by Maxine Durand
They say travel is good for the soul, but cross-cultural exchange can also be beneficial for public health.
Susan Esp, an associate professor with the School of Social Work, has been selected to be a Fulbright specialist in Malaysia, where she is hosting a series of workshops on psychological intervention in addiction treatment.
“It’s one of the leading causes of death in our society, across the world,” said Esp. “We talk about diabetes, we talk about cancer… we’ve been talking about suicide a little bit more, because it’s been in the national headlines, but the majority of suicides I know were also substance abusers.”
Esp said the focus of addiction studies is to approach the client with acceptance and respect, rather than judgement, shame, or marginalization. She said she wasn’t sure of what kinds of challenges she will find in Malaysia, where there can be many cultural and religious backgrounds with differing ideas on how to handle substance abuse—and while this kind of evidence-based practice is usually required as a part of the process for seeking government funding in the United States, that doesn’t mean that it’s always being done here, either.
Esp’s Focus on Motivational Interviewing
People tend to have a reason for the things they do, or in this case, for the chemicals they use. Esp said that it’s important to understand these reasons, as well as the unique characteristics of the client, in order to help them—but stigma around substance abuse and older attitudes toward treating it can make this difficult.
“When I first entered the addictions field, I was one of those people, we used to say, ‘Oh, they just have to hit rock bottom,’” said Esp. “That never worked for me—I thought we should give people the opportunity to talk about change, and to talk also about why they don’t want to.”
Getting the client to change through their own determination to do so, rather than by command, is a key component in Esp’s lesson plan during her trip. Known as “motivational interviewing,” or MI, the clinician takes a person where they are with no judgement, shame, or blame, and the client is responsible for change, not the clinician—the client does the majority of the talking, while the clinician identifies and amplifies talk of change.
“If I go into the doctor’s office and they say, ‘Susan, you have high cholesterol, you need to go home and do this and this and this,’ that doesn’t tend to work,” said Esp. “They would have to ask me, ‘how do you feel about your cholesterol, would you like to do anything about that, have you tried anything in the past.”
MI is increasingly important worldwide, but even in America, where Millennials are dying younger than their counterparts in other developed countries, and where the opioid epidemic is in full swing. Esp said even a reduction in harm, such as a client committing to less consumption of addictive substances, is better than no commitment from the client at all—and people tend to be more receptive to gradual reduction over time than they are to an abstinence-only approach.
While Esp has travelled extensively throughout southeast Asia, she has never previously been to Malaysia, and said she fully expects to come back changed. She said the trip is the culmination of 25 years of combined professional experience, which she is eager to share with her new host country. Esp said her career has led her through a somewhat nontraditional trajectory into teaching, and her unique background was what originally pushed her to pursue the Fulbright opportunity.
“One of the things that drew me to this particular call was that I had been working in the substance abuse field as a clinician for about 15 years prior to teaching courses,” said Esp. “When I read this, I thought they wrote it for me.”
Esp will return from Malaysia in August, and will resume instruction at Boise State in spring of 2019.