Dr. Jarell Myers Supporting Clients Challenged with Substance Abuse

Today our guest is Dr. Jarell Myers, a clinical psychologist who works specifically with a category of people that we don't normally think about in the dental office. 

Welcome to you, Dr. Jarell Myers. Please share a little bit about yourself and your area of expertise regarding providing the best possible care for our clients in the dental office.

Jarell:

Thank you so much for having me. My name is Jarell Myers, and I am a clinical psychologist working at the Center for Motivation and Change in the New York area.

Our specialty is working with people who are abusing or dependent on substances for their own reasons. There are multiple reasons why people use substances.

Our goal is not just to focus on substance use but also on the underlying reasons for their substance use.

In the world in which we currently live, people are struggling with a lot and do not necessarily have the coping skills to deal with everything that they are being asked to manage, especially in an environment where we've had to be isolated and socially distant and not interact with people and do the types of things that we're accustomed to doing.

In addition to that, I work with people who struggle with mood disorders, anxiety, depression, post-traumatic stress disorder, or different types of trauma.

I've worked with adolescents and children, but now I'm working primarily with older teens and young adults.

Heather-Dawn:

Thank you for sharing. What I find interesting is that we don't necessarily think of people struggling with substance abuse as trying to cope.

We just think that maybe they've made bad decisions and ended up in a situation that has overtaken them.

So it's good for you to highlight that point that sometimes they grasp at whatever they can catch to help them cope.

Jarell:

Absolutely. As humans, we engage in any behavior because we're getting something out of it.

Most people will look at people who use substances and see them as just looking to get high, or drunk, or intoxicated, or whatever the case may be.

We are only looking at what I believe is a symptom as opposed to the underlying issues.

So we downplay whatever else may be occurring and are just looking at the overt behavior.

We're looking at the fact that somebody is drinking all the time or smoking all the time or snorting all the time or injecting things into their bodies all the time, but not the reason why. 

And if we want someone to change, that is what we have to address.

Heather-Dawn:

Wow. That alone could be a discussion for hours on end, because so many of us are looking at it from the perspective of disciplining somebody who is doing something wrong, rather than looking at it from the perspective that this is someone who is in trouble, maybe in crisis mode, and they are trying to cope.

Adding to that is the anxiety that even normal, stable people sometimes feel when going to the dentist.

We have dental assistants who prepare the patients for the dentist, usually escorting them into the clinical area and taking vital signs and having discussions with them before treatment begins.

Do you have any suggestions as to how the team should approach someone to maybe first determine the signs of substance abuse and then, if we have determined or suspect that there may be substance abuse, do's and don'ts?

Jarell:

I think first we have to understand that going to the dentist is a normal experience if everything is going well. It happens once every six months. That's twice a year.

Dentists, hygienists, and dental assistants use sharp objects that make very loud noises and are in an area that feels extra sensitive to humans, i.e., the mouth.

So you're right, the average person who may be coming into the dental office may feel a little bit of anxiety unless they've just become accustomed to the experience.

They may feel a little bit of anxiety or discomfort about going into the office and having a routine procedure like a cleaning done, much less having a cavity filled, root canal or bridge.

There are people who are able to use substances recreationally and it doesn't really affect their functioning, while others depend on it as a coping mechanism.

So I think the expectation should be that everyone who is walking through the door is feeling a bit uncomfortable.

There could be an assumption that there are people coming into the office who may use substances as a way of calming themselves down.

But for someone who may be addicted or dependent on substances, there's nothing that has that short-term effect that I've come across like what substances provide to them.

The most obvious signs are: if they smoke, they may have red eyes; if they have consumed excess alcohol, their speech may be slurred or staggering. They may have difficulty focusing on the things that they are seeing.

So you're looking not just for the level of discomfort that someone is feeling, because someone who's having anxiety may have difficulty concentrating or exhibit behaviors that don't seem normal.

Heather-Dawn:

I think that's the point that's being driven home to me today. That is to be more understanding than judgmental.

You're right. We would not want to treat someone who's had some substance in their body.

But you suggest in between visits, having conversations to check in and see how they're doing, and their oral hygiene, letting them know what the next visit will entail, and trying to make sure that they know as much as possible so they aren't as apprehensive.

Jarell:

Absolutely. I think the more information we have, the better it can be because with anxiety, our minds tend to create experiences.

We catastrophize and think of the worst-case scenario, or if we're unable to create whatever that worst-case scenario is in our minds, we just assume that it's going to be negative.

So it makes us want to avoid that experience as much as possible.

I think that with more information,

people are able to come to terms with what to expect.

There could be some sort of practice for the assisting team to help people who may be struggling with anxiety about going to the dentist, just to help them become more accustomed to it.

I think that's a positive procedure to engage in as well. The more comfortable that we can make it for people, knowing that at some points in time, going to the dentist can be very uncomfortable.

I think the more comfortable and the more aware we can make people of what that experience will be like, the better the outcome overall.

Heather-Dawn:

You truly opened our eyes, Dr. Myers. I have another question for you. Do you think the time of day matters when setting an appointment?

When I'm treating young children, I prefer to see them early in the day before they get tired and frustrated, when they tend to be less willing to be compliant and less cooperative.

What time of day or any particular aspect of the appointment is important as we consider scheduling an appointment for someone who may be struggling with anxiety, drug abuse, or other issues?

Jarell:

Yeah, absolutely. I do think so. As human beings, we have what are called "vulnerability factors," meaning that whenever we walk into a situation or an experience, we're not walking in as complete blank slates.

We're taking into that experience our past history of being in that place or assumptions that we may have made based on our past history of being in that place, but also things like whether or not we've had something to eat for the day or whether or not we've got enough sleep the night before, etc.

So I do think that time of day can play a role because they're more likely to have more vulnerability factors later in the day, as they've had much more of the day to experience, as opposed to earlier in the morning, where you may be a bit more rested.

You may have more resources to deal with the stress that's associated with being in the dental office.

So that can be helpful, especially for anxious patients. For people who may use substances, I don't know that it makes that much of a difference because you can use them at any point in time and get the desired benefits fairly quickly.

However, I do think that having that contact that we spoke about before can be helpful, especially for people who may be coming into your office who may have more of a vulnerability to feeling anxious and or using substances, because then there can be that reminder about not using a substance prior to the session.

You're answering the questions, you're providing more information, and you have a point of contact at the office that makes it feel a little bit more comfortable for that person to stay with you through the procedure, etc.

Heather-Dawn:

That sounds great. I have another question. Are there things that we could do in the dental office to create more calm?

For example, would it be helpful to ask them to perhaps bring their favorite playlist and listen to something with their earbuds? Would the noises in the dental office affect them?

Should we ensure that maybe that person is seen by themselves to reduce the chances of other sounds coming from other treatment? I am really in the dark, so I'm asking.

Jarell:

Yeah, having things like music or watching videos can help to distract you while you're waiting. I think it would be great if you could allow a patient to continue listening to music.

If there are ways that a person can ground themselves, or a dental assistant could also ground themselves, and what I mean by that is orienting them to where they are right now using their senses. I do think that setting milestones for a person can be helpful.

So if a dentist or a dental assistant knows that they're going to be doing cleaning and they may have someone extra anxious in the chair, tell them what kind of cleaning you'll be doing.

"I'm going to be taking out the floss and flossing your teeth. You may experience a little bit of discomfort. We can take a pause for a moment, and you let me know when you're ready to get back to it".

Or, "I'm going to be using the suction in your mouth; it's going to be there for the majority of the time. It's not doing anything. The only reason it's making noise is that it's constantly sucking up moisture in your mouth so that I can work effectively."

Again, the more information that people have, the more they can do with it. Otherwise, especially for someone who's anxious, it makes it more of an uncomfortable experience for them.

Heather-Dawn:

Okay, that sounds great. A lot of times, when I have anxious patients, I kind of give them a little bit of control. In the sense that I will tell them if for any reason they need to stop, they can signal me and I'll give them what that signal is.

Usually, it's the lifting of the hand that is further away from me where I'm working. And it kind of gives them the freedom to say,

Do you think that that's a good thing to provide or to share with the patient?

Jarell:

Absolutely. I think that gives them the ability to pause things for a moment and collect themselves.

I think that is a good thing if it happens in addition to doing something to help calm themselves down or prepare for whatever is going to happen next.

Perhaps that could be an area where dental assistants could jump in and provide some coping skills, whether it's deep breaths or, again, that grounding technique.

We're just encouraging them to kind of stretch and relax, whatever the case may be. But doing something that helps them relax just for a moment so that they can prepare themselves for whatever is going to happen next.

Heather-Dawn:

Well, Dr. Myers, I have to tell you, this has really been an eye-opening session. You have shared so much.

PRIMARILY, THE FACT THE WE REALLY OUGHT NOT TO BE JUDGMENTAL.

WE NEED TO BE PATIENT. 

WE NEED TO MAKE SURE THAT PATIENT HAS AS MUCH INFORMATION UPFRONT AS POSSIBLE.

And that may require touching base with them in between appointments so that they don't, as you have said, get too much in their heads, but we can bring them to the present by asking them questions about what's happening in their environment.

What's happening with the chair? Things that they're seeing, things that they're hearing how loud or how soft they are; giving them the control to stop, to pause, letting them know what a signal can be beforehand.

And just, in general, recognizing that some people just need a little more care, and we need to be mindful of that. Did I summarize what you said in its entirety?

Jarell:

No, I think that covers what I was hoping to portray today. So yes, it was a great summary.

Heather-Dawn:

Okay, so at the end of each session, I try to leave a quote, and I thought of this one that I'm going to share with you today.

"Never judge someone without knowing the whole story. You may think you understand, but you don't."

Dr. Myers, thank you so much for opening our eyes today. If someone wanted to reach out, is there some way that they could contact you?

Jarell:

Sure. My primary email address is [email protected]. So if someone wanted to reach out to me, that would be the best way for folks to contact me, and I'll get back to you as soon as I possibly can.

Heather-Dawn:

Every time I leave one of these sessions, I end up saying, "Wow, that was awesome."

Well, this week is no different. I think that there were so many pearls shared by Dr. Myers.

And we're just so grateful to have been blessed to have had so many knowledgeable guests so far.

Dr. Myers is a clinical psychologist at the Center for Motivation and Change, and he can be contacted by email at [email protected].

Once again, we have proof that as we learn, as we grow and sharpen our swords, we can definitely be more confident in sharing and serving our clients.

Being motivated and encouraging to other members of our team who may be a little intimidated by certain things, such as creating systems, and understanding what you're going to do before things happen makes life so much easier.

Because if something happens and you already have a plan, you just flow with the plan.

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