Sex, Drugs & Science
Sex, Drugs & Science
Natalie Brousseau: Stigma, Social Support & Opioids
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Natalie Brousseau recently earned her PhD in Human Development & Family Sciences from the University of Delaware and will soon begin a post-doctoral fellowship at the University of Connecticut. Natalie, Valerie, and Carly chat about their work on the UDisclose study, which focused on understanding disclosure experiences among people in recovery from opioid use disorders in Delaware. Natalie shares the results of her three dissertation studies, and Valerie and Carly wish Natalie good luck in her next round of science adventures.
This is our last episode of the season. Follow us on instagram @sexdrugsscience to stay up to date on future episodes.
I'm Valerie Earnshaw.
Carly HillI'm C arly Hill
Valerie EarnshawAnd this is sex drugs and science.
Carly HillToday's conversation is with thee Natalie Brousseau.
Valerie EarnshawNatalie Brousseau!
Carly HillDr. Excuse me,
Valerie Earnshawrecent Doctor!
Carly HillI -- t here's so many other things to be amazed with Natalie about an d s o proud of her for that somehow that that es caped m y mind. But more importantly, Natalie's research focuses on how stigma and other social determinants of health impact treatment outcomes among people living with HIV and substance use disorders.
Valerie EarnshawSo maybe you can tell from our high levels of enthusiasm that Natalie recently graduated from our lab. So Kylie and I have been working with Natalie for the past four years as she got both her master's and then her doctoral degree. And we are, oh, terribly sad to see her go.
Carly Hilldevastated, I think is the word that I would use.
Valerie EarnshawOkay. We're devastated to see Natalie go. But she is off to really tremendously great things. She has the postdoctoral fellowship lined up at the university of Connecticut with Dr . Lisa Eaton and Seth Kalichman from season two . So we are also tremendously excited for all of the great things in her future.
Carly HillRight? But as if letting Natalie go, wasn't sad enough, we also have to let our listeners know that this is our last episode of the season. So if you want to stay updated about future episodes, please follow us on Instagram @sexdrugsscience, and hit the subscribe button on whatever app you're using to listen.
Valerie EarnshawWe very much hope that you enjoy this conversation with Natalie Brousseau. We hope that you enjoyed the season and we hope to connect with you next summer for another season of Sex, Drugs, and Science. Dr. Brousseau, welcome to the show. Carly and I have an ongoing joke that you have listened to zero of the podcast episodes. Despite being in our lab. Zero of , I guess we have 13 or 14 hours .
Dr. Natalie BrousseauOkay. I've had, I've definitely had four.
Valerie Earnshawfour in the tank. All right.
Carly HillWell, I feel like 14 hours of podcasting is a lot when you're working on busting out your doctorate too .
Valerie EarnshawHey, that's true. Yeah. Also like, I can't imagine anyone would want to listen to 14 hours of their dissertation advisor talking to them or talking in the background. They're like enough already.
Carly HillThe last thing Natalie wants to do in her leisure time.
Valerie EarnshawYeah. Fair, fair. Well, Dr. Brousseau, doctor, as of like two weeks ago, you just defended your dissertation. So this is like a celebration podcast recording . So I'm super excited. We have gotten several requests from folks Who to talk more about the work that our lab does, which formed part of the basis for your dissertation. So we're going to use today's episode as a little bit of an opportunity to introduce you to the Dr . Natalie Brousseau. And also talk a little bit more about what our lab does. So, starting with Dr. Brousseau, so you were born and raised in Delaware, Native Delawarean.
Dr. Natalie BrousseauYeah. Native here. Yeah . It was amazing. And there's no better place in Delaware. Everybody knows everyone.
Carly HillYeah, that is true.
Dr. Natalie BrousseauI've been in my comfort zone. Just kind of stuck around.
Valerie EarnshawOkay. Yeah. You went to university of Delaware for undergrad.
Dr. Natalie BrousseauI did. Yep. So went there. I think I did early decision. That was when they were starting to say, oh, it's getting hard to get into U of D. It's not a guarantee anymore. So I did that and I got in with psychology and pretty much stuck with that. Oh , well eventually my second year in, they got like speech path and.
Valerie Earnshawoh yeah. Okay.
Dr. Natalie BrousseauKind of broadened their scope. So I switched to cognitive science. So that's where my BS is in Cog Psy. But I also have a psychology under the umbrella of like linguistics too, like a whole big meld of fun thing.
Valerie EarnshawA lot of brain , a lot of brain science. Yeah. So at some point in the mix, one of my favorite stories about you as an undergrad is you go to meet the Roberta Golinkoff, who is a big deal researcher in college of education, human development, which is our college's school of ed. And you are a research assistant in her lab for, I don't know. How long was that it was at least a semester, Right?
Dr. Natalie BrousseauOh no, no.
Valerie EarnshawOkay.
Dr. Natalie BrousseauIt started Sophomore year and worked till after I graduated. So it was like,Probably three years. And it was great. That was because of my dad read her book and was like, "look, you have like a bad-ass at university of Delaware who is doing big, big things. Like you said, I think she's the head of education. She's also in psychology. She's in Cog Psy where I was in linguistics." So she just has, she did all the things I did.
Valerie EarnshawShe does it all.
Dr. Natalie BrousseauI went to her lab and wrote her a little email, informal as a sophomore. I had no clue. And she said, come in, I'll interview you. I went in and like the summer sat down with her. She was so nice in her New York accent. And she's had this lab since like the seventies called the Infant Language Project. Well now it's called.
Valerie EarnshawChild's Play Learning and Development Lab today.
Speaker 4Yeah . Childs Play Development Learning, exactly what they did there. Yeah . So just kind of focusing on children, how they develop and all their social interactions and things they do with play and fun, things like that. So it was , it was eye-opening to see research in this background of things you're not always exposed to. So she really started me on my path of research. She told me "you're going to be, you're going to be a doctor. You're going to do it. You should really look into it." She was just a great mentor in the background, encouraging everything.
Valerie EarnshawThat's pretty amazing. I mean, Roberta Golinkoff is wonderful. She's like a great mentor to me as well, as like a newer faculty member at the university. But she is not telling every undergraduate that she sees that they are going to be a doctor. So to have this BFD Researcher tell you that like you're going to be a doctor is pretty incredible.
Dr. Natalie BrousseauI know. So we used to have weekly meetings and we were all sitting around this huge table with all her post-docs and a few doctorate students. And like, she had the best postdocs . Like she, you know, she had people flying all the time and there's just a few of us undergrad. And she was like, "I want to write a paper, you know, about X, Y, and Z". I forget what it is. And she's like, "who's going to do it with me". And I was the only one to raise my hand as like a sophomore undergrad and had no clue what I was taking on. And she looked around the table like, "Really? This is the only one who wants to help me out here?" She's like, all right, we're going to do it. It was like a rejoinder for something wrong with the paper she read.
Valerie EarnshawOh, okay. So you , I didn't realize this so you worked on a paper with Roberta when you were an undergrad .
Dr. Natalie BrousseauI just worked on it. I don't know what happened to it.
Valerie Earnshawyou don't know what happened to it, Okay.
Dr. Natalie BrousseauIt could have been that bad that she was like, "yeah, that's not going anywhere"
Valerie EarnshawWell we're all super grateful that she encouraged you, because then you stuck with the University of Delaware and you joined our department, Human Development, Family Sciences. And I actually remember meeting you. I don't know if you remember this, but I came to do my interview and that was like April, 2016. I gave my talk and then you and another graduate student came up after and introduced yourselves, which was really neat . Especially, you know, those, those interviews are like two days of, of a whole lot of,
Carly Hilltorture?
Valerie EarnshawYeah. So they're long. So that's always a nice little break.
Dr. Natalie Brousseauyeah. Just wanted to meet people who like, want to work with you
Valerie EarnshawAnd yeah , it was cute.
Dr. Natalie BrousseauIt was nice. I totally remember that. And that was something I was so excited about to have you come in because our department was really in its infancy, in my interests, especially around like substance use disorder. And you were bringing stigma into the mix and these are all things that were so interesting and exactly what we needed in our department to kind of broaden from just child development to human development in general, and social determinants of health and all these things.
Valerie EarnshawWell, I'm going to cry soon. Waterworks of an episode. Well, that's really nice. Yeah. So for folks who aren't as familiar with our department as others are , I can't imagine why not? We have a really strong program in early childhood. Yeah. So I would be a little bit of a different duck coming in.
Carly HillThe wild card.
Valerie EarnshawSo it was within my first year there also that I like, I snagged you. So by the end of that year, I snagged you for some summer work. And you and Carly start on your first team science activity, which was interviewing people, living with HIV, through the state of Delaware about their experiences with stigma.
Carly HillRight. And I was saying to Valerie earlier that I don't know if you remember it , but we hadn't actually met yet, but we knew that we were doing the work. And I was like, "well, I'm staying at my grandparents' beach house . If you want to come." And then like, as soon as you were like, "yeah, that's cool." I was like, "oh my God, wait, what if she's terrible? And now I still talk with her and I don't know this person at all." Like what if I just come home from a long day and don't want to see her at all. But it ended up being actually super fun. It was like adult camp. We did fun things during the day, ate way too much pizza at night.
Dr. Natalie BrousseauLike all the activities,
Carly HillSo many activities were done. So that was also our origin story as well. I just thought the listeners would --
Dr. Natalie BrousseauOh the little princess?
Carly HillOh my God. No, it was the Secret Garden though.
Dr. Natalie BrousseauYeah. Right.
Carly HillOh, that's such an odd. That is such an odd movie that we both somehow had in our childhood. She was like, "wait, do you, by any chance, want to watch this?" I was like , "oh my God. No. But yes." And it was as bad as we remember it being
Dr. Natalie BrousseauIt was VHS also.
Carly Hillit was, we had to rewind. Yep , sure was.
Dr. Natalie Brousseaumake sure you rewind it every time
Carly HillJust in case anyone else wants to watch the Secret Garden.
Valerie EarnshawI just really love the idea of Natalie, like transitioning from like the child's play lab to HIV stigma, Delaware, because it's a very different population that you're working with. And I think this was also your first time doing qualitative interviews, right ?
Dr. Natalie BrousseauYeah. Yeah. It was,
Carly HillIt was both of ours actually.
Valerie EarnshawYeah. So what was that like? Cause we did some training, but then you guys , then it was all you with a new population of folks to work with through the state.
Carly HillI remember, I was really nervous. I was like, I don't know what I thought it was going to be like, but I remember thinking like, the same level of like nerves as a job interview, did you have the same experience at all?
Dr. Natalie BrousseauYeah. I definitely think going in and like sitting down in our back room , whatever was available and telling nurses before, you know, everybody kind of walk in like, Hey, we're from university of Delaware and where we're allowed to be here.
Carly HillExactly. Yeah. And then you have all these people that you have to go over to recruit and be like, "Tell me how you feel about living with HIV. Do you mind?" Like, it feels super weird to do if you've never done it before.
Valerie EarnshawYeah.
Carly HillAnd we nailed it.
Dr. Natalie BrousseauThat was pretty great .
Carly HillI mean, I think we did a pretty great job..
Valerie EarnshawThe best thing about this team is how modest we are.
Dr. Natalie BrousseauI mean, for two people that have never done it like It went all right.
Valerie EarnshawA lot of people opened up to both of you. I mean, it was , it's pretty cool . Incredible. Yeah .
Carly HillSome people opened up more than I think we would would've liked to have had them open up, but It was a good time.
Dr. Natalie BrousseauY eah. Super interesting to talk to and had some emotional and great experience to share and some good stories.
Carly HillYeah. That's true. Like the one where yeah . We had a woman that when we asked her the question about sexual orientation was like, what did you just ask me? Like all sorts of insulted. So I had to try and explain it to her. And afterwards she was like, oh no , no, no, no. I just use my toys. You can just write that. And this was on our first day, the first day of data collection, I was just like, "I don't, this was not one of the curve balls. Dr. Earnshaw threw me , when we were training for this uh , all right . I'll just end the record now."
Valerie EarnshawI f y ou're like toys, I guess that w ill be "other", for sexual orientation.
Carly HillPrefers to self describe . Yeah.
Valerie EarnshawWell that was only the beginning of, of long several years Carly, for you having to like break down the, these questions and surveys that I've included and , and try to be like, well, this is what this means, or
Carly HillI know. Well, luckily I had Natalie for all that too .
Dr. Natalie BrousseauWho would have known that in this emotional survey of your experiences or stigmatizing responses and the hardest question was "what's your sexual orientation?"
Carly HillHow did that throw people? Yeah. Race actually does also, but sexual orientation people are like, I don't know if they think we're asking for sexual history. I don't know what it is, but for some reason, I mean, you'd be surprised at how much that question does not land. Like people get so offended.
Valerie EarnshawYou mentioned. Yeah. Yeah. I need to take it back for more like revising. I was about to say what's the meter.
Carly HillOnce I explain it people are like "Oh!" But you know usually that's more where like, even on the iPad, they're like "what?"
Valerie Earnshaw"sexual, w hat? Excuse me now." That's Funny. Y eah. Y eah. A ll right. Well that was also though, you know, as I'm thinking about it, Natalie, l ike the first papers that you wrote with o ur, o r like data with our group, you had already written another paper, but it was one of the first times where you, you took things that we were studying and y ou put on this like HDFS human development and family sciences, like lens to it, applying the stuff you were learning in class and blew my mind because you did a really nice job. D elaware i s a retirement state, and you did a really nice job looking at the differences between the experiences of older people, living with HIV and younger people. And one of the things that our community partners talk a lot about is like, you know, folks are asking for these social support groups and then no o ne's ever showing up for them. And some of your analyses ended up landing on the observation or the insight that, you know, older folks living with HIV, where we're asking for more social support and social connected with other folks living with HIV. But younger people living with HIV w ere like, Nope, got it. Like they had their own friend network or networks. They don't really feel like maybe they are connected with people living with HIV, but they certainly don't feel like the organizations need to further connect them. And I thought that was a great observation b ecause it helps to explain why some people aren't showing for that when it is offered.
Dr. Natalie BrousseauYeah. I mean, age is one of those things that you don't really think about as a researcher. You just kind of have it as a control or a covariate in the background. But if you think about the development of HIV as a disease and what these people went through 20 plus years ago and being diagnosed versus being diagnosed today, when it's treatable, it's not a death sentence. It makes sense that their experiences are just totally different. That's definitely what we're seeing.
Carly HillYeah.
Valerie EarnshawAll right. Well, this study with folks living with HIV in Delaware ends up then hopefully being like a nice setup or training ground for you to level up into UDisclose, which is the primary study that the two of you have been working on for. I think it's been three , three years .
Carly HillIt has, I thought, yeah. Something like that. 2017, 2018, somewhere there abouts .
Valerie EarnshawYeah, it was right after you graduated.
Carly HillAnd I don't remember what year that was.
Dr. Natalie BrousseauIt's been work.
Carly HillYeah. It's been a while. Yeah.
Valerie EarnshawAll right . So I thought I'd give a little bit of a background on this study for folks. So I started doing work related to stigma and substance use disorders and a little bit around disclosure and disclosure is, as we've defined it in our study, sharing something new about yourself with someone else for the first time. And in this context, it's that year in recovery from a substance use disorder, or that you have a history of a substance use disorder or you're in treatment really like anything related to substance use or substance use disorder. So this was something that I became interested in when I was working in Boston before I got to Delaware and I was doing really like a stigma focus study. But within that, we would always ask people, "well, who knows about your substance use disorder or your treatment." And then we would go on ask them, like, "how did they respond to you? Are you getting stigmatizing reactions or social support or supportive reactions?" And so the disclosure, wasn't a focus of this study. It was kind of like alongside, but ... We asked people about it just as a way to get to stigma. But as we were talking to people, I was like, experiences of disclosure are all over the board. Like some of them , some of them didn't go so well. And at the same time that I was doing that, I had a friend who disclosed to me that they were going into treatment and it was like a textbook disclosure. They said, "your friendship means a lot to me. I'm going into treatment. I'm telling you because I want your support." And it blew my mind because I was like, "did someone teach you how to do this?"
Carly HillAnd it set you up for such a home run there.
Valerie EarnshawYeah. There's like nothing. Yeah. Yeah. There's nothing you can do. Yeah. There's nothing you can do in response to that. After being told what a good friend you are, how supportive you are, but be supportive and friendly. So it made me think like, "oh, wow maybe this is something that we can teach people to do." And when would someone have learned how to do this? You know, like this, isn't something you're going to get like in middle school, or I don't know you're gonna get this in other places. So I wrote a grant to study how it is that people disclose that they have a substance use disorder or that they're in treatment. And then part two was to develop a little baby intervention to help people to do it. So that study got funded in Delaware. And luckily we had already done this study together with people living with HIV. I knew what good research chops you both had. And I recruited you into the study, which we called UDisclose, because I think Natalie, was it you who pointed out how we need to name things? Do you wanna explain that?
Dr. Natalie BrousseauThat was coming from -- that was an experience from Roberta too, just learning how to brand things and making your study recognizable. So we put U D for University of Delaware, and we're trying to think of a U D word. So UDisclose.
Valerie EarnshawIt was perfect.
Carly HillIt was Natalie's idea .
Valerie EarnshawLike all the best things in our studies, are Carly we're so tanked for her leaving Oh my gosh. Okay . Just a little bit of background, because what we're gonna do is walk through the findings from Natalie's study, which, you know, we're about a week or two out from her dissertation defense. So hopefully she hasn't like completely wiped out the past four years. But the way that this went was was you two camped out, essentially at our local substance use disorder treatment clinics, right ? These are places where people are going in to receive medications, mostly for opioid use disorders. So they're going in either every day, once a week or monthly. And so you're camped out and you would ask someone, or people were eligible to participate, if they were planning to tell someone new in the next three months, you know , anything related to their substance use disorder treatment. And so then essentially they would go into back room with one of you two.
Carly HillSometimes both of us,
Dr. Natalie Brousseausometimes the closet.
Carly Hillliterally sometimes a closet or the lunch room,
Valerie Earnshawthe lunch room.
Carly HillYeah.
Valerie EarnshawThey'd answers some questions, some survey questions like on an iPad, and they would have a conversation with you. They would do a qualitative interview to tell you about how they think it was going to go, why they were thinking about disclosing. And then after three months they would come back and they would tell us about whether or not they disclosed. And if they did disclose how it went. And so they did a bunch of, they did like a combination of surveys and interviews.
Carly HillYes. It is like a little bit of a back and forth there. Yeah . It was good though.
Valerie EarnshawI mean, it is good. They kept you on your toes.
Carly HillThey kept us on our toes. Yeah. Actually Natalie stopped me from getting beat up once.
Valerie EarnshawOh no.
Carly HillYeah. Cause I , I got a little saucy back with someone that was getting saucy with me and then quickly regretted that decision. And Natalie was like, "I'll be right there." And like came in and saved the day .
Valerie EarnshawYeah! Because she wasn't , I remember this too, because Natalie, I thought Natalie wasn't at the clinic. You called her. Okay. First off, let's all reflect that when stuff is happening during data collection, Carly does not call me. She calls Natalie, like, "I need backup".
Carly HillI needed, y ou k now, b ackup for a fight with all due respect, I'm going with Natalie.
Valerie EarnshawYeah. That's fair . I see that now .
Carly HillIt was just also Natalie. I t was closer.
Dr. Natalie BrousseauYeah, sure.
Carly HillThat's what it was, also, you don't want to have to call your boss and be like, "I messed up to such a degree that someone's about to hit me." So call the one boss right below that. See how that goes.
Valerie EarnshawSo always an adventure at the clinic. But my impression is though that overall lots of fun. You're happy to be back there right? After a year away, during COVID.
Carly Hilllike the best time I've ever had. It's such an amalgam of beautiful people and like beautiful, different, such different experiences. But like, yeah, exactly. Every day is totally different. I have never, ever been at work there and thought, "man, this is boring". Like that's never been. That has come across at all. And it's not, it's just so exciting and changes all the time and you get to meet new people. And the other unique part is being a Delaware resident my whole life also is that like you see people that are actually in your community and you get to serve them or at least feel like you're helping them out too. So even if you know , there are people you don't know, if still feels like just cool work. I just love it.
Dr. Natalie BrousseauSome of these people, this is like the worst day of their life. And they're taking time to talk to you and you feel like you are helping, right? Like any little bit of help is like doing something for them. And they love just being able to talk to somebody who wasn't like jumping down their throat or judgmental.
Carly HillYeah, exactly. Yeah. And actually I was telling Valerie earlier this week, so for the listeners, we had a pause between phase one and phase two, we'll call it. And so I wasn't in the clinic for awhile . And when I came back, it's like every day someone comes up and they're like, "cool, but where's Natalie". I'm like, she's actually a doctor now. And I'm serious. And so many people are like, I always say, I'm like, "um, she's a doctor now." So she's off doing these big things like, you know, and they're all so happy, but it's cool . I mean, you know, you can't help, but sort of -- people see your face and you're talking to them about some things, you know, like if the disclosure doesn't go very well and you're talking to someone about things that are pretty personal,
Dr. Natalie Brousseauit brings you together.
Carly Hilllike yeah , it really does.
Dr. Natalie BrousseauWe were familiar faces like greeting. We were kind of the greeters, we greeted at -- the desk was in the center of the room that they walked into first. So we knew names. We knew people coming in and we were just kind of high and mighty at our desk.
Carly HillThey'd know our names If I ever remembered to wear my nametag.
Valerie EarnshawName tags! Yeah. Well, it's so interesting because you both just kind of like hung out there for awhile . The first time it took like a long time, like we were slow to start recruiting and that makes total sense. Like, you're two new people you had to , you want to have people tell you about -- you're right. I mean, this could be the worst day of their life. And then maybe you're wanting to talk to them about like, for example, their mom calling them an asshole and kicking them out of the house for being in treatment, you know? And so like, yeah, that takes like a lot of trust and a relationship. And so what's been really interesting though, Natalie, is that so took you guys, you know , a little bit of time to get folks to warm up, but Carly was in there for like two days and has already like enrolled like 15 people for the new phase of our study.
Carly HillIt helps because all of our old friends, well, yeah, a few repeats, but all of our past participants are like, "oh, Carly!" , You know? So people are like, oh, how do people know you? What are you doing? Why are you sitting at the front desk before? So yeah. It's definitely quicker.
Dr. Natalie BrousseauYeah. They recognize the new face .
Carly HillWe also showed up. I mean like, just about as green as green could be like, I'm pretty sure I had a leather briefcase.
Valerie Earnshawoh my gosh, you did.
Carly Hillin like a wholel ass business suit was just like, "would you guys like to tell me your secrets?" And they were like, "no, not at all. Like avoid that girl at the front desk"
Dr. Natalie BrousseauThis FBI looking girl.
Carly HillRight. Yeah. So we toned it down, wore some jeans it got there. Yeah.
Valerie EarnshawI'm just really enjoying this y this vision of you in a suit with a briefcase asking for people's secrets.
Carly HillSeriously yeah, that's basically what we're doing.
Dr. Natalie BrousseauI'm like, yeah. She, she'll take you secrets over here, come with us to this creepy closet in the back.
Carly HillWe don't work here.
Dr. Natalie BrousseauWe may or may not work here... It's fine.
Valerie EarnshawAll right. Well, nonetheless, we got some good data. Yeah. Which informed Natalie's dissertation. So for folks who aren't familiar with the process, if you're a PhD student, you take a bunch of classes you take , uh , maybe a comprehensive exam, which is essentially like an exam on everything. And Natalie did so well her year, her semester that there was like ringing endorsement from the faculty about how much she rocked it , which was very cool. You don't always get that. And then you do a big research study. So what Natalie did was to write three different papers or basically do three different analyses with the data. And then that becomes her dissertation. So the first study was about like disclosure experiences to focus specifically on methadone. And this was a qualitative study. So you were focused more on the data from the interview portion when people were talking to you and to Carly . Right. So do you want to talk a little bit about what you expected and what you found?
Dr. Natalie BrousseauYeah, so I was looking basically at people who disclose their medication use. So, or people who don't know when you are living with an opioid use disorder, a lot of people here were taking methadone or some type of medication that could help them buy some time, establish new life patterns, re- establish their relationships. And this was kind of their treatment.
Valerie EarnshawI'll just say too , that we talked a bunch about these different medications on the episode with Scott Hadland. So I'll plug that a little bit, but yeah. I just want to underscore that, that withdrawing from an opioid, like heroin or fentanyl, or maybe a prescribed opiate is really, really rough. And so these medications can be helpful to prevent withdrawal symptoms and yeah, just kind of ease people into recovery. So methadone has been around for a lot , for a long time and it's been well-researched
Dr. Natalie BrousseauYes. Yeah. So clearly Scott Hadland was not one of my four episodes of the podcast. He's next!
Valerie EarnshawWell, I would not have expected you to be plugging the other episodes. That's Carly's and my job. I know you haven't listened to any, you don't have to pretend.
Dr. Natalie BrousseauSo people were, some people were disclosing that they were in treatment and other people were disclosing that they're taking this medication either methadone or kind of an , a newer version called Buprenorphine. So that was kind of what we talked about. What I got their experiences from was just to characterize what these disclosures look like and if they were different. And so we expected that they were probably going to be a bit different because of their medications. Methadone has been kind of established and there's some literature that it's highly stigmatized against, but this newer kind of drug Buprenorphine, we don't know as much about, although we think it's kind of similarly stigmatized. It could also be for some people seen as maybe a better alternative because of some of the components that can make it so that-- the methadone doesn't have. So basically we wanted to see if they were different, how these disclosures looked and whether people knew what these k ind o f medications were and were able to be supportive.
Valerie EarnshawAnd I think that one of the reasons we were interested in not only because there's like a decent literature on people's responses to methadone and how bad that is. But I think even as you were talking to participants that some participants disclose -- even if they were taking methadone, they told people they were on Suboxone or sorry buprenorphine as you're referring to it, because they like expected it would go better. S o based on the literature, based on like some of our observations with participants, we all thought, "okay, maybe people have better experiences with disclosing this new medication."
Carly HillYeah. Yeah. And I think a lot of that too, is like, you have to go to the methadone clinic and there's like a stigma with that. And like waiting in the line every day versus Suboxone is easier. I guess maybe just in Delaware for doctors, you can have like your primary care prescribe Suboxone in some cases. And so that kind of, I think carries a stigma whether or not you have to like show up publicly to a place every day and like wait in a line or is it like a private thing you can just do in your home.
Dr. Natalie BrousseauYeah. It has this kind of added component that you can't overdose on Suboxone versus methadone. So people feel comfortable with giving you 30 day prescription versus showing up every day at 5:00 AM just to interview them.
Valerie EarnshawAs much as we love that. All right . So we had some reasons to study. Yeah . We had some expectations that people might have better reactions to one medication versus the other. What did you find Dr. Brousseau?
Dr. Natalie BrousseauWell, we did have some people who kind of confirmed our suspicions. They have the same suspicions that maybe Booper nephron or Suboxone would be an easier disclosure. One of the quotes I have in front of me is a man, I remember interviewing, he was talking about disclosing to his friend that he was using methadone. And for him, it wasn't necessarily telling his friend that he used heroin that was the bad part, It was saying that he was treating this with methadone, that his friend like hated. And so he said "the methadone part was the hard part for me. He thought it was just basically heroin that I was taking". And let's say if I was on Suboxone or Buprenorphine, I wonder what he would have said then. So we found that, although we had these kind of sneaking suspicions and some people did disclose that they were on Buprenorphine because they thought it would kind of fly better or it would be a bit easier or their families would be more positive. They really kind of look the same, families just seem to be misinformed about both of these medications equally.
Valerie EarnshawYeah. It was no good all around. Yeah . There was, there were really not a lot of bright spots.
Dr. Natalie BrousseauNo, there wasn't. And it seems like a lot of these stigmatizing reactions were born from this just misinformed responses that were coming behind these medications. And so it was definitely a big learning experience for me to see how people approach them. You know, like I'm so familiar with these things. It was good to be able to see this misinformation and how it was stemming from these medications. And they were very similar. So we had a few different areas that they were the same. We had a lot of people talking about their family members or friends saying either methadone or this buprenorphine Suboxone is just the same thing as the drug. It's kind of this government subsidized drug taking.
Carly HillYeah. Substituting one drug for another, I think, has to be the line we heard the most.
Dr. Natalie BrousseauIt really does. It really does kind of carry these preconceptions of like seediness. So a lot of people saying, well, you know, "my mom said, methadone's the same thing as heroin. I'm basically substituting because now I'm on legal heroin. I feel just as stigmatized now that I'm getting treatment and doing better versus using", and you can see how that may impact your behaviors going forward. I mean, what a huge leap you made to go out there to get treatment to better yourself. You're waking up at 5:00 AM before work every day.
Carly HillYeah. You have to jump through hoops every day to get there. Like it's not a walk in the park. It's not like ...
Dr. Natalie BrousseauTo get accosted by us.
Valerie EarnshawBe just swept into a closet in the back of the room with a recorder.
Dr. Natalie Brousseautell us all your secrets!
Carly HillYeah.
Valerie EarnshawNo, I think about that a lot too. Just how hard it is to be on this medication and how you really have to want this for your health and your wellbeing . And then when you go to tell someone about it, for that to be the recation that you get, I mean, it's just. Reading those is like super heartbreaking it's, yeah.
Dr. Natalie BrousseauSo I mean, how many people who have a similar chronic disease out there with cancer or something if they told their parents, like I'm getting treatment, I'm on chemotherapy and that's like thing . Oh my God.
Carly Hill"why can't you just q uit the cancer cold turkey." Y eah. Seriously. T hat's w hat, it's this.
Valerie EarnshawYeah. I disclose to people that I'm on a pretty heavy duty medication that, you know, I have to go in once a month and get an infusion, which you know, is how they deliver chemo as well. And then I'm always in the position of like managing other people's like emotions about it and they feel sorry for me, or they want to like help. And I'm like, usually this leads me to joking around that, like, "don't worry, I'm just getting infused with a superhero power and waiting for it ot work" Like I have to manage them. But I can't imagine having an experience where I'm telling people and they're just like, well, why can't you just get your immune system to stop attacking itself on its own? Yeah.
Dr. Natalie BrousseauAnd another thing that I found is exactly what Carly was mentioning kind of the building and coming into methadone . So a lot of people mentioned the treatment atmosphere was highly stigmatized. And just, just going into that building or being seen outside of it was something they didn't, they didn't want to do. Like somebody gave me a quote that their friend felt like, you know, every day they're lining up to get their fix or something, or, you know, another woman had disclosed to her daughter that she was coming to this building, getting methadone. And her, her daughter said that she doesn't want her making friends there, don't think that she's going to fit in. "She doesn't fit in with the classless people going to this clinic and , and please, God, don't bring them home because they'll steal all our stuff." Oh my God. So that's something where you're like, "oh, okay, I'm in this crowd. And this building signifies exactly that to everyone", so why would I want to go to that treatment, right ?
Valerie EarnshawYeah, yeah, no, I mean, there's no better way to make you feel like shit for going in and getting medical care for yourself to ... yeah.
Dr. Natalie BrousseauAnd that even translated on them. Like some people were like, yeah, this is a such a sad way to spend government money. Just weird. If you hear that constantly from other people to just kind of internalize it.
Carly HillRight? Yeah. Like you're not worth the help.
Valerie EarnshawYeah. I think this qualitative study in particular has me super fired up to figure out how to do more work with families in Delaware. And because you know, our next step for this project is to help people navigate disclosure, which we can come back to. But more than anything, this has me fired up about like, let's do some light education about medication! You can only go up. Essentially what we were seeing.
Dr. Natalie BrousseauI did not expect so many people to not know and to not be willing to learn what these kind of medications were.
Valerie EarnshawYeah. And I should say earlier, I said, I kind of framed it as like a short term thing, like transition into recovery. But I should also just say for folks who are listening and who may not be familiar with these medications, that some people are on these for a long time in the same way that I'm on a medication for a chronic illness for a long time and are rocking it. So if you have a family member who is on one of these medications and has been on them for years, like A+ to them for being in recovery and for being able to, you know, stick with their meds. And so it's not for everybody like a medication that you take for a short term, for some people, they take it longer and that's totally fine. So, you know , it's between them and their doctor,
Dr. Natalie BrousseauTheir doctor knows more than their family
Valerie EarnshawJust wanted to do that real time fact check. So, okay. So that was study one. So study two focused a bit on looking at predictors or things that were associated with or related to concurrent opioid use during treatment. Right. So you were looking at why are some people continuing to use opioids even when they are in treatment or receiving medications for this opioid use disorder? And so they may be using heroin or fentanyl or something else. So what did you find for that study?
Dr. Natalie BrousseauYeah , so that one was really interesting. I don't think we expected to have so many people kind of readily admit or talk to us about how they're still using heroin while they're also taking their methadone, which is another thing that is super stigmatizing. It can also be a predictor of eventually just kind of dropping out of treatment,
Valerie Earnshawright.
Dr. Natalie BrousseauUsing the heroin. That's eventually going to kind of win out as a better option. Why are you even doing treatment?
Carly HillWell, cause you don't have to wake up at 5:00 AM and show up and get judged by everyone in your life. Use heroin.
Valerie EarnshawSo yeah. Your mom told you that you're replacing one drug for another, so why not just stick with your one drug? Yeah. Okay. Yeah.
Dr. Natalie BrousseauSo it was good to kind of look at that as our outcome. And in looking at that, we kind of wanted to see if some of these other factors like stigma and depressive symptoms, gender, outness, which is kind of the degree to which you are out or tell people that you're living with an opioid use disorder, whether these had an impact on this concurrent opioid use over time. So for this study, actually we found some interesting things. One thing we found that I think is pretty known is that OUD outness had basically people who were more out about their OUD actually had a negative impact on their concurrent opioid use.
Valerie EarnshawUh , basically people who told more people that they're in recovery or that they have a history of opioid use yep . That they were engaging in less concurrent opioid use over time. Yeah . Sometimes we always joke around like positive and negative is hard to interpret. So, but yeah, no, I mean, basically that's by some indications, maybe that's a good thing. I don't know. But yeah. So this association between like if more people in your life know about your recovery or your opioid use disorder, you're probably going to be engaging in less opioid use while you're in treatment. So yeah, that was, that was a very interesting one.
Dr. Natalie BrousseauYeah. And that's one we hadn't really found before and really does kind of highlight how these social relationships can be highly protective and things that really help us in recovery. And then we also found that those who are going into their disclosure anticipating more stigma or expecting that their brother who they're about to tell is really going to stigmatize their methadone use or their treatment or whatever it is. Those who had this higher kind of amount of anticipated stigma are engaging in more concurrent opioid use. So more stigma, more concurrent opioid use. Um, we can clearly see this connection between the two.
Valerie EarnshawYeah. And I think there's probably a , you know, there could be a lot of different reasons for that. You did control for like the severity of someone's opioid use disorder, which helps a little bit with, you know, it, it, it could be that people who have a more severe opioid use disorder are more worried about stigma and those people are also engaging in more concurrent opioid use. But you did, you did control for that a little bit. If it's a stigma process, it could be that if you're thinking about disclosing to someone, which is when we caught people and you're worried that they're going to treat you negatively, then you're stressed out about that.
Carly HillRight.
Valerie EarnshawIt's super stressful to be walking around, waiting to have that conversation. And for some people, you know, their coping mechanism is substance use. So it can be a lot of things. I think we have to keep digging into it. But that was a really interesting finding. We haven't seen that one before, either.
Dr. Natalie BrousseauAnd then yeah. Out of those other kind of controls or covariates people who had greater severity or their opioid use was very severe, they had more concurrent opioid use, which we were to expect. And then kind of the younger people had more concurrent opioid use, which is another thing that kind of changed .
Valerie EarnshawYeah . Yeah. Age Mattering.
Dr. Natalie BrousseauIt matters.
Valerie EarnshawAll right. All right. So then for your third study, you looked at associations between social support and commitment sobriety. And so to set up for the methods here, people would disclose to somebody, and then they would tell us about who that person is. So how close am I to that person has that person, you know, [inaudible] our used substances. And then they would also tell us about whether they received social support from the person after they, after they had disclosed. So you found this sort of really interesting finding, and very nuanced finding, but one that also like makes perfect sense. I mean, in the literature, just for folks like to know more broadly, when we study social support, we usually find social supports, like always related to the good thing. So social support is related to living longer, to like taking your medication more in a lot of different chronic disease contexts it's associated with like all sorts of indicators of wellbeing . And so here we're looking at is social support related to more commitment to sobriety among folks in this population.
Dr. Natalie BrousseauYeah. And it was definitely more of a nuanced look, we're kind of looking at social support from who, from who, which relationships, is this social support super beneficial, or maybe not. And that was kind of what, what came back. One of the first things I think we looked at was kind of closeness. So if I'm disclosing to my brother and I'm very close with him, this closeness kind of really mattered. So higher closeness, better commitment to sobriety, which is something you would kind of expect. But then we also had this more nuanced kind of three-way interaction, which was super delightful to interpet.
Valerie EarnshawIt's complication station for your dissertation. You don't want to have a three-way interaction to interpret for your dissertation, but there you were!
Dr. Natalie BrousseauThere I was, working my way through it between social sport closeness, and then the other thing that was in that interaction was looking at this disclosure recipient . So, you know, my brother who I disclosed to, whether that person used substances. So it was kind of a combination of, okay, me and my brother had used before and my brother may currently have a problem with opioid or some type of substance use disorders . So we wanted to know whether we already knew closeness mattered and that better closeness with somebody getting social support from them was a good thing. But what about getting social support and being close with somebody who, who is also using, or you've used with, is this, is this always a good thing? So we found that typically being close to somebody who doesn't use is , you know, what we'd expect, this is a good thing for us having high closeness, getting social support from them, "they don't use, this increases my commitment to sobriety" over the time period that we looked. So that was something we would expect.
Valerie EarnshawAnd you started -- sorry to interrupt -- but you started to describe this person is like, yeah, like maybe your brother who doesn't use substances, like maybe a family member, a close person hasn't used substances. Okay. All right. Continue. Sorry.
Dr. Natalie BrousseauSo no , that's a good idea to put kind of labels on them. Okay. So the next person we looked at would be this kind of low closeness, but they do use, so let's imagine maybe a friend, somebody in my peer support group or in my therapy group, they're in AA with me. We're not as close. We're not, you know, I don't know where they live and I go to their house and we hang out all the time and they have used in the past, you know, they're currently dealing with some type of substance use disorder, but that closeness again, kind of dictated how this relationship went. So for them, interacting with them, getting social support from them was also a good thing, which is kind of surprising. But in going back and kind of wondering over this relationship, we figured, all right, well maybe it's because this is somebody you're not as close to. They're not somebody who their behaviors really kind of impact your life. They're just there to give you social support and give you enough social support so that you can kind of enhance your commitment to sobriety.
Valerie EarnshawYeah. I think when you describe it, cause this was a counterintuitive finding, we were like, "uhhh" Yeah. But when you landed on thinking that this is probably someone who you know from AA, alcoholics anonymous or narcotics or narcotics anonymous (NA) like from a recovery community is where you sort of landed at. And that makes a whole lot of sense. Like this is someone who I probably am not going to necessarily disclose as being super close to yet. I mean, maybe you will become, but yeah. Receiving social support from someone in AA or NA, it should definitely be increasing your commitment to sobriety over time. So that makes a lot of sense.
Dr. Natalie BrousseauYeah. So those are two instances that we really want, especially with the person who we're close with, they don't use, this was a great person to disclose to they had all the things that could help you with your commitment to your sobriety. And then this kind of final pathway or interaction that we found was people of high closeness. So let's say my brother again, but my brother does use, he's used in the past. He's currently living with a substance use disorder. Getting social support from my brother who I'm very close to and he uses was a bad thing. It lowered my commitment to sobriety over time. Which made a lot of sense when you think about it, you know, maybe I'm always dropping in on my brother. I'm hanging out with him and his behaviors are kind of influencing me. Maybe I stop in one day and he's using, you know, it does make sense that we saw this very minute between types of social support and which relationship differences might matter .
Valerie EarnshawI think intuitively it makes so much sense that, you know, in any community, but particularly this community where people's social networks, like the people that they're connected with might really be shifting as they go into recovery. You know, transitioning from people who might also have substance use disorders to maybe more of a recovery community or reconnecting with family or other folks. So
Carly HillThat one made so much sense. Like, and it's something I can see where you would like to look at that data and be like, "what is happening?" You don't, you know, if everyone in your life knows about your substance use disorder and you don't have the luxury of these new relationships, like these people kind of, sort of have this idea about you, you think, and it's, it can be such a dark cloud to go into a place like NA or AA and have someone that you're not really close to might be like the look, because it's like, you don't have any eggs in that basket. If they really give you this terrible stigmatizing response, it's like,
Dr. Natalie BrousseauWho cares ?
Carly HillWho are you? I'll go to a different meeting. Like, you know, so it does make sense, but yeah, it's not something I, I think I would've thought to look for.
Valerie EarnshawWell, Dr. Brousseau, I got to say, this is the last time I will quiz you on the results of your dissertation. So, pass! Yeah, well done. And I mean, I'm always, like, I think that these results are really tricky results. Like especially, I mean, for folks who are familiar with statistics who might be listening, like interpreting again, that three-way interaction is , is really challenging. And I'm just like really impressed with how you're able to talk about it and like real-world language and layer in some like examples to try to hook in what might be going on there.
Carly HillShe makes it look easy.
Valerie EarnshawShe does! No, that's the thing dude, like Natalie has always made things look easy,
Carly HillRight. Yeah. Yeah. I know.
Valerie EarnshawI know. Y eah.
Carly HillI know . Sometimes things can get frazzled, but for the most part you're like, yeah, whatever, not a big deal. Like, oh yeah. Like, oh sure. There was never like that high energy doctoral student. Like "what if I don't do it ?" Like all these different, like Natalie all, "it's going to work out. Everything's fine". It feels so manageable to see Natalie do it because she's so good at it though.
Dr. Natalie BrousseauVery good at denying my feelings
Valerie EarnshawWell, this is a little counterintuitive but I would aks, now that you're at the end of the program and you know, you have your PhD, you did it. You're a doctor, you know, one of like 2% of the population who has a PhD. I was wondering if there any like advice or anything you would tell your former self. I mean, Carly and I though have an impression that you've always been fine. Maybe never needed advice, but is there anything you would say it a little Natalie or other little Natalies starting their program?
Dr. Natalie BrousseauYeah, I mean, one of the first things, this is just for me in general was that I was on the right path. I think that I just, I , I don't think a lot of people go into their PhD program not being a certain, but I was kind of like on the fence of like, oh, I don't know, is this the thing I want to do for the next big commitment of my life?
Valerie EarnshawI mean, a lot of people don't make it, but that's part of the process. And I think you also, like, don't really know what you're getting into when you start a PhD program. So I went in wanting to be like a teaching professor. I was like, I want to teach, I want summers off. I want to like
Carly HillJokes on you.
Valerie EarnshawI know we've come far away. And Now I'm like science forever! Science all of the minutes. Yeah. Science all summer. All right. Well, I like that. So what's next.
Dr. Natalie BrousseauWhat's next. So I'm going to go work with one of our other episode guests, Lisa and Seth, which I -- that's one I listened to, it was great!
Valerie EarnshawSure you did.
Dr. Natalie BrousseauLisa Eaton and Seth Kalichman.
Valerie EarnshawLisa Eaton and Seth Kalichman, big deal HIV researchers,
Dr. Natalie BrousseauBig deal. Yeah. Uh, university of Connecticut. So I'm doing postdoc there, which is going to be awesome. I've already worked with them a little bit during my last few years here on a grant they're doing, they're doing a training grant with NIH. So at T32, it's called, which is very kind of proper sounding. But basically it's all about training, new HIV and stigma researchers. So worked with them. We got to love them. Just like you guys probably did in your interviews and Val you worked with them before.
Valerie EarnshawYeah they've been stuck with me for awhile .
Dr. Natalie BrousseauAnd so, yeah, one thing I didn't know is that Seth is not about having postdoc students. He isn't,
Valerie Earnshawoh, I didn't know that. So you have snuck by this then
Dr. Natalie BrousseauHe said he's only ever had one
Valerie EarnshawEileen Pitpitan and he loved her. I mean, what she, so she was in my cohort. We'll have to get her on for next season. Yeah. She was incredible. Wow. I didn't realize that you are, you are the second postdoc following Dr. Pitpitan. Okay.
Carly Hillno pressure
Valerie EarnshawYou guys are equally awesome.
Dr. Natalie BrousseauAnd that , uh, that's the reason he's never had a postdoc because they never thought one would ... Yeah .
Valerie EarnshawOhhh, Eileen was too good! No, but I mean, he's been talking about this post-doc for a year, so it's a lot of enthusiasm. That's awesome. Yeah. They are great. Well, Dr. Brousseau, you are just so super stinking smart. I can't, you know, it's hard for me to imagine you not feeling like, you knew thar you were on the right path because I don't know, at least from where Carly and I are sitting , it's you're, you're like a fish in water with this stuff. You're so natural at it. You're really, really good at it. You're so talented. You're super duper hardworking .
Dr. Natalie BrousseauYes, keep going
Valerie EarnshawI cannot wait to see all the amazing things that you're going to do in your career. And we have been way too spoiled having you in our lab, like too spoiled.
Carly HillLike, I don't know what I'm going to do. If I get beat up, does that mean I have to call you Valerie?
Valerie EarnshawYou are. I t's not going to go very well. Yeah.
Carly HillIt's not!
Valerie EarnshawI just want to warn you right now with everybody listening that I am very much already looking forward to embarrassing you at future conferences. I'm going to do it total Dance Moms style. I'm going to, I think you need to like get ready for all of the signs. The t-shirts the banners cheering, the whole thing. I'm going to bring Carly . We're just going to sit in the back and go like full out,
Carly HillWe're going to get jackets made.
Dr. Natalie BrousseauFair amount of glitter.
Valerie EarnshawOh yeah. We'll do all of the glitter. No problems.
Carly HillSeems like a good ask .
Valerie EarnshawYeah, because I think we're forever going to be your biggest fans. Yes. Dr . Brousseau. So thank you so much for joining us, talking about your dissertation and good luck with all the things.
Dr. Natalie BrousseauAll right. Well thank you for having me. And this is going to be my fifth episode!
Valerie EarnshawThanks to the Stigma and Health Inequities Lab at the University of Delaware for their help at the podcast, including Sarah Lopez, Molly Marine, James Wallace , and Ashley Roberts.
Carly HillThanks to city girl for the music as always be sure to check us out on Instagram at @sexdrugsscience, and stay up to date on new episodes by clicking subscribe.
Valerie EarnshawThanks to all of you for listening.