When I was working outreach in Cleveland, Ohio, I heard a story from some friends at The LGBT Center in Gordon Square. It was about a community activist group, which ran out of a local church some years ago, before I arrived in Ohio. The goal was to offer the local youth of the surrounding community free after-school services such as study space, athletic activities, arts & crafts and home-economic skills. All of these services were offered on church grounds as an alternative to the criminal temptations that harrowed so many young people in that area of Cleveland. The only prerequisite was that the adolescents would have to attend a thirty-minute sermon to receive The “Lord’s Message” prior to these services. These services were provided through a  state charity grant that the church had applied for and had been awarded for that year. 

Now, even for a non-religious young person, it doesn’t seem like a big ask right? I mean, sit in a pew, doze off while some geezer reads a verse or two. In half an hour, you’re back playing three on three. Well, what if I were to tell you that in this community, many of the adolescents were part of the LGBTQIA community and had previously or were still suffering from religious trauma? The thought of participating in anything to do with religion on a recreational basis was simply ludicrous. This program eventually failed because of lack of attendance. Take a moment to think about that. It didn’t fail because it was unpopular. It failed because the organizers did not do their due diligence concerning the population they were attempting to serve.  In the end, their need to serve their own self-interests caused the continuing suffering of a declining neighborhood. This population could have benefited from funding and resources a grant like the one this church was awarded could have provided. This brings me to the topic I want to share with you today, understanding the importance of cultural competence on a global scale when it comes to the art of behavioral health & addiction recovery provided by treatment organizations or mutual support groups. 

I am a person who identifies as being in recovery, who has the honor of being employed by the world’s largest nonprofit, evidence-based recovery organization in the world, SMART Recovery Global. Today I want to talk to you about what cultural competence is and what that means to the world of recovery. It is my intention that my perspective as an addiction counselor, a recoveree and as a Man of Color can motivate the readers to the gravity of the importance of this crucial concept and how to notice some of the warning signs that some of our peers have missed in the past.

Let us start by clarifying what cultural competency is. I think we can all agree that the word culture embodies the customs, traditions, daily habits, colloquial norms, and societal commonalities that we all recognize as commonplace within our regions of the planet.  Not only do we enjoy ethnic diversity, but our sentient individuality has allowed us to evolve our collectives into gems of dazzling, unique patterns of life that can be similar but never identical. To be culturally competent while treating individuals in recovery, is to understand that these nuances in lifestyles play a significant role in the outcome of progressive treatment in addiction and mental health. (I deliberately hesitate in using words such as “successful” when describing treatment in mental & behavioral healthcare. For more on why, please see SMART Recovery’s work on Word Exchange and Dr. Richard Saitz, M.D. Presentation at our 2019 United States’ Annual Conference on Changing Language within the Recovery Community)

But herein lies the dilemma when treating issues such as addiction or mental health. For too long modern science has treated addiction and mental health recovery with the same approach as other diseases that attack the body; develop a treatment, duplicate it, send it out to the masses. If there is a medication available for said diseases, incorporate that into said treatment. This creates the well-known colloquial phrase “cookie cutter” effect of addiction treatment many of us have heard many times before. Sure, there are medications that can be effective for many symptoms of both addiction and mental health disorder or MHD, but we have learned that there are many factors that affect the outcome of each disorder, such as social, environmental, even seasonal aspects that can modify the results of treatment techniques. For this article, we are focusing on the importance of the social, in this case, cultural impacts, that can be game changers in either direction, depending on the treatment providers’ attention to detail. 

Let’s look at some examples. There is always a big module on any social service network training program’s syllabus on communication. Usually, during the course of this training they will go over what Princeton University Experts refer to as the Four Main Styles of Verbal Communication. These are Passive, Aggressive, Assertive, and Passive Aggressive. Now, it’s usually taken in many Western Cultures that a blend of all four is a good strategy to have as it is believed to give you a good baseline for many types of social interactions. However, certain types of communication can be misunderstood depending on your culture, environment and life experiences. For instance, some cultures can misinterpret a passive style as insulting; misjudging this as a sign of communicating in a childlike manner because you perceive them as intellectually inferior. I have personally seen this mistake made by inexperienced undergraduates in substance abuse intensive outpatient program (or “SAIOP”) sessions for mandated probation attendees. This was largely due to the counselor who had recently graduated from their university and was inexperienced, not understanding the culture of the criminal element they were tasked to instruct. 

Oh wait, did I just catch some of you off-guard?! Culture can have nothing to do with an ethnic group, regional birthrights or nationalities. It can simply be a way of life. Professions, Religious Sects, Fraternities, Cults, for example, all can be considered cultures in their own rights, and all should be treated with the same respect when approached for recovery treatment, especially on a global scale. This will make the task particularly daunting if you are a foreign instructor to one of these groups in a land you are not native to, so be particularly wary of both the customs of the region you are in, and the disciplines your clients follow.

Which brings me to my next point which is equally crucial when taking cultural competence into account for our calling. Be wary of tunnel vision of your recovery model and your client’s person-centered goals based on their cultural lifestyle. Many articles you will read focus on the client’s culture as the focal point to be most wary of when dealing with treatment parameters, but this is only one side of the coin. For instance, if you were trained in a faith-based recovery model, but have begun to treat clients whose culture is primarily atheist or follow a spiritual path that does not resemble your methodologies, does your model have enough flexibility to be effective for those clients or will you attempt conversion? If your answer is the latter, you are attempting an age-old tradition of proven failure, that a study conducted by Harmony Ridge Recovery Center in April of 2023 on Forced Recovery (Mandatory Rehabilitation), produced data regarding this method of treatment. Their piece and many others like it show that while such approaches may produce short term success in creating abstinence during the course of the lock down of the program, the chance of self-harm, trauma, and relapse of the client skyrocket upon release. 

It is much more beneficial during the intake phase to have an honest and transparent conversation about your program, its assets, as well as its limitations. 

Flexibility is a necessity if you plan to be vital to the global recovery community. For instance, many western European and African nations thrive on the spiritual and familial aspects of the recovery process being incorporated into the client’s process of healing, while some cultures in Asia would immediately be disinterested in having to shame themselves by involving their family elders in their personal addiction that could cause their family to lose face. Therefore, programs such as SMART Recovery have made “Person-Centered” its core principle as an ever evolving, evidence-based platform. We are a recovery model that goes beyond the Bio-Psycho-Social Model by incorporating Balance into the equation. What better way to adhere to a person’s culture than by helping them to achieve their version of lifestyle balance?

I take cues from very close friends on what’s acceptable behavior towards addiction ambivalence in Poland. I study virtually under a PhD during SMART meetings to find out what Recovery Proficiency is classified as in Lagos, Nigeria. I am learning slowly and steadily what Malaysians who are being treated for Chemsex Disorder wish to achieve through Harm Reduction and support groups.

The unifying feature is the program we all share and the understanding and respect that our differences are our strength, not our obstacles. Let learning about the cultures your clients thrive in become a glorious experience of wonder you both can traverse together, rather than an obstacle holding you back from your shared recovery goal. I wish you all the best on your journey.

Burnout is a harsh reality for many professionals across industries. My journey with burnout began long before it became a common topic of discussion. Though I often felt isolated, my experience with burnout as a pediatric physician taught me valuable lessons about recovery, resilience, and aligning with one’s true self. 

Suffering Through Residency

My first year of residency as a pediatric physician was intense and relentless.  For the first time in my career, my recommendations carried weight and directly influenced patient care. The demanding schedule of 80-hour workweeks, combined with the emotional toll of treating critically ill infants and children, was overwhelming to say the least.

In the midst of this grueling routine, I experienced my first bout of burnout and depression.  While I didn’t have the language to describe it at the time, I knew this:

• My stomach was in knots every morning as I drove to the hospital at 5 a.m.
• I felt a deep, persistent sadness.
• Most days, I didn’t know how I would make it through.

I tried yoga, spent time in nature, and confided in colleagues, but these only brought me transient moments of relief from the weight of daily life.  When I felt my mental health declining and nothing seemed to provide consistent solace, I decided to transfer to a program closer to my family in hopes that the proximity of loved ones would ease the strain. While the workload remained intense, the support of my family made a meaningful difference in my overall well-being.

As I continued to struggle through the next two years, I began taking mental notes about what truly mattered to me. I realized that 80-hour workweeks, overnight shifts, and the emotional weight of inpatient care weren’t sustainable for me. I valued quality time with loved ones, creative pursuits, and a sense of balance. These insights became a compass for my future decisions, prioritizing roles that allowed for the sense of balance and alignment that I valued. 

A Pivotal Moment of Choosing Differently

Years later, despite my best efforts of keeping repeat episodes of burnout at bay, I was faced with another crossroads. I was working in pediatric urgent care through the height of the COVID-19 pandemic and found that the collective trauma of the pandemic, coupled with rising hostility and violence in healthcare settings, left me burnt out and physically manifesting symptoms of trauma.

This looked like bubbling anxiety at the thought of going into work each day.  Heart racing at the slightest sign of an escalating patient interaction.  Fighting back tears while walking into a shift.  And, experiencing sharp pains through my neck and shoulder that limited my movement.  

The self-care practices that had sustained me for two decades (daily meditation, breathing exercises, affirmations, prayer, journaling, and physical activity) were no longer effective at calming my body’s heightened stress response. I knew I couldn’t simply switch jobs and hope for a different outcome. This time, I needed to choose an entirely new path.  I left clinical medicine, without plans to return.

The uncertainty of this transition felt scary.  I grieved leaving a career that I had devoted so much of my life to.  I initially sought stability through seeking a non-clinical job, but when nothing materialized, I surrendered my tight grasp to expectations of what my next step would look like and opened myself up to other possibilities. While navigating the complex tapestry of emotions that this time held, I continued to pour myself into the coaching business that I had started as a side project years prior.  In doing so, glimmers of joy started to resurface and I decided to take a leap of faith and trust that feeling of joy to guide me to my next steps.  

This journey has been anything but smooth. Initially, I struggled with expectations of what my new career “should” look like. A turning point came when I found myself crying in the bathroom of my co-working office – it was then that I realized my attachment to these external expectations was causing unnecessary suffering.  Once again, I had to let go of the “shoulds” that were no longer serving me.

I began listening to my intuition and prioritizing joy as my guide. I saw it as an experiment to follow my inner voice’s guidance, and in doing so, I have found an incredible sense of freedom that has opened doors to new relationships, opportunities, and experiences.

Burnout Defined

Literature¹ describes burnout as a prolonged response to chronic exposure to stress. While it’s often linked to job-related stress, it can also occur within relationships and caregiving.

Regardless of the inciting stressor, burnout has three defining dimensions:

Overwhelming Exhaustion

Physical, mental, or emotional fatigue that can lead to irritability and difficulty making decisions.

Feelings of Cynicism and Detachment  

Loss of interest in work and feeling detached from its quality and results.

A Sense of Ineffectiveness and Lack of Accomplishment  

Feeling less effective, confident, and self-assured, despite maintaining a consistent quality of work.

Lessons Learned & Practical TakeAways

Two years later, I don’t have it all figured out, but I’m living in greater alignment than ever before. Here are a few insights from my journey:

Listen to Your Body’s Signals

Your body often knows what you need before you do. The stomach knots I experienced during residency and the shoulder pain when I was working in urgent care – these were physical manifestations of the emotional distress I was experiencing.  Before I could even name what I was going through, my body already knew.  

What messages has your body been sending you lately?

Seek Support

Recovery is not a solo journey. Therapists, coaches, friends, family, and spiritual communities have been lifelines for me. Remember that reaching out for help is a sign of strength, not weakness.  

Who’s one person you can reach out to today?

Let Go of “Shoulds”

Clinging to expectations of how life “should” be can lead to unnecessary suffering. This has been a recurring theme in my own journey, and each instance of intense emotional suffering reminds me that there’s something else I need to let go of.  

What are the “shoulds” that you are clinging onto, and can you approach these with self-compassion as you begin to release what’s no longer serving you? 

Burnout rarely follows a prescribed path, and recovery is just as unique.  But, you have the capacity to make it through.  By listening to your body, seeking support, and releasing rigid expectations, you can begin to take meaningful steps toward a more joyful and authentic way of living.

I’m Megan Cornish, a licensed clinical social worker who helps people with their mental health every day. 

Fifteen years ago, fresh out of college, I was working a job that involved assessing patients for depression and anxiety. I would walk into a room, make some small talk, and then screen for mental health concerns.

Do you have little interest or pleasure in doing things?
Are you sleeping too much or too little?
What about feeling down, depressed, or hopeless? 

These were the questions I asked every day, multiple times a day. I knew what the answers meant. I could recognize depression and anxiety in others from a mile away. But somehow, I didn’t see the same symptoms in myself. 

Today, I’m in a much better place—not perfect, but stronger. My experiences have taught me that recovery is an ongoing process and that we’re all more than one story.

Recognizing the Signs

Back then, I was 21 years old and just starting out as a social worker. I had just finished my bachelor’s degree and was eager to prove myself.

I didn’t notice it at first, but slowly, a sense of unease started to creep into everything I did. I chalked it up to stress- totally normal for new graduates, right?

After a while, though, I woke up every morning with this heavy feeling in my chest, like a literal weight was sitting on me. Driving to work, I’d focus on my breathing, checking constantly to see if that black hole of pressure below my sternum had gone away. It never did.

Sometimes at work, I would step into my office, shut the door, and slide to the floor. I would press my hands tightly against my chest to steady my breathing, just enough to make it through the next few hours. I burned through all of my sick days and then borrowed against days I didn’t have because getting out of bed felt impossible—until it wasn’t an option. When the only alternative was losing my job, I dragged myself to work, even though it felt like I was barely holding myself together.

I stopped crying, listening to music, or really doing anything that made me feel any emotions. I couldn’t afford to go there because I knew that life doesn’t pause for a breakdown; it just keeps going, and I was barely keeping up. But I did start sleeping more and more, taking long naps after work and counting down the hours until bedtime. I pulled away from my friends and barely noticed how much of myself I was losing. But even then, I didn’t think I had a problem. I thought I just needed to manage it better.

The Breaking Point

Everything changed at a Christmas party at work. I was sitting by a window, watching cars drive by, and I had a thought:

I wish one of those cars would come through this wall and put me out of my misery. 

There was a lot of noise in my head those days, but somehow, that thought clanged through it all like a bell and stopped me in my tracks. It was the same kind of thought I’d described to clients countless times as a sign of depression.

I remembered something I told my patients regularly:

“Your brain’s number one job is to keep you alive. If it stops trying to do that, you can be sure that something needs to be fixed.”

I didn’t want to die—I just wanted a break from the constant struggle. I was exhausted. Anxiety is exhausting.

With the alarm bells finally ringing in my head, I left the party, sat in my car, and called my partner. We’d only been dating for six months, but I told him I thought I was depressed and I really needed help. He told me to stay where I was and came to get me. He and my best friend helped me pack a bag and brought me to my parents’ house. My mom, who I always count on, found a doctor who could see me the next day. She drove me there herself. 

That first call for help wasn’t easy, but it saved me.

The Work of Recovery

That first doctor I saw was a family practice doctor, not a psychiatrist. But he was able to put me on a low dose of medication, and, for a little while, just the hope that something might change was enough to make me feel lighter. But the medication itself didn’t help much, and it came with a side effect—a racing heartbeat—that only made things worse. He had also prescribed benzodiazepines to help in the short term, but I didn’t feel comfortable taking them. I knew the risks. He told me I should see a psychiatrist as soon as possible, but the waitlist was six months long.

Six months felt unbearable, but what choice did I have? When I eventually saw a psychiatrist, they adjusted my medication and recommended therapy. But my HMO had rules. Before I could do individual therapy, I had to go through group therapy first, which came with another long waitlist. I couldn’t take waiting anymore. So, I found an out-of-network psychiatrist and a private practice therapist and paid out of pocket. It wasn’t cheap, and it stretched my budget thin, but it was the only way I could keep moving forward.

It took five years of small, slow steps to get to a fully stable place. I tried four or five different medications before we found the right combination. Therapy helped me make sense of everything and kept me grounded. Medications didn’t solve everything, but they lifted enough of the weight for me to actually engage in therapy and do the work I needed to do.

The hardest part wasn’t the appointments or the waitlists or the side effects. It was realizing that the person I thought I was—the carefree, happy-go-lucky version of me I’d always identified with—was gone, and I needed time to grieve her. Recovery wasn’t about going back to who I used to be. It was about figuring out who I could be now. And while it’s not the story I would’ve chosen for myself, I’ve learned to be okay with it. In some ways, I think I’ve even grown to like this version of me more.

Progressing Up

Therapy taught me how to understand my story and accept myself. Medication helped stabilize me, but it wasn’t a magic fix. My parents gave me a safe place to land, and my partner showed me that I wasn’t alone in this. Every setback taught me something new about myself and what I needed to heal.

There were days when progress felt slow, but looking back, I can see how far I’ve come. Recovery isn’t about perfection; it’s about persistence. Each small step added up to a path forward.

Today, I’m not just a social worker. I’m a partner, a friend, and someone who lives with mental health challenges. Those challenges don’t define me, but they’ve shaped me in ways I’m proud of. I’ve learned that joy and pain can exist together, and that’s okay.

If you’re reading this and struggling, I hope my story helps you see that it’s okay to ask for help. Your mental health matters just as much as your physical health. Asking for help isn’t a weakness; it’s an act of bravery. Recovery is possible, and you don’t have to do it alone.