Welcome back to the Pain Science Education Podcast with Walter Midkiff And The Honorable H. Lee Harrell

Dive into the transformative power of Recovery Courts as we explore the groundbreaking integration of exercise into addiction recovery programs in this episode. Dr. Joe Tatta welcomes Walter Midkiff and The Honorable H. Lee Harrell as they share their pioneering work in implementing Recovery Fitness as part of recovery court programs. Discover how exercise not only aids in substance use recovery but also enhances physical and mental well-being, fostering a supportive community and empowering individuals to overcome challenges and build resilience. Join us as we look into success stories, challenges, and the potential for expanding this innovative approach to fuel positive outcomes in recovery programs nationwide.

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Transforming Recovery Courts With Exercise To Support Substance Use Disorders With Walter Midkiff And The Honorable H. Lee Harrell

It’s great to be joining you again. In this episode, we are discussing the concept of Recovery Court. Recovery Court has been used around the United States to help people overcome substance use. However, one of the challenges with Recovery Court has been connecting people to services that not only help them with substance use but also improve their physical and mental well-being.

We know based on scientific evidence that exercise helps people with substance use, as well as improves people’s physical and mental wellbeing. My guests are doing just that. Walter Midkiff and the Honorable Judge Lee Harrell have come together to integrate fitness into addiction recovery, which is called Recovery Fitness and is a part of Recovery Court. They’re seeing some amazing results with their participants.

In this episode, we’ll discuss the concept of Recovery Court, and how to integrate fitness at the community level to fuel recovery. Without further due, let’s learn about how to use fitness to fuel the positive outcomes in Recovery Court and give a big welcome to Walter Midkiff and the Honorable Lee Harrell.

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Welcome to both of you.

Thank you. It’s good to be here.

I gave people a little bit of an introduction to both of you so people have a little bit of background on who both of you are and some of the great work that you’re doing. I want to get the backstory here though before we dive into where both of you are now and how you’ve collaborated.

Recovery Fitness

The best place to start with that is with Walter. Walter, you have a background in fitness and health education. Even when I look at the literature and the research behind the area of exercise for things like addiction and mental health. It’s still relatively new, so the things you’re doing are cutting-edge. How did you come to develop what you call Recovery Fitness?

It happened by happenstance. I have been involved in fitness and nutrition my entire life. I say for many years, I’ve done some fall fitness coaching, nutrition coaching, teaching, and some sort. Judge Harrell approached me one day and asked if I would come and lead some exercises for his recovery court group. I said, “Sure, why not?”

I was doing another job and one afternoon I came over. We did some exercises and they enjoyed it. He said, “Why don’t you come back?” I came over and they enjoyed it again. We got to talking about it and said, “This could be something. This is affecting them. We need to dive deeper into it.” That’s when the idea of recovery fitness started to how fitness affects their recovery from substance abuse. It grew from that. We started doing this in other recovery courts and other groups in the community. Showing them how fitness helps their recovery and it got successful enough. I quit my job and I’ve started a nonprofit foundation and this is what I do now.

I’m assuming this evolved over a period of time that you developed some framework to the program that guides you in the things that are the interventions that you’re using.

It was a slow start to that and it’s always evolving. We start with the basics of fitness and how it affects them like, “This is what you’re doing in fitness. This is how it makes you feel better.” You’re releasing endorphins in your body. You’re releasing dopamine. You feel better because of the things you did yourself. You don’t have to go out and find those substances in other places.

You can make yourself feel better through fitness and that’s the basis of what we start with. It’s just evolved from there. We teach more lessons as we go about getting to the threshold where dopamine is released. A community coming together and working out together and helps them to be more physically active and to push a little harder than what they were going to do. We go through a process every week just so they can build on what they’ve learned.

It’s great that you’re talking about some of the neuroscience science behind that. That double hit of dopamine from 1) exercise, and 2) being in the group together is important. A lot of people don’t realize that group aspect combined with the exercise oftentimes is the special recipe. Especially for populations where people have substance abuse or there may be a mental health condition like depression that is also impacting their recovery.

We’re working out together and you’re pushing harder because you have your friends there and we’re doing partner workouts and team workouts. We’re playing music, which helps you go a little longer in it. It helps you feel better when you’re doing it. We are exercising at higher intensities and that helps too.

That’s a good point, you’re exercising at a higher intensity. There is some good research that the moderate to high-intensity levels are what impacts people’s brain health in a positive way.

That’s where our focus is high-intensity workouts.

Recovery Court

Judge Harrell, why don’t you hop in or tell us how Recovery Fitness became Recovery Court?

We have had Recovery Court for quite some time. We started it in 2016. It is a program that is allowed under Virginia’s criminal justice system to divert individuals who might otherwise go to prison. The easiest way to think about it is an extremely intensive form of probation. The goal here is a total reformation of the person who focuses on their treatment, getting help, and recovered.

During the pandemic, we struggled because we were not able to meet as a group and missed out on what you were talking about, that socialization. When that started to clear up, I was very anxious to get our group back together. Walter and I were good buddies. I just reached out to him because I knew he could help. I also did know for myself, personally, that my mental health and my ability to deal with pain are intricately linked to my physical fitness.

I’m always better when I’m physically fit. I knew that this was a component that was missing in recovery. We’ve spent a lot of time working on the mental aspects. Mental health, recovery, and substance abuse disorder are all interlinked. Almost everyone I work with in recovery court has some issue related to mental health, but what was missing was physical fitness. We had these folks who had completely ignored the physical side of themselves for decades. It was the hope that we could kill two birds with one stone by bringing us together as a group and doing something positive. Also, taking advantage of that physiology and neurobiology that you all are talking about. It’s over my head.

It’s exciting for me to hear this because I live in New York State. I’m not aware of a similar program if there may be one in the state here. It sounds like this is an alternative that the participants in your program are segued into this recovery court. Are they receiving other services during this time?

Yes, they have a rigorous treatment service through our Community Services Board. Everyone who goes in will have an evaluation of their substance abuse disorder. They’re going to receive individualized treatment and group treatment. Sometimes in-patient before they start with us. It depends on where they are in terms of their recovery. That’s always been the primary thrust of this program is treatment and what we even out was the physical fitness side of it.

They’re receiving the counseling aspect of it, either before and/or during. Now you’re bringing in the body aspect of it, so to speak.

They are under a lot of strictures in our program. They are under the supervision of the recovery court team, which means their location is constantly monitored through digital tracking. They’re subject to constant screening and testing for controlled substances. They’re required to attend narcotics anonymous meetings two a week. They have to have whatever stage of their treatment. They have to comply with that and they meet with us two times a week in the basement of this courthouse and work out.

Inside The Program

That was my next question, where is the actual recovery fitness taking place? What does that look like? Is there a built-out gym with nice equipment? Is it more mats and some dumbbells? What’s happening with the actual fitness component of it?

It started in this courtroom. On the first day, we did body weight exercises then I started bringing dumbbells and kettlebells. Anything I had at my house, I started bringing and I showed up in my Subaru. I packed it full and we put it right in the courtroom. We put the tables and the chairs off to the side. We just worked out in the courtroom and sweating on the carpet. It evolved. The county got behind us and they supported it. They gave us some funds. We cleaned out a room in the basement. Put rubber mats down and we have exercise equipment. A plethora of dumbbells, kettlebells, and pull-up bars. We have a fully kitted-out gym downstairs now.

How many people are in the gym at one time?

Including some kids that show up, they participate in this. Local attorneys come and participate. The county administrator is there every day working out and volunteering at his time. We’ve probably got 20 to 30 people down there shoulder-to-shoulder working out.

You have members of the community who realize that this recovery program is going on and they join them as part of the overall social aspect. It’s important because that takes the stigma out of what the participants are potentially going through in their recovery process.

Agreed. We had one of our participants’ mother working out with her own great-grandson. We had a great-grandchild and a great-grandmother working out that weren’t even part of our program. They’re just there.

I know that’s how you met our colleague, Professor Rose Pignataro, correct? I know he’s come into the gym and worked out with you. I believe she’s going to potentially do some research for the program.

She came and worked out with us. She had a great time.

You have a physical therapist in the gym working out with everyone. I’m assuming it sounds like it’s obviously probably a gender-diverse group of people and multicultural. All walks of life are coming into the program.

Everyone that comes into this program has been charged with a felony. The code of Virginia doesn’t allow people charged with violent felonies to come into our program, but it doesn’t have to be limited to drug crimes. There are people in our program who are charged with property crimes that are usually associated with their substance use disorder larceny and shot puttings.

The goal is at the completion of the program, which typically takes about eighteen months and their charges will be dismissed when they graduate. That’s our goal. There was something I wanted to tell you about related to the equipment and where we’re getting that from because it’s so exciting. You are probably familiar with the opioid settlement that occurred nationwide.

That money has now been released to the states and Virginia got over a billion dollars. The county we’re in now, where Recovery Court occurs. They used a portion of their money to buy us equipment. We have some terrific equipment down there. Top-of-the-line stuff from Rogue. It’s such a wonderful irony that that money came from the opioid settlement. It’s heartwarming to see that money being used to help these folks.

That’s a wonderful use of money. I know a lot of money has segued into covering legal services and legal help. I love that they’re using it for the direct treatment, care, and recovery of people with substance use and things like chronic pain, which oftentimes these are overlapping. Is chronic pain something that you recognize in this group that you’re working with?

Every day. Every participant comes in with some pain. I don’t want to use the word excuse, but a reason why they don’t think they can participate. Things that are going on, “I’ve got CDOPD. I can’t do pushups because it hurts where I got shot. That was a new one for me. These ailments that I have. I can’t, my chest hurts because I dropped a transmission on my chest at work. I fell out of a tree. I got a chainsaw injury.”

They have ailments of all types that they deal with. Working through those pains that they have and trying to figure out what’s best for each individual during that workout could be a challenge. They’ve learned that they’re going to come in and they’re going to work. I might modify it. Judge Harrell might do 300-pound deadlifts and they might be picking up an 18-pound kettlebell but we’re all going to work together. We’re all going to do very similar movements. It’s just all scalable and we’re going to listen to our bodies. They’ve learned that they can do it. No matter what’s going on, they can push and they can get a little more from their body than they thought they could.

Success Stories

We know that both addiction and pain recovery have an emotional component that is part of the recovery process. Maybe you can give us almost like a case study. You don’t have to mention names, but what this looks like for someone’s success story, if you will, of how you’ve seen someone change. When we say change, people change physically, emotionally, and psychologically. Even change spiritually when they go through addiction and pain recovery processes.

A good one that sticks out as a young man we have in one of our recovery courses. When he first started, he was honestly full of excuses for why he couldn’t do things like, “I need my inhaler. I can’t run. I need this. I can’t do that.” Through this process of pushing a little harder each day and getting a little better over 6 or 9 months, he’s learned that he can. I haven’t seen him pick up his inhaler in months. I haven’t seen him come up with an excuse why he can’t do things.

He’s picking up the 55-pound kettlebell instead of the 20-pound kettlebell. He’s doing push-ups and pull-ups. He’s asking me if we can bench press. Some things that he thought were holding him back, he’s learning that it’s an excuse in his head. This has helped him become a better person inside and out. He’s challenging himself more because of what we’ve been doing.

That confidence building that is so lacking in them when they come in. They’ve been stigmatized by our culture here and been told that they’re no good, that they’re castaways. Having them pick up weights, most of them have never done it. They’re terrified to do it. When they do it and start to see that success and that they can. That confidence and belief in themselves is not just about, “I picked up a barbell.” It’s, “I can do something I didn’t think that I could do, and I did this myself.”

This is a real skill-building process that’s happening here. You mentioned this quite well so far. People think they can’t move and can’t exercise. They can’t do things physically. When you take them through this process, they look back and say, “I overcame that challenge.” The research shows that’s what’s called self-efficacy. It tends to flow over into other aspects of their life meaning their personal relationships improved. They now go out and look for meaningful work. Maybe they go back and get a certificate or education, but have you seen that happen with the participants in your program?

It has translated across the board and everything they do. When their physical health starts to improve and socialization begins to improve, they get excited about their lives in a way that they haven’t been before because their lives have been just substances. That’s what they’ve been doing and some of them for decades. We have a guy in our group who started using when he was thirteen years old. Up until his joining our program, he had never had a day of sobriety. Now, he’s over 100 days sober with us.

Systemic Challenges

That’s such a success story. It’s tremendous. There are probably some challenges and barriers that show up here as well. You mentioned a couple like interpersonal challenges, if you will. Are there more systemic challenges that the two of you as professionals have come up against or that you’d like to maybe see change so that this type of program could expand not only in your state but potentially to other states?

People think we’re nuts. As you said, I don’t know if anybody else is doing this. It’s pretty unusual to have this level of interaction with criminal defendants. It doesn’t happen in the criminal justice system, but I don’t think it’s possible to do this without that interaction. We run into relapse a lot. Relapse is probably our biggest systemic problem. It’s just dealing with relapse and trying to work through that. The fact that they now have Walter whom they trust, believe in, and has helped them. It gives an outlet. It’s another person that they can turn to when they are struggling. Developing those relationships, that trust, and that socialization has been important. I don’t know what other barriers you’ve seen.

Getting the word out because what we’re doing is different and people are afraid of different things. People are afraid of lifting weights. They don’t think that they can do that and they don’t think others should be doing that. We want this to be more mainstream. Fitness is part of life. Being in good physical health is part of everyone’s life. We want to give them that opportunity. If we can get the word out to make this more mainstream and everybody’s recovering. Not just recovery court, but anybody out there that can learn, “Wherever I’m at, fitness should be part of my life and it’s going to help me.” That’s a big thing for me.

I was going to say, people have said, “I’m going to get hurt.” My answer to that is, “You might.” Injury is always a possibility when you’re exercising but you’re going to get hurt a lot worse if you don’t exercise, don’t use your body, and don’t put your muscles to work. You’re going to hurt yourself a lot more. Getting over that fear or gym fear, is what I call it. I’m sure there’s another term for it, but that’s been a barrier for us. Trying to convince people, “You can do this.”

Always a mental component when it comes to movement in people who haven’t moved for a long time. When they have injuries, oftentimes, they’re what’s called fear-avoidant. It means they have this fear and it causes them to avoid movement. All the things you’re saying are well-detailed and completely supported by evidence.

You just have to put it in a completely different context. It’s interesting to me because as I listen to you talk about this. It’s amazing that you have this first recovery court fitness component. There are things like this that exist in some of the VA circles, the Veteran Administration with wounded warrior projects. I’m surprised that some of that has spilled over into the judicial system. I think that’s the right term. Correct, Judge?

I’m not aware of it though, but I would like to see it expanded. Virginia has started some trial mental health courts where it isn’t limited to substance abuse, but other mental health issues. The relationship, I’m sure you know, between mental health and criminals is intricately tied together. There are plenty of people out there who suffer from mental health issues. They get tangled up in the criminal justice system that doesn’t involve substance abuse. Virginia has started some mental health courts in the larger jurisdictions. This would be great for them to do something like what we’re doing.

I imagine there’s a funding piece to this that has to be accounted for on a state level.

Funding is an issue. That’s for sure. I meet people all the time, different groups, NA groups, and recovery courses that think this is a wonderful idea, but there’s no funding out there. We have to fund it, buy equipment, and travel.

The opioid settlement has opened a lot of doors in that regard. I’m hopeful that other jurisdictions can take advantage of that money as it flows out and try new things and different things. It doesn’t have to be this. It’s so clear that what’s been tried in the past, doesn’t work. We haven’t found anything that has worked and history shows that.

The cycle of incarceration, probation, and reincarceration is a death spiral for anyone. It simply doesn’t work. It doesn’t help the taxpayer. It doesn’t help the community. Locking someone up because they possess drugs for six months then letting them out and putting them on probation. They come back within three months. It’s not good for anyone. We have to find a different way to handle this issue. That’s what we’re trying to do here. Try something new and something different.

We have an ongoing conversation here in the show about innovation and pain care, meaning we have all these skills, tools, and knowledge. We probably don’t use all of them. All of us do things on a regular basis that we’ve been doing for years. Some of those things work well and for some of them, we need to just blow up the system and start something completely new. Which is what both of you are doing, which is wonderful.

Starting A Recovery Program

I encourage, as people read this, to think about how you can do something new and innovative such as Recovery Court or Recovery Fitness. What are your recommendations? Let’s say a health professional or a legal professional who wants to enter into this, develop a program, or start to explore this. If it is a possibility in their community, how would you recommend that they go about starting that?

Something similar to this. It takes a little bit of gumption, but I would reach out to community organizers. We’re lucky where I am now, which is Giles County, Virginia. The county administration has been so supportive of this notion and this idea. That has been extremely helpful. I’m not sure we could function without them.

Bringing someone in like Walter who has the charisma personality and certifications, the know-how to do it is also appealing. We’re offering free workouts for people. We’ve tried to make it fun and get exposure within the community and get the community behind us. The Rotary Club here in Giles bought every single member of our group Adidas or Nike Shoes and had sweatshirts made for us. That was an example of them stepping forward and supporting us. I don’t know if you have any thoughts.

If somebody wants to get started, give me a call. Honestly, I would love to help spread this all over the country. No financial gain for myself. I want to help spread what we do. Please, reach out.

We think this works. It sounds like a risk. I would love to see some outcomes on it. Tracking things like fitness outcomes, mental health outcomes, and mental wellbeing outcomes. People love to see the statistics and the data behind what’s happening.

We’re working on that. We’re getting some numbers. We’ve seen a drop in relapse. We know we have. We don’t have the numbers now, but we have. We had a young lady write a letter. We saw it and she was sober for two years. She said, “All I was doing was not using. I wasn’t healing.” She sees the difference now. There’s a difference between not using substances and healing. That’s what we’re seeing, is a difference. They’re not white-knuckling it and holding on as long as they can. They’re changing and this has been a big help.

Whenever you bring movement of any kind into a program, it becomes more of a whole person approach, an active approach, and more of a holistic healing environment for people, which is exactly what you’re describing. Walter and Judge Harrell, it’s been great speaking with both of you. I love the idea of recovery fitness and recovery court. If people want to reach out to you, learn more or connect with you and talk to you, how can they do that?

My website would be the easiest way. It’s just RecoveryFitness.org. We also have a very new Facebook account, it’s Recovery Fitness. They can find me there. The website’s a good one. Thank you.

No one wants to come and see me, so just contact Walter. If you come to see me, it’s probably because you’re in trouble.

I’m assuming other legal professionals may want to connect with you and figure it out.

The best place to get in touch with me is to contact the Circuit Court Clerk’s Office in Giles County and they’ll put you through to me. If somebody has any questions about what we’re doing here, Walter also can get in touch with me. I’d be happy to talk to anybody who’s interested in trying to start a program like this because I do believe, and it’s been very beneficial.

We will link the link you just mentioned. It’s RecoveryFitness.org, I believe was the link. You can reach out to both Walter and Judge Harrell there. We’ll also link to the court information that you gave us as well. If you’re reading this episode and you’re a health and wellness professional or maybe you’re a legal professional, make sure to share this with your colleagues who have an interest in recovery fitness or recovery court.

Please reach out to Walter and Judge Harrell and connect with them, see what they’re doing, and how you can bring it to your community. Every community in the United States has been impacted by addiction, especially by the opioid epidemic. It has an interconnection with pain recovery and mental well-being. Again, I want to thank you gentlemen for being on the episode. I’m Dr. Joe Tatta and we’ll see you in the next episode. Take care.

Important Links

• Walter Midkiff on LinkedIn
• Professor Rose Pignataro
• Recovery Fitness
• Recovery Fitness on Facebook
• Circuit Court Clerk’s Office

About Walter Midkiff

Walter graduated from Emory & Henry College in 2005 with a BA in Physical Education and Health. He received his master’s degree from Grand Canyon University in 2012 in Education Administration. Walter taught physical education and health in the Virginia public school system for 12 years. Coached various varsity sports during this time and officiated NCAA volleyball for 8 years. He is currently a CrossFit Level 2 instructor. Walter founded Recovery Fitness in 2022. Recovery Fitness helps those dealing with substance abuse use fitness to help fuel recovery.

About The Honorable H. Lee Harrell

Lee Harrell is a judge in the 27th Circuit of Virginia’s circuit courts. He was appointed by Virginia’s General Assembly to the bench in 2013 after serving as a local prosecutor. He received his doctorate of law from William and Mary and holds a master’s degree in biology from Wake Forest University where he also completed his undergraduate degree.