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Stephen Loyd: Compassion & Science in Appalachia: Healing Opioid and Other Addictions


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Video Recording (Jul 11, 2020)

Nuggets From Stephen Loyd's Call

Last Saturday, we had the privilege of hosting Awakin Call with Stephen Loyd.

“I’m Steve Loyd, and I’m hurting,” Stephen Loyd, M.D., began in one of his first 12-step group meetings. His addiction to pain pills had escalated to about 100 a day by 2004 when his father intervened. “I’m gonna lose my wife, my family, my house and cars,” Dr. Loyd said when confronted. "None of that stuff’s gonna do you any good if you’re dead,” his father said. It was a hard road to recovery, but it led Dr. Loyd on a path that eventually had him rising from addict to Tennessee's "Opioid Czar" from 2016-2018. He is a recognized thought leader and clinician with decades of experience in internal medicine, mental health, and substance abuse service and a tireless activist for those living with addiction and co-occurring mental health disorders. Experiencing addiction first-hand has allowed him to develop a unique approach to patient care, one that is passionate, effective, and impactful.

Below are some of the nuggets from the call that stood out for me ...

His Background

  • Stephen Loyd grew up in the heart of Appalachia going to church every Sunday with his family where his mother played the organ. He didn’t connect with the sermons about love because they differed so much from what he experienced outside of church where his family life was like World War III, including mental illness and suicides. He suffered sexual abuse, from molestation to rape, and physical abuse, including whippings with sticks and bottles. He learned at a young age to keep what happened secret or he’d suffer additional abuse.
  • As a discipline problem at school, Loyd was placed with the under-performers, sometimes receiving spankings in view of the other children. After taking a test in the 7th Grade, however, he was placed with the smart kids.
  • His relatives laughed when he said he wanted to be a doctor, which profession he chose because of his desire for respect. He worked quite hard and stacked up athletic and scholastic achievements, but still felt empty on the inside. He was the first with his last name to graduate college.
  • He used chemicals in high school and college, but didn’t party like the others, because once he started drinking, he had difficulty stopping.
  • At the beginning of medical school, he was intimidated by the backgrounds of his new classmates. He was elected Class President, the biggest honor he had ever experienced and took that job quite seriously, and remained President of his Class all four years. He appreciated the relationships and used no illegal chemicals during medical school.
  • His medical school relationships suddenly ended when he graduated. He was unhappy in his relationship with his wife, felt like he wasn’t enough and a fraud. Within a couple of months he began using chemicals, which continued throughout and beyond his residency. He did very, very well as a doctor, including an appointment to the medical school faculty despite having a severe opioid problem. He knows that one can do well in one’s job and still have a secret serious addiction. His addiction took precedent over his wife, kids, job, relationships, food, water, sex, everything. He felt, “If I don’t use, I will die.” He was starting stealing drugs from patients and others. Leading a double life, he was dying on a daily basis.
  • One day, as Loyd heard an intern present the case of a young woman who was in the ICU from an overdose and needed a Life Flight to Nashville for a liver transplant, he learned that she had taken roughly the same dosage that he was abusing daily. Loyd went into the bathroom, looked into the mirror and just started crying thinking nobody was going to find him. He thought he was going to die. But after a few additional months of abuse, his father caught him taking pills and confronted him. When Loyd expressed that he was going to lose all that he had, his father replied, "None of that stuff's going to do you any good if you're dead." This got him into rehab and he’s been clean since. I didn't know about drug treatment and asked, “How is it possible to go through medical school and residency and not understand any of that? But I didn't.”
  • In about 720 hours of rehab, only about two were focused on drugs, alcohol, sex and gambling. The opposite of addiction is not recovery, but is community and relationship. When he started to wake up, he thought there’s no way that this was the path out of addiction. The more he got outside of himself and started helping others, the more he woke up.
  • Things got way better. He was able to put back together his relationship with his wife. His son recently asked him to be his best man at his wedding.
On the Value of Community and Vulnerability
  • “If I can remain a light and if I remain consistent and be that myself, I think that’s attractive. It attracts me and I think it will attract other people. And I can't lose it (the light). I can't kill it. It's impossible. I've tried to. I've wanted to a few times, but I can't kill it. It's exactly what Dr. King said -- hate cannot drive out hate. Only love can do that.”
  • “Whenever we're able to name it, now we can start to address it. That's what worked for me in my life. When I started identifying things that I had to really take a hard look at, no matter how tough they were --  if I address those and retain faith that I'll prevail in the end, the weird thing is that I have, and I continue to do so.”
  • “The opposite of addiction is relationship or community or connection.”
  • “What I've seen over time is I've been consistent and I've suited up and I've showed up and I have met them where they are in a nonjudgmental way.  The more I do that, the more I see them willing to open up and be vulnerable, then I can start to meet their needs with other resources.  For me, that's the key.”
  • “That's where we start, because it's not the norm. It's not what we're used to. We don't have political candidates that start off their campaign by getting up and telling you their hurts and fears. If we did, I would buy in and be willing to listen and I really think that most of us are that way.” 
  • “It's one thing to be vulnerable. That's a choice.  But we have to go a step further and be okay with discomfort in the room and often that's the first barrier -- it feels like an energetic barrier -- and just be okay with it.”
  • “When we create environments that let people become vulnerable, we'll start to move forward. As long as we're lobbing hand grenades at each other, then I start to lose hope.”
On Addiction, Recovery, Grace and Medicine
  • Addiction is an attempt to solve separateness. Recovery and healing requires the vulnerable sharing of abuse and trauma in a meaningful relationship, which is met with compassion.
  • The current coronavirus isolation is so hard, because social isolation is the opposite of what we were meant to do. We were meant to be with others. In the Nashville area, in the first 4 months of the pandemic, deaths from overdose have risen by 20%.
  • Addiction is like an “obligate anaerobe" -- an organism which can only live in environments that lack oxygen. Similarly when the addiction and its underlying abuse and trauma are met with the oxygen of compassion, relationship and community, the addiction cannot survive.
  • The criminal justice system is designed to keep people there. After rehab we have to remain open and create these meaningful relationships.
  • Stockdale Paradox (named after Admiral James Stockdale, Ross Perot’s running mate in 1992) is that you must never confuse faith that you will prevail in the end—which you can never afford to lose—with the discipline to confront the most brutal facts of your current reality, whatever they might be.
  • Having trauma-trained personnel in our school system who can identify the vulnerable and patiently help build relationship and community.
  • In communities where sharing emotions is not the norm, he urged that exactly because it is not the norm that we need to “be the change” by modeling opening up vulnerably and be a example. And he’s seen this work in communities where he did not expect them to open up. But he cautioned that he’s not saying to open up vulnerably while in line at the grocery store. Loyd feels the discomfort every time he opens up, which is why his favorite place to share is when he is with the incarcerated.
  • He’s sees the key is bringing one’s authentic self with all one’s fear, shame, guilt, hope, gladness and tries to do that with his patient. And where the healer does not have the answer or certainty to offer, the healer can bring and share his/her authentic self.
  • He grew up with the Old and New Testament. But at this point in his life, he sees God in all people all day and every day, and tries to make sure that he’s present to see it when it’s in front of him. The biggest thing that he does is getting outside of himself, and prays for that when he wakes up and when he goes to sleep at night. He wants to look at the world in that it’s not just about benefiting him. He centers himself multiple times a day in meditation and reading. He does go to church every week, as “it’s about meeting people where they are,” but he has Hindu, Buddhist, and Koran readings that he loves, jots down and carries with him. He tries to get grace across to his patients. When he was in a active addition and for a while after, he could heap tremendous amounts of shame on himself, but sees walking through the shame was the way through. He knows that he receives a tremendous amount of grace and wants to pay that grace forward. He hopes that we still allow others to receive redemption and grace. He urges, “Accept the grace.”
  • He advises that when we face a difficult situation, perhaps with a loved one who is deep in addiction and shame, that we first take care of ourselves, because we can’t change another’s behavior. And if we are too attached to making someone else do something, we will increase our anxiety if they don’t. So if we are taking care of ourselves, then we can offer another a path and opportunity to meet them where they are no matter what. “That’s the loving thing to do.” For example, ask “What is bothering me about what I’m watching him go through and how is that affecting me? And “What can I do to better take care of myself in that area, so that I can be ready whenever he’s ready to step into relationship?” We have to be ready for him to stay in his situation and not change. Stay true to the heart of who you are.
  • His treatment programs and centers include Cedar Recovery, Journey Pure, Next Door and Renewal House. We meet people where they are and make the path that is right for them. We have outpatient programs. The first thing we do is use the tools are our disposal to make them feel better about who they are. Once they feel better, we address helping them get better. Help people step into some of the realities of their life, start to form those relationships to help them start to heal themselves. To help them stay better, we connect them with people who have shared goals, interests, experience, strength and hope.
  • “I tell all the young folks that I know that are entering residency that asked me this question.  It is this:  Stay true to who you are.  Residency has a way of scarring us, has a way of changing the way we look at things and to become jaded at certain circumstances and become judgmental.  And my prayer for you would be that you would stay true to the heart that you had when you answered the questions for your AMCAS application because if you can do that, you'll separate yourself out really, really quickly.”
Lots of gratitude to all the behind-the-scenes volunteers that made this call happen!


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