there's not any problems we have to deal with tomorrow so I'm available to them really 24-7 and I think I made that into my purpose in this program myself it's certainly not ordered by Judge Crabill but it's something that I offered to them because there's so many times it's critical for them so many times that they rely on a response where they can't reach a counselor or they can't reach their probation agent and honestly after working 10 years in narcotic I'm so used to answering my phone 24-7 so it is at my bedside there is a response so the detachment is difficult it certainly comes with my family but then again on vacation so it's something that is very challenging but it is very rewarding and it's humbling to be involved in an addict's life trying to understand addiction when you maybe don't have all of those components of addiction so it's a very rewarding and he plays golf on Wednesdays yeah well I haven't for three years judge because that's when our drug court is yeah one of the things I did was quit drinking wasn't an alcoholic but it became an issue for me so I did quit drinking and I also have buried enough people who were successful in their self-destruction whether it be through suicide or drugs that in order to find balance in this it's to have really good boundaries to know that these people that I'm loving and caring for who are addicts are not my wife and kids they're people who I love and care for but they're not my wife and kids I also have developed and understand my role as clergy is that I'm not there to be everybody's best friend I'm there to be clergy not friend I can be friendly and that's fine but they're not friends and colleagues they are parishioners and neighbors and people that I am working with and it's been necessary for me to find different models of how to do that work because my predecessor did commit suicide 11 years ago and if we don't have good models while we're doing this work it can be deadly and I'm with some of the rest of you I'm not quite sure self-care in this field is very important because we don't you burn out really quickly years ago when I was a child I lost my favorite uncle to alcohol how I ended up going into this field I didn't really think about it until years later and realized how much that did affect me and my family and so I guess my satisfaction comes from if I can put a glimmer of hope in someone if I can help them to overcome feelings of shame and if we can as a society really take a lot of the stigma away from the disease of addiction then I think we've all done something worthwhile and my other thought is I know and it was trained into me I have very couple of good mentors that when you're working you better be thinking clinically and you don't let yourself become attached because if you do that's kind of the slide down the slope and then pretty soon you're not as objective as you need to be and in this field you need to be thinking clinically because people in the throws of addiction are tricky they are not very honest most of the time they're very manipulative and if you're not careful you know they're feeding you probably a lot of information that's not real accurate and you're buying it so that's kind of how I try to do it the next question is so far you haven't added relapse into the equation please address that's a great question in drug court relapses part of recovery we expect relapse we don't love relapse but we expect relapse and the in my courts I can't speak for every drug court in my court you will not be punished or sanctioned for relapsing you will be sanctioned for lying about relapsing so the entire premise of the court is based on honesty if you are honest with me about what's happening you will not be sanctioned if you are lie about it and I find out about it I will send you to spend a few nights in jail because you lied not because you used and I have found that that works very well you know when they come up in front of the bench I'll say and usually I know because I have a test but they don't know that I have the result of the test and I'll say I want you to be honest with me and usually giving them many chances giving the mention usually they are honest but I don't know that's so relapse is part of recovery and I used to think that it was and I used to think I mean I've learned so much over the years but I used to think if you relapse that was just a huge failure and I started to look at it differently if you relapse after a year of sobriety you have a year of sobriety and if the relapse lasts a day or a week and you go back into your recovery you still have that year of sobriety and you can go from there I will tell you something very interesting though just last week I sent an individual to prison for a long period of time and he had he was not in drug court because he had disqualifying factors he had some assault of behavior and we can't take violent people into drug court and he did it on his own and he'd gone to new beginnings here in town he went through treatment everything was going well and he used meth and he sat in my courtroom and I had already given him a downward departure before I didn't have much of a choice he I had to send in prison and he was crying and he told me one month I used meth I started using meth one month ago I have lost everything in that month I've lost my wife my children my home my job so that relapse for him just that short of time he had I think 17 months clean around there and then in one month he lost everything and now he's in prison so relapse is an issue it's incredibly common I mean the the one addiction doesn't have quite the stigma of most of the stuff we're talking about would be to nicotine and I'm guessing that many of you in here have smoked and many of you here have quit smoking but it probably wasn't the first time or the second or the third time that you attempted to quit that you were successful relapse is just a part of chemical addiction of chemical dependency so okay one of the cases that I've been involved with for the last several years have been issues around sex addiction and sexual predators and whereas the relapse not every relapse in chemical addiction has huge costs to other people if you're driving a car at might but not every one of them has huge cost other people but people who are sexual predators every relapse leaves a trail of carnage and that has led me to recognize the importance of understanding that yes relapses happen but how is it that we as a society as a culture as communities as neighborhoods tried to keep the impaired people from being behind the wheels of automobiles to keep impaired people are people who are relapsing from molesting our children all of these pieces are all still dealing with issues of addiction and relapse and it becomes a different piece as we think about how do we as community how do we as a church community love and care for people in such a way that we love and care for them in a way that they don't hurt others and that gets to be an awfully tricky conversation because I've got a number of addicts who are destroying their own lives but they're not hurting anybody else and then I've got other addicts who are acting out in ways to where you know coming on to their 17 year old daughters that's just not okay that these these are the pieces where relapsing brings in a whole different set of challenges I also think relapse is part of recovery and through the process of trying to work with individuals to bring them back to a more healthy stance in life part of that is teaching them how the self-care for themselves how to reach out and ask for help if they feel you know like there is a possibility that they may relapse in building helping them build a support network and people that they can reach out to if they feel that situation and also helping them to be aware that relapse is a very real possibility because a lot of people think that if they go through treatment if they maintain sobriety for a little while they're totally out of the woods and it's never going to happen I've had colleagues that have been sober for 20 years went to school got their counseling licenses ran a business helping other addicts they relapsed and yes in a period of about a month there too they lost everything even their licensure and right now I don't know what they're doing or where they are and it's very sad but it's a very real possibility and that's something with you know the disease of addiction it's it's there and people have to be mindful of it and keeping themselves in a good place day by day and I think we'll try to squeeze in one last question that's how difficult is it to succeed how hard is it to deal with mental health issues that contribute to lack of self-worth and I think one of the first things we need to discuss is how do you define success and that's so individualized as Judge Crabill was saying a relapse after 17 17 months of sobriety that could be considered a success I can say I saw success today and I don't know if the young lady's here and I'm not going to point her out but I was walking through here today because I wanted to hear I wanted to get educated as much as I could today and a young lady stopped me and said Judge Crabill and I turned around and I saw this absolutely beautiful young woman just dressed to the nines beautiful hair beautiful skin and she's one of my drug court graduates and when I met her probably three and a half years ago she didn't look anything like that and she didn't look she had no self-esteem and that young lady worked very very hard and I have a lot of failures too but for the way I define success for my work is that young lady and she said she was gonna be here tonight I don't know if she is if she is I admire you I'm not gonna use her name or draw any attention to her but if you want attention you you're certainly you can stand up but you don't have to I wanted to one of the pieces that you were talking about about trying to get people to be honest and if not put them in jail I tend to stop worrying about people as much when they will be honest with me and honest with themselves right that that's when I stop worrying about the chance of them committing suicide or the chance of them doing the really crazy go out and get drunk and drive the whatever that when people have come far enough down the healing that they're honest with themselves I don't feel like the need to call them at nine o'clock at night and see are you in so those those of those of that that to me is my definition of success if the system has gotten them to where they can be honest with themselves and honest with me because I have a fairly high BS meter I can tell and most of the time when people are BSing I suspect everybody at this table has a pretty good BS meter because we have two in our professions and when people are being honest it's a long way towards healing and wholeness to me that's really turning the corner when you can really feel that they are really being honest with themselves above everything else because a lot of times that's kind of the last holdout they might get honest with you first but they're still lying to themselves somewhere deep inside that I can I can still do this use now and again or you know whatever but that that to me is a real turning point for an individual because it says then that they are really truly committed to making lasting changes not just to jump through the hoop so I can get my children back or get back in the house or I can get a lesser sentence or whatever else so it probably means then that they are accepting of that person they see in the mirror they have gotten to that point where they're okay with who they are and when you're I mean it's like you say that low self-worth when they can get to that point and how you get there that's a whole nother thing but yeah that's success and it's so blatant when they're not I had an individual that came into my office kind of yesterday afternoon late and wanted what we call a rule 25 which is our standard assessment done for chemical dependency and so happens she had her year old child removed from her care why because in the last three months she's been in what we call a detoxification unit over the weekend three different times her mother and her significant other called the police to have her picked up one of the times when she was in there her blood alcohol level was at a point three two seven and for those of you that don't know anything about levels of blood alcohol content an unseasoned drinker at that point should be in a coma yet she's standing there telling me that I don't need treatment I'm just fine this lady's been to treatment five times previously she's still got an open DWI charge in Wisconsin from two years ago she has an answer to but she's been on an alcohol monitor which is a ankle bracelet that is placed on the individual if they drink goes off they have to blow so many times a day keep them sober she's been on that three days before she came in to see me so she's good to go she's got no problems anymore so she should have her baby back defined differently okay and I think we are about out of time so I appreciate you all taking your time out of your evening to join us and thank you for your questions we didn't get to them all but perhaps some of us will be sticking around afterwards if you want to stop up and chat and think thank you more