WEBVTT 00:00:00.418 --> 00:00:07.946 - All right, so without further ado, Ashley Collins, so thank you so much for being here. This is a spring 00:00:07.946 --> 00:00:15.259 - care, Monroe County CARES community meeting. I'm Lee Muser, the CARES coordinator, and Ashley Collins 00:00:15.259 --> 00:00:22.859 - is giving her time today to present to us on substance use disorder 101, what you didn't know. All right, 00:00:22.859 --> 00:00:23.934 - thanks Ashley. 00:00:24.674 --> 00:00:32.142 - Thanks. Yeah, of course. Thanks, everyone. If any of you guys already know me, know I love like nerding 00:00:32.142 --> 00:00:39.539 - out about the topic of substance use disorder is one of my topics I love to nerd out about. So my name 00:00:39.539 --> 00:00:41.406 - is Ashley Collins. I am a 00:00:41.634 --> 00:00:49.476 - I'm a licensed clinical social worker and the director of adult and family services here at Centerstone. 00:00:49.476 --> 00:00:57.317 - I'm over the West region, which includes Monroe and then the Spoke counties around it, which are Morgan, 00:00:57.317 --> 00:01:05.159 - Owen, Lawrence and Brown. So I'm going to dive into this and so yeah, definitely jot down your questions 00:01:05.159 --> 00:01:11.582 - as you have them so that I can get to them, but I'm going to be talking kind of fast. 00:01:12.194 --> 00:01:19.993 - What is addiction? It is a chronic, often relapsing brain disease that causes compulsive drug seeking 00:01:19.993 --> 00:01:27.869 - and using despite those harmful consequences to the person using the substances and those around them. 00:01:27.869 --> 00:01:36.279 - Drug use changes the structure and function of the brain. And you're going to hear me repeat that frequently. 00:01:36.279 --> 00:01:42.014 - And so a lot of times people are like, well, they had a choice. Initially, 00:01:42.786 --> 00:01:48.939 - they, most of the time people have a choice, although I have definitely worked with people that their 00:01:48.939 --> 00:01:54.972 - first use was not their choice. But most of the time it is. However, what ends up happening is that 00:01:54.972 --> 00:02:01.125 - use then changes the structure and function of their brain and it's no longer a choice anymore. Their 00:02:01.125 --> 00:02:07.338 - brain's telling them they're going to die without that substance. And we're going to dive a little bit 00:02:07.338 --> 00:02:11.742 - deeper into how addiction affects the brain in a little bit. And so what 00:02:12.002 --> 00:02:20.405 - is a drug. A drug, it's important to realize there are legal and illegal drugs. So it's really any substance 00:02:20.405 --> 00:02:28.268 - that is absorbed into your body that results in psychological and physiological changes. So I'm going 00:02:28.268 --> 00:02:36.208 - to go over a little bit in terms of like the categories that this falls into. So we're going to review 00:02:36.208 --> 00:02:40.062 - a little bit of each one of those. So depressants 00:02:40.674 --> 00:02:48.550 - do what it kind of says, it depresses, it slows down your central nervous system and reduces arousal 00:02:48.550 --> 00:02:56.426 - or stimulation. One of the most common legal ones is alcohol. We also have benzodiazepine, which are 00:02:56.426 --> 00:03:02.430 - generally prescription drugs, although we're going to go over something that 00:03:02.722 --> 00:03:09.983 - there are now benzos that are not pharmaceutical grade. But historically, benzodiazepines have always 00:03:09.983 --> 00:03:17.386 - been pharmaceutical grade medications generally prescribed to treat anxiety. I refer to people, I refer 00:03:17.386 --> 00:03:24.576 - to benzos to people as alcohol in a pill form. It's very similar. If you like one of the substances, 00:03:24.576 --> 00:03:29.630 - you pretty much like the other. And while there's no research on this, 00:03:29.730 --> 00:03:35.703 - whatever reason, when you combine the two, people rack up a lot of theft charges. Something 00:03:35.703 --> 00:03:42.195 - about benzodiazepine and alcohol giving people sticky fingers. There's no research that shows this, 00:03:42.195 --> 00:03:48.752 - but if you're in this field long enough, you will absolutely see that correlation. There's also GHB, 00:03:48.752 --> 00:03:54.206 - kava, other things that fall into that category. Then we have stimulants. So that's 00:03:54.370 --> 00:04:02.852 - The other side of the spectrum in terms of depressants are depressing your central nervous system, stimulants 00:04:02.852 --> 00:04:10.639 - are speeding up your central nervous system. So we have amphetamines, which are pharmaceutical grade 00:04:10.639 --> 00:04:19.198 - medications that are generally prescribed for ADHD. Then you have methamphetamine, you have crack and cocaine, 00:04:19.458 --> 00:04:26.564 - and then nicotine and caffeine, which are completely legal substances. I do want to take time to talk 00:04:26.564 --> 00:04:33.809 - a little bit about methamphetamine here. Methamphetamine, the way it's being made now is very different 00:04:33.809 --> 00:04:40.776 - than how it was. When I first came in in this field, methamphetamine was frequently being cooked in 00:04:40.776 --> 00:04:46.558 - people's backyards, in their homes, and that. So what ended up happening, how this 00:04:46.786 --> 00:04:53.117 - Why is it cooked differently and this is this is the chain reaction of events well. One of the things 00:04:53.117 --> 00:04:59.323 - that where people were able to make it in their backyards and stuff was access to pseudo ephedrine. 00:04:59.323 --> 00:05:02.302 - Pharmaceutical like you get it at the pharmacy. 00:05:02.402 --> 00:05:08.771 - They're all over the counter now. Now you have to like give them your license and all of that. So we 00:05:08.771 --> 00:05:15.076 - put things in place where people cannot unlimitedly access pseudo phedrine any longer. Because what 00:05:15.076 --> 00:05:21.508 - they would do with the pseudo phedrine is they cook it and do chemical reactions to cook it down into 00:05:21.508 --> 00:05:26.174 - a phedrine. So what we had was methamphetamine that was a phedrine based. 00:05:26.306 --> 00:05:33.257 - Now, that's not the case because we put things in place in the United States to stop people from having 00:05:33.257 --> 00:05:40.275 - access. Well, folks in Mexico were like, this is great. They can't make all of their own stuff. So we're 00:05:40.275 --> 00:05:47.159 - going to make it for them. So then we saw that there was that shift. Right. So the United States works 00:05:47.159 --> 00:05:54.110 - with the Mexican government to be like, hey, we need to work on stopping to allow people to have either 00:05:54.242 --> 00:06:02.383 - accessing precursors to make ephedrine or ephedrine itself. So they crack down on that. Then the people 00:06:02.383 --> 00:06:10.681 - that are cooking the methamphetamine are like, well, what do we do now? They went back to using a cooking 00:06:10.681 --> 00:06:18.743 - method called P2P method. This used to be used back in the 80s and 90s when biker gangs were in charge 00:06:18.743 --> 00:06:22.814 - of the methamphetamine distribution in our country. 00:06:23.202 --> 00:06:30.122 - What you get when you do this 2P2, there's some perks in terms of cooking it like this. A, using the 00:06:30.122 --> 00:06:37.042 - P2P method, you can make significantly more amounts of methamphetamine. And two, you can interchange 00:06:37.042 --> 00:06:44.167 - different ingredients. So say if like one of the ingredients you're using, they put stop gaps so you're 00:06:44.167 --> 00:06:49.374 - not able to access that, you can change that out for some other chemical to 00:06:49.666 --> 00:06:56.336 - do the same thing. So what happens when you're cooking it this way is you have two products at the end. 00:06:56.336 --> 00:07:03.005 - Those names are really, really long. But basically you have the stuff that gives you that euphoric high 00:07:03.005 --> 00:07:09.739 - that people, why they like to use methamphetamine. And then you have this garbage that just really super 00:07:09.739 --> 00:07:15.768 - speeds up your central nervous system. And that is the crap that's causing skyrocketing rates 00:07:15.768 --> 00:07:18.846 - of methamphetamine induced psychosis right now. 00:07:19.074 --> 00:07:27.159 - there's a lot of issues that are occurring with that, but you see that shift. In fact, in a book, I 00:07:27.159 --> 00:07:30.878 - read somebody who was in the military, he had 00:07:31.714 --> 00:07:37.978 - been using methamphetamine it actually he had trauma before he went to the military when the military 00:07:37.978 --> 00:07:44.303 - had more trauma than when he came out he would use methamphetamine to be able to socialize with people 00:07:44.303 --> 00:07:50.567 - because if he wasn't on methamphetamine he was locked in his apartment not talking to other people so 00:07:50.567 --> 00:07:56.708 - he went from using methamphetamine as a way to socialize with other people to one day he's using it 00:07:56.708 --> 00:08:00.638 - and he's like I know exactly the date that the meth changed and 00:08:01.026 --> 00:08:07.213 - He went from being able to socialize with people to a little bit further down the road. He's ripping 00:08:07.213 --> 00:08:13.461 - out the drywall in his apartment because he's convinced his girlfriend has hidden a man in the walls. 00:08:13.461 --> 00:08:19.954 - That is the difference in how it's responding to the same person being cooked in those different manners. 00:08:19.954 --> 00:08:26.692 - So I did want to talk about that because I get a lot of questions about that and that's helpful to understand 00:08:26.692 --> 00:08:28.958 - that background. So we have opioids. 00:08:29.090 --> 00:08:36.855 - One of the things I want to talk about here is the word opiate versus opioid. So opioid is this umbrella 00:08:36.855 --> 00:08:44.397 - term that includes having semi-synthetic, synthetic, and then opiates, which are natural opioids such 00:08:44.397 --> 00:08:52.088 - as heroin, morphine, and codeine. So these come from the opium poppy plant. So it includes all of them. 00:08:52.088 --> 00:08:58.078 - So when you hear opiates, you're talking mostly about heroin, morphine, codeine. 00:08:58.274 --> 00:09:05.074 - If you say opioids, you also have like fentanyl, any of the semi-synthetic things are also included 00:09:05.074 --> 00:09:12.010 - in that. So there's a lot of knowledge out there about opioids, so I'm not going to spend a whole lot 00:09:12.010 --> 00:09:18.946 - of time on this, but know like this is really serious, especially with fentanyl, carfentanil, all the 00:09:18.946 --> 00:09:23.774 - different opioids that are coming out. Psychedelics and hallucinogens. 00:09:23.970 --> 00:09:32.470 - have their class of psychoactive substance that produce change in perception, mood, and cognitive processes. 00:09:32.470 --> 00:09:40.267 - So the primary purpose is to trigger a non-ordinary state of consciousness, which people frequently 00:09:40.267 --> 00:09:48.143 - refer to as TRIPS. And again, you have multiple different things that fall under that. Cannabinoids, 00:09:48.143 --> 00:09:51.262 - I think everyone knows about marijuana. 00:09:51.362 --> 00:09:58.983 - What I want to take a moment to talk about here is spice, is synthetic marijuana. It started out as 00:09:58.983 --> 00:10:06.833 - synthetic marijuana. What it is now, I don't feel like it should be called cannabinoid anything. A lot 00:10:06.833 --> 00:10:14.606 - of times people are having really crazy reactions. They're similar to people being on bath salts. You 00:10:14.606 --> 00:10:17.502 - guys remember bath salts for a while. 00:10:17.922 --> 00:10:26.211 - Spice anything that's like considered Synthetic marijuana is now frequently causing really high fevers 00:10:26.211 --> 00:10:34.338 - like lots lots of issues that we're seeing with this and what I will say is I feel like I the active 00:10:34.338 --> 00:10:42.385 - ingredient the most active ingredient I've been aware of is they're using like hornet insect Killer 00:10:42.385 --> 00:10:47.294 - on this like on this stuff like that's awful for sure and so 00:10:47.682 --> 00:10:54.758 - What I will say is there's some people that have been heavily using spice that I feel like they never 00:10:54.758 --> 00:11:01.695 - return to the same person because of the chemicals that are in there. And I see some people nodding 00:11:01.695 --> 00:11:09.534 - their heads as like anyone that's experienced this. I think this is long lasting brain damage that it's causing. 00:11:10.370 --> 00:11:20.649 - So then we also have dissociatives. So this is characterized by distorting sensory perceptions and feelings 00:11:20.649 --> 00:11:30.358 - of disconnection or detachment from the environment or self. So ketamine, PCP, DXM, nitrous oxide are 00:11:30.358 --> 00:11:33.118 - some of those dissociatives. 00:11:34.018 --> 00:11:42.523 - And lastly, we have empathogens. So these really increase an individual's feelings of empathy and benevolence 00:11:42.523 --> 00:11:50.332 - towards others and increase those feelings of wanting to be social, feeling connected to others. You 00:11:50.332 --> 00:11:56.286 - have the EM or ED, I'm sorry, blah, MDMA. And now, you know, seeing how that 00:11:56.514 --> 00:12:03.161 - all spelled out. That's why they call it MDMA. Could you imagine if you had to say that whole word that 00:12:03.161 --> 00:12:09.872 - whole time? So there's lots of different street names for this. Ecstasy, Molly, E, Flippers, Caps, Ekis, 00:12:09.872 --> 00:12:16.583 - M&Ms. Some people like a certain brand with a certain, a lot of times as you see in the picture, there's 00:12:16.583 --> 00:12:23.230 - certain stamps that are put in there and be like, this is the Bluebird. So like also you have different 00:12:23.586 --> 00:12:31.874 - variations called that based on like what it is. I'm sure like these things are called dominoes. This 00:12:31.874 --> 00:12:40.487 - is probably called skull, you know, so on and so forth. We also have bath salts and PMA, PMMA, and things 00:12:40.487 --> 00:12:43.006 - like that. So I also wanted to 00:12:43.234 --> 00:12:50.336 - to touch on some of these more emerging drug trends that you're seeing. So everyone knows about fentanyl. 00:12:50.336 --> 00:12:57.171 - What I want to hit on in this slide is historically when we're talking about naloxone, we were always 00:12:57.171 --> 00:13:03.938 - trained you give naloxone to somebody that's using opioids. I tell people now you're giving naloxone 00:13:03.938 --> 00:13:07.422 - to anyone that's using any substance you don't know 00:13:07.682 --> 00:13:15.948 - what is in it. So there's a lot of times we've had overdose deaths with people who were intending to 00:13:15.948 --> 00:13:24.459 - just use methamphetamine, but fentanyl was in it. And so you're seeing more and more fentanyl is pretty 00:13:24.459 --> 00:13:32.643 - much in any substance that's out there right now. Warning, this is graphic. Xylazine, also known as 00:13:32.643 --> 00:13:35.262 - Trank Dope, Benzo Dope. This is 00:13:35.522 --> 00:13:43.011 - really horrible stuff. Number one, it's bad because this is not an opioid. This is a veterinarian 00:13:43.011 --> 00:13:51.265 - tranquilizer. It was never meant for human consumption. There's no studies on human consumption. Therefore, 00:13:51.265 --> 00:13:59.212 - we weren't really sure what we were going to see. Now we know one of the worst side effects is the fact 00:13:59.212 --> 00:14:04.638 - that you have this kind of flesh grossness that's causing skin ulcers. 00:14:04.738 --> 00:14:11.720 - that can become necrotic requiring amputation. People that are using xylazine are losing their hands, 00:14:11.720 --> 00:14:18.838 - their feet, their legs, their arms. Now, one of the things to know about this is I think a lot of times 00:14:18.838 --> 00:14:26.025 - people just assume that, like for instance, this person must have been shooting up in their legs. That's 00:14:26.025 --> 00:14:32.254 - not necessarily accurate. In fact, a lot of times, regardless of where you're shooting up, 00:14:32.386 --> 00:14:40.566 - It's showing up on your limbs, on your arms, on your hands, on your legs, on your feet. It's very rare 00:14:40.566 --> 00:14:48.825 - for it to show up in the trunk of your body. If it is showing up, that may in fact be an injection site 00:14:48.825 --> 00:14:57.164 - where that's happening. And I wanted to show you, this is somebody that went into one of our facilities. 00:14:57.164 --> 00:15:01.214 - And as you can see, this gets like really hard and 00:15:01.410 --> 00:15:09.514 - It goes down deep too, because it's almost like eating you from the inside out. This is what these two 00:15:09.514 --> 00:15:17.539 - indicators here, this is what it looks like before it becomes an open wound. So I would say within 24 00:15:17.539 --> 00:15:25.721 - hours, this is going to be an open wound. So it almost looks like kind of like a little bruise, a small 00:15:25.721 --> 00:15:30.206 - abrasion, but that will in fact turn into an open wound. 00:15:30.338 --> 00:15:37.668 - In taking care of these things, the guidance really is to avoid alcohol, rubbing alcohol and hydrogen 00:15:37.668 --> 00:15:45.069 - peroxide because those two things dry it out. What you want when you have these wounds is to keep them 00:15:45.069 --> 00:15:52.830 - covered and keep them moist because as you see, this person wasn't putting any kind of protection on there. 00:15:53.218 --> 00:16:00.213 - infection is an issue but also when it becomes hard like this it becomes harder for your body to heal 00:16:00.213 --> 00:16:07.209 - so it almost is like that scab and again it goes in deep becomes almost like a cork and your body can 00:16:07.209 --> 00:16:14.204 - only heal so far because as you can see there's like pink granular tissue it's healing however it may 00:16:14.204 --> 00:16:21.200 - get to a spot where like you know there's there's still a line it's going deep and it's hard for your 00:16:21.200 --> 00:16:22.846 - body to heal that piece 00:16:23.138 --> 00:16:30.258 - So really clean it with soap and water, clean water. And I know like you and I are like, of course, 00:16:30.258 --> 00:16:37.378 - clean water. Tell your clients use clean water. If it's dirty water, then that increases chances of 00:16:37.378 --> 00:16:44.640 - infection. Cover it with something that isn't going to actually stick to it. So non-adhesive and then 00:16:44.640 --> 00:16:45.566 - wrapping it. 00:16:45.730 --> 00:16:54.888 - And if you do want to put something on it, they recommend using vitamin A and D ointment instead of 00:16:54.888 --> 00:17:04.596 - like neosporin. So if that's not bad enough, we also have metatomidine, which is very similar to xylazine 00:17:04.596 --> 00:17:13.846 - in the fact that A, it was never intended for human consumption. This is only veterinarian-based use 00:17:13.846 --> 00:17:15.678 - that's approved of. 00:17:16.098 --> 00:17:23.391 - This is less likely to cause wounds. However, it is found to be stronger and longer lasting sedative 00:17:23.391 --> 00:17:30.828 - than xylazine. And it's here. It's here in the state of Indiana. What I tell people when we're talking 00:17:30.828 --> 00:17:38.338 - about xylazine, metatomidine, and in a minute we're going to talk about some novel benzodiazepines that 00:17:38.338 --> 00:17:42.526 - are out there, if somebody looks like they're overdosing, 00:17:42.690 --> 00:17:49.427 - still give them naloxone. The likelihood that there's some kind of opioid in their system is really 00:17:49.427 --> 00:17:56.367 - high. What you might find, though, if they have xylazine, metatomidine, and any of these novel benzos, 00:17:56.367 --> 00:17:58.590 - they may not be coming like two. 00:17:58.722 --> 00:18:05.590 - The only thing you may be getting back is their breathing. They may still be unconscious because of 00:18:05.590 --> 00:18:12.458 - the sedative effect. So that's really important for you to know, which makes it even more important 00:18:12.458 --> 00:18:19.326 - for us to be getting medical personnel there to them immediately. And then we have Bro Mazelam. So. 00:18:19.682 --> 00:18:26.965 - This first appeared in the United States in 2019 since then it's skyrocketed in fact of like it's it's 00:18:26.965 --> 00:18:34.389 - being mixed into a lot of different things. It can be sold as tablets, powders, gummies, it's frequently 00:18:34.389 --> 00:18:39.550 - mixed with other opioids such as fentanyl. It's very similar like how it 00:18:39.714 --> 00:18:47.414 - reacts as other benzodiazepine. The effect occurs about 15 to 45 minutes after you've taken it. It lasts 00:18:47.414 --> 00:18:54.894 - about five to eight hours. All of these are very similar to any other benzodiazepine. But this is not 00:18:54.894 --> 00:19:02.887 - pharmaceutical grade. That's something that's really important to know about this. These are benzodiazepines 00:19:02.887 --> 00:19:08.094 - that are being made in drug cartel labs. This is not something that is 00:19:08.290 --> 00:19:15.688 - pharmaceutical grade whatsoever. And there's a whole bunch of other ones. So these are some of the other 00:19:15.688 --> 00:19:22.805 - ones we're starting to see in there. Now, what is really important to know about these things that I 00:19:22.805 --> 00:19:29.992 - just went over? All of these things, benzodiazepine, xylazine, metatomidine, and then opioids, all of 00:19:29.992 --> 00:19:33.022 - those have respiratory depressing impacts. 00:19:33.154 --> 00:19:40.079 - on something. So the more respiratory depressants you're putting in your body, the higher likelihood 00:19:40.079 --> 00:19:47.140 - you are to have an overdose. Something else that I just want to throw out there that's not really part 00:19:47.140 --> 00:19:54.476 - of this presentation, but something I've seen in, I sit on the Monroe County Suicide and Overdose Fatality 00:19:54.476 --> 00:19:58.590 - Review, is a lot of people take Benadryl not as prescribed. 00:19:58.882 --> 00:20:05.314 - You see a lot of people that die of overdoses that have a bunch of things in their system, some of which 00:20:05.314 --> 00:20:11.440 - is Benadryl. Benadryl, you can take enough to die. That's really important for people to understand 00:20:11.440 --> 00:20:17.565 - because I think some people are like, oh, that's over the counter. That Benadryl causes respiratory 00:20:17.565 --> 00:20:23.875 - depression as well. So the more things you're putting into your body that are respiratory depressants, 00:20:23.875 --> 00:20:25.406 - the higher likelihood of 00:20:26.466 --> 00:20:33.690 - of having an overdose. So what causes addiction? I wish it would be a simple answer. It's not, it's 00:20:33.690 --> 00:20:40.987 - complicated. So firstly, we have kind of the, oops, no, I'm looking at the right one. Okay, biology. 00:20:40.987 --> 00:20:48.717 - So this is more of like the nature piece of it, right? So we're looking at genetics. Children with parents 00:20:48.717 --> 00:20:51.390 - that have substance use disorder are 00:20:51.522 --> 00:20:58.151 - eight times more likely to be biologically predisposed to addiction. And that's not even taking into 00:20:58.151 --> 00:21:04.714 - consideration the environmental factors that they would be experiencing as well. Then you have your 00:21:04.714 --> 00:21:11.277 - brain structure. Substance use rewires your brain. If you have chemical imbalances before you start 00:21:11.277 --> 00:21:15.806 - substance use, that can impact addiction happening or not happening. 00:21:16.866 --> 00:21:24.744 - Then we have here, this is more of the nurture piece of things. So the age of experimentation, individuals 00:21:24.744 --> 00:21:32.770 - who tried marijuana or alcohol before the age of 15 were almost four times more likely to suffer a substance 00:21:32.770 --> 00:21:39.102 - use disorder than those that wait until 18 or older. And I know there's that good old 00:21:39.490 --> 00:21:45.960 - like fashion, like, oh, they're kids, they're going to experiment. You're like, yeah, don't experiment. 00:21:45.960 --> 00:21:52.492 - If you want to experiment, wait until your brain is more fully developed to do that. Because the earlier 00:21:52.492 --> 00:21:59.148 - you do that, the higher likelihood of developing a substance use disorder will be. You have peer pressure, 00:21:59.148 --> 00:22:05.556 - right? Family, friends, community, and even work environments can expose or protect you from substance 00:22:05.556 --> 00:22:07.422 - use. And then trauma history. 00:22:07.682 --> 00:22:14.520 - teens who've had experienced physical or sexual trauma were three times more likely to report substance 00:22:14.520 --> 00:22:21.226 - use. Behavioral patterns, right? We all have different behavioral patterns and that can either put us 00:22:21.226 --> 00:22:28.063 - on the side of protecting us or putting us at more risk based on what those are. Then this, I feel like 00:22:28.063 --> 00:22:35.098 - your psychology, that's kind of the combination of nurture and nature. Some individuals have more positive 00:22:35.098 --> 00:22:37.662 - or negative coping skills than others. 00:22:37.826 --> 00:22:44.298 - And a lot of times that's the caregivers you're around, whether it's your primary or not, are people 00:22:44.298 --> 00:22:50.961 - giving you healthy tools or negative tools to deal with issues. Whether or not you have a mental health 00:22:50.961 --> 00:22:57.561 - issue or not can contribute to whether or not you develop a substance use disorder. There's definitely 00:22:57.561 --> 00:23:01.598 - people that are more impulsive and thrill seeking than others. 00:23:01.730 --> 00:23:07.998 - Also looking at them at the locus of control. Is this somebody that constantly blames everything on 00:23:07.998 --> 00:23:14.642 - everyone else and takes no responsibility at all? Or the flip side where you blame everything on yourself 00:23:14.642 --> 00:23:21.160 - and taking on responsibility that is not yours and not putting the responsibility back on somebody else 00:23:21.160 --> 00:23:27.616 - that is their responsibility. The expectation of what drug use will lead to. This is something I'm not 00:23:27.616 --> 00:23:29.246 - necessarily proud of, but 00:23:29.378 --> 00:23:35.590 - My family, ironically, I will say this, there's a lot of alcohol use disorder in my family. But one 00:23:35.590 --> 00:23:41.864 - of the things they taught me was like drug use. It's horrible. It's awful. Little did I know until I 00:23:41.864 --> 00:23:48.075 - was much older, I was like, you guys were doing drugs too. It was just legal. So you thought it was 00:23:48.075 --> 00:23:49.566 - okay. But they're like, 00:23:49.858 --> 00:23:56.134 - drugs will lead to bad things, you will be homeless, you won't accomplish anything in your life, you 00:23:56.134 --> 00:24:02.349 - won't have a job, you know, all of these things. That is what I was taught that drug use would lead 00:24:02.349 --> 00:24:08.625 - to. That did not sound appealing to me. There's a lot of people I work with that their drug use is a 00:24:08.625 --> 00:24:14.963 - rite of passage in their family. A lot of times the first time they use is with their mom, with their 00:24:14.963 --> 00:24:17.822 - dad, with their siblings, with their cousins, 00:24:17.922 --> 00:24:25.037 - All family events are surrounded by substance use things as well. There's a lot of times where I work 00:24:25.037 --> 00:24:32.013 - with people that going to jail is also kind of a rite of passage in their family. Everyone in their 00:24:32.013 --> 00:24:39.128 - family goes to jail. That's just something that happens. And then some people have more motivation in 00:24:39.128 --> 00:24:46.174 - terms of like goals and all of that sort of thing that they're kind of just more driven in that way. 00:24:46.594 --> 00:24:56.999 - I'm going to show you this little video and then let's see. If you're visual, this will really help 00:24:56.999 --> 00:25:08.236 - you. The question is often asked, why do some people use drugs and never get addicted? People are extremely 00:25:08.236 --> 00:25:12.606 - complex and complexity creates diversity. 00:25:14.434 --> 00:25:23.451 - Each of us is a unique collection of different layers, representing our genes, brain development, parents' 00:25:23.451 --> 00:25:31.879 - influence, social environment, diet, and many more. Each layer is like a slice of Swiss cheese. The 00:25:31.879 --> 00:25:40.559 - areas with holes are the dangerous areas of the slice because they can let risks go through. The areas 00:25:40.559 --> 00:25:42.750 - without holes protect us. 00:25:43.234 --> 00:25:51.664 - because they can block risks. For example, hanging out with friends who abuse drugs punches a huge hole 00:25:51.664 --> 00:26:00.014 - in our social slice. While playing sports, learning a second language, or hanging out with friends who 00:26:00.014 --> 00:26:08.606 - don't use drugs can shrink the holes in the social slice. For drug abuse behavior to become an addiction, 00:26:08.606 --> 00:26:12.254 - the risk must cross through a lot of slices. 00:26:12.770 --> 00:26:21.045 - Usually, a few of our slices are solid enough to stop the addiction before it's too late. Thinking about 00:26:21.045 --> 00:26:29.320 - addiction in this way helps us understand it is impossible to predict who will become addicted. However, 00:26:29.320 --> 00:26:37.358 - recognizing the risks that can lead to addiction creates many opportunities to protect our future and 00:26:37.358 --> 00:26:39.486 - build a healthier society. 00:26:47.266 --> 00:27:00.560 - Right, so why do people use drugs? This is not an exhaustive list by any means, but basically in our 00:27:00.560 --> 00:27:05.694 - brains, we are rewarded with dopamine. 00:27:06.082 --> 00:27:13.440 - for doing the things that keep us alive. This is why you eat that delicious cheeseburger, you get dopamine 00:27:13.440 --> 00:27:20.316 - release. You have sex, you have dopamine release. You do the things that you need to do to survive, 00:27:20.316 --> 00:27:27.467 - you get dopamine release. What addiction does is basically hijack that. And then it makes us think that 00:27:27.467 --> 00:27:34.206 - we're gonna die without that specific substance. So I've been in the field for a pretty long time 00:27:34.370 --> 00:27:41.170 - I can usually boil it down to one or two reasons, and sometimes it's the combination of both, of why 00:27:41.170 --> 00:27:48.038 - people use drugs. One is they self-medicate for mental health, physical health problems not otherwise 00:27:48.038 --> 00:27:55.175 - treated. Two, they're using to numb, to escape, to avoid dealing with problems. And this is almost always 00:27:55.175 --> 00:27:58.878 - related to underlying trauma. And what I will say just 00:27:59.074 --> 00:28:05.031 - quickly about trauma is there's a lot of times I'm working with individuals and they don't recognize 00:28:05.031 --> 00:28:11.048 - that what they've been through is trauma. And I think part of that has to do with the context of when 00:28:11.048 --> 00:28:17.418 - we started talking about trauma in our country. It was mostly in the context of PTSD and military settings, 00:28:17.418 --> 00:28:23.552 - right? They're like, well, I didn't have my best friend shot next to me. I wasn't in an explosion. What 00:28:23.552 --> 00:28:25.086 - do you mean I had trauma? 00:28:25.186 --> 00:28:32.339 - Well, if you grew up feeling as though nobody loved you or you were unlovable or you were broken or 00:28:32.339 --> 00:28:39.778 - something was inherently wrong with you, that is trauma. It changed the way your brain developed having 00:28:39.778 --> 00:28:45.214 - those things happen to us and those absolutely play out in our adult lives. 00:28:45.378 --> 00:28:52.610 - Whether we want them to or not, so I think a lot of times people are in denial about how much some of 00:28:52.610 --> 00:29:00.125 - those things are still impacting them today because we would rather just pretend like it wasn't affecting 00:29:00.125 --> 00:29:05.726 - us. Right? So we're going to dive into addiction and brain. So a little neuro. 00:29:06.466 --> 00:29:14.522 - biology brush up. So your brain, it's made of billions of cells called neurons. And then those neurons 00:29:14.522 --> 00:29:21.639 - are organized into circuits and networks. And each neuron acts as a switch controlling the 00:29:21.639 --> 00:29:29.538 - flow of information. So how does this work in your brain? So one way is drugs interfere with the way 00:29:29.538 --> 00:29:33.214 - the neurons send, receive, and process signals 00:29:33.378 --> 00:29:40.301 - via those neurotransmitters. So those are the chemicals messengers in our brains that transmit a signal 00:29:40.301 --> 00:29:47.423 - from a neuron across the synapse, which is this little space in between, which can, it can be like through 00:29:47.423 --> 00:29:53.614 - the synapse to either target cell, which could be another neuron. It could be a muscle cell, 00:29:53.614 --> 00:29:59.006 - a gland cell. They're all made of neurons or they all are made of neurons. Yeah. 00:29:59.170 --> 00:30:07.624 - And so sometimes it's interfering with those signals, sending it, receiving, processing it. Other times 00:30:07.624 --> 00:30:16.322 - drugs mimic natural neurotransmitters in our body. We have opioid receptors in our body because we release 00:30:16.322 --> 00:30:21.118 - naturally occurring opioids in our body. When we get hurt, 00:30:22.114 --> 00:30:28.954 - signal stuff, but that is why an opioid that's outside of our body that's made from the poppy plant 00:30:28.954 --> 00:30:35.999 - or fentanyl, we have opioid receptors because of that. So it mimics those natural opioids that we have 00:30:35.999 --> 00:30:43.181 - in our body, which is, you know, and then there's a lot of different drugs that mimic those. Now, before 00:30:43.181 --> 00:30:50.910 - I get into this third point, I'm going to give you guys a little information about how an antidepressant, an SSN 00:30:51.042 --> 00:30:59.840 - SSRI, a selective serotonin reuptake inhibitor is what that stands for. So let's just say these little 00:30:59.840 --> 00:31:08.468 - balls here are serotonin. So what happens when you're on an SSRI is, well, what would happen if you, 00:31:08.468 --> 00:31:17.095 - regardless of being on it. So this is serotonin and it hangs out here and then it gets absorbed into 00:31:17.095 --> 00:31:18.462 - this next cell. 00:31:18.754 --> 00:31:26.090 - Well, what happens when it doesn't get absorbed, it doesn't just hang out there, it gets sucked back 00:31:26.090 --> 00:31:33.571 - up into here and kind of recycled. So what an SSRI does is it prevents, it kind of puts an X on these. 00:31:33.571 --> 00:31:40.834 - And so it doesn't allow it to be sucked back up. So it does have to stay out in the synapse. So you 00:31:40.834 --> 00:31:48.606 - have more serotonin in your synapse for the receptor of this other cell to be able to suck up when needed. 00:31:48.834 --> 00:31:57.775 - So that's definitely how it works. And sometimes some drugs do something similar. So some drugs cause 00:31:57.775 --> 00:32:07.154 - neurons to release abnormally large amounts of a natural neurotransmitter, dopamine. Almost all substances 00:32:07.154 --> 00:32:15.920 - work on dopamine. And then they sometimes also prevent that normal recycling process based on that. 00:32:15.920 --> 00:32:18.462 - And what neurotransmitter is 00:32:18.978 --> 00:32:25.910 - impacting kind of depends on the substance that it is. So in short, those are like a few different ways 00:32:25.910 --> 00:32:32.576 - that it impacts the brain. And what, and we're going to highlight these three things, but the truth 00:32:32.576 --> 00:32:39.308 - is, is like what parts are affected by drug use? All of the parts of your brain are affected by drug 00:32:39.308 --> 00:32:44.574 - use. However, we're going to touch on these three things. So the basal ganglia 00:32:44.706 --> 00:32:52.518 - which is this like teal right here, that is our, it activates this reward circuit. So this is where 00:32:52.518 --> 00:33:00.487 - our reward circuit kind of sits, where we're getting natural neurotransmitters released for doing the 00:33:00.487 --> 00:33:08.611 - thing that keeps us alive. But in this case, it's doing the substance that then our body thinks we need 00:33:08.611 --> 00:33:12.830 - to keep us alive. We also have the extended amygdala, 00:33:12.930 --> 00:33:19.464 - And so this plays, this is the purple right here, that plays a role in withdrawal that motivates the 00:33:19.464 --> 00:33:25.933 - person to use again. In fact, when you work with people who, or know people who have been using for 00:33:25.933 --> 00:33:32.467 - a really long time, a lot of times they'll tell you, I'm not using to get high anymore, I'm using to 00:33:32.467 --> 00:33:36.478 - not be sick. And that withdrawal, you feel like crap when the 00:33:37.378 --> 00:33:45.128 - drugs coming out of your system, so you want more so you don't feel sick again. And that is what the 00:33:45.128 --> 00:33:52.955 - extended amygdala keeps you in that vicious circle. Then we have the prefrontal cortex, which is kind 00:33:52.955 --> 00:34:01.089 - of our executive center of our brain. That's where, you know, we reason out right from wrong consequences 00:34:01.089 --> 00:34:04.542 - and effects of like making this decision. It 00:34:04.770 --> 00:34:13.207 - It doesn't completely pull it totally offline, but it's offline enough that you're, you have a decreased 00:34:13.207 --> 00:34:21.644 - self-control over your impulses. Um, cause that's the part that's like, okay, this is a bad idea because 00:34:21.644 --> 00:34:29.760 - of X, Y, and Z. And if that isn't online, you're not able to do that as well or at all. Um, so here, 00:34:29.760 --> 00:34:32.894 - this is your brain survival hierarchy. 00:34:33.570 --> 00:34:41.338 - one food, two water, three sleep, four social interactions. Now if you're talking about somebody who 00:34:41.338 --> 00:34:49.260 - is an active addiction, you may have fentanyl, methamphetamine, marijuana, alcohol, all before you get 00:34:49.260 --> 00:34:56.798 - to food, water, sleep, and social interactions. So I've had a lot of people tell me like, hey, so 00:34:56.962 --> 00:35:04.128 - My kid said he hadn't eaten in three days. I gave him $15 to go get food and he used it to buy drugs 00:35:04.128 --> 00:35:11.436 - instead of food. Why? This is why. This is why. And this is the nucleus accumbens. And that's the part 00:35:11.436 --> 00:35:18.745 - of your brain that's triggered like you are going to die without this substance. Now, when I first got 00:35:18.745 --> 00:35:24.350 - into this field and having had experience with substance use in my own family, 00:35:24.802 --> 00:35:31.300 - I would get really angry when people would lie to me and I knew they were lying to me. A lot of people 00:35:31.300 --> 00:35:37.671 - do, right? Like, it's not cool to be lied to. However, when you're thinking about it in this context 00:35:37.671 --> 00:35:44.042 - of what's happening in their brain, if I need to lie to you to make sure I get that substance that I 00:35:44.042 --> 00:35:50.351 - need or I'm going to die, I'll tell you anything you want to hear, right? And that makes a lot more 00:35:50.351 --> 00:35:53.694 - sense when you're thinking about it in this context. 00:35:56.674 --> 00:36:07.281 - Alright, so this is very interesting. So this is dopamine release when you're eating food. Not somebody 00:36:07.281 --> 00:36:17.888 - that has a dictionary thing. This is dopamine release if you're on cocaine. So and something that we're 00:36:17.888 --> 00:36:24.926 - going to talk about in a little bit when we talk about withdrawal is 00:36:25.730 --> 00:36:32.765 - Here's the thing is like, it can take up to two years after somebody stops using for their brain chemistry 00:36:32.765 --> 00:36:39.602 - to get back to normal. And sometimes I would argue, sometimes it may never go back to normal. Just like 00:36:39.602 --> 00:36:46.176 - for me, because of the trauma I went through as a child, I will always need antidepressants for the 00:36:46.176 --> 00:36:47.294 - rest of my life. 00:36:48.450 --> 00:36:55.541 - And sometimes for them, like when they're in those two years, so like, let's say you're working with 00:36:55.541 --> 00:37:02.703 - somebody that just stopped using and like, let's say they stopped for six months right now. When they 00:37:02.703 --> 00:37:09.934 - eat food, they're not going to have as much dopamine release as this. And part of that is because your 00:37:09.934 --> 00:37:17.166 - body gets used to you putting chemicals in your body to be able to have those releases, right? So your 00:37:17.166 --> 00:37:18.430 - brain is depleted 00:37:18.850 --> 00:37:24.807 - by a lot of the, and you're not having normal chemical stuff that's going on for quite some time. And 00:37:24.807 --> 00:37:30.765 - if somebody has been using for like 20 years and they stop, I don't know that two years is enough for 00:37:30.765 --> 00:37:36.664 - that to get completely back to normal. So when you think about it in that context of like, you know, 00:37:36.664 --> 00:37:42.563 - when people are in early recovery, it can be really challenging, really tough. Life is not nearly as 00:37:42.563 --> 00:37:47.294 - exciting. Look at all that excitement with cocaine. And now they even have less, 00:37:47.490 --> 00:37:55.761 - excitement eating food than the rest of us do. So that's really important thing to understand as well. 00:37:55.761 --> 00:38:04.273 - I don't have time to do this, but I highly recommend you guys going and you can probably just even Google 00:38:04.273 --> 00:38:12.062 - mouse party. This is the site and you can go there. It's like a terrarium of all these different 00:38:12.610 --> 00:38:18.923 - cartoon mice that are on all these different substances. Alcohol, marijuana, heroin, methamphetamine, 00:38:18.923 --> 00:38:25.359 - cocaine, ecstasy, and LSD. And whichever one you want to learn about, you pick up that mouse, you click 00:38:25.359 --> 00:38:31.795 - on them, and it like puts them into centrifugin. It shows you on like a chemical level what's happening 00:38:31.795 --> 00:38:38.046 - in your body when you're using that substance. It's very informative. I've definitely used this with 00:38:38.242 --> 00:38:46.489 - When I'm teaching staff also with clients as well, it's like, do you want to understand how this impacted 00:38:46.489 --> 00:38:54.424 - your body? Some clients are really into that. Some clients are like, no, I'm fine. I trust you. Let's 00:38:54.424 --> 00:39:02.282 - just move on. Okay, so co-occurring disorders. What is that? So according to SAMHSA, the coexistence 00:39:02.282 --> 00:39:07.806 - of both a mental health issue and a substance use disorder is referred 00:39:08.002 --> 00:39:14.286 - to co-occurring disorders. Not to be confused with comorbidity. Comorbidity is when you have a medical 00:39:14.286 --> 00:39:20.387 - issue as well as a mental health and substance use disorder. Now, hear me when I say this, a lot of 00:39:20.387 --> 00:39:26.488 - the people I work with have co-occurring and comorbidity, right? Because a lot of times when you're 00:39:26.488 --> 00:39:32.771 - an active addiction, you're not taking care of yourself. You're not going to the dentist, getting your 00:39:32.771 --> 00:39:36.798 - eyes checked, going to your regular checkups, that sort of thing. 00:39:38.690 --> 00:39:46.505 - So what are the reasons why they occur frequently together? So the National Institute of Mental Health, 00:39:46.505 --> 00:39:54.396 - they say that research suggests about these three different possibilities of why. So common risk factors 00:39:54.396 --> 00:40:01.986 - can contribute to both a substance use disorder and other mental health disorders. So both substance 00:40:01.986 --> 00:40:07.998 - use disorders and other mental health disorders can run in families, suggesting 00:40:08.130 --> 00:40:15.961 - that genes can be a risk factor. There's also environmental factors such as stress or trauma that can 00:40:15.961 --> 00:40:23.715 - cause genetic changes that are passed down through generations and may contribute to the development 00:40:23.715 --> 00:40:31.622 - of mental disorders or substance use disorder. So I wanna say that again, we now know through studying 00:40:31.622 --> 00:40:37.150 - epigenetics, we can pass down trauma to our offspring, to our children. 00:40:37.890 --> 00:40:45.217 - So I'm like, I'm sorry, I apologize to my daughter all the time. I'm sorry I have passed down my trauma. 00:40:45.217 --> 00:40:52.195 - So that's a real thing. And then secondly, we have mental disorders can contribute to substance use 00:40:52.195 --> 00:40:59.522 - and substance use disorder. So studies have found that people with mental health issues such as anxiety, 00:40:59.522 --> 00:41:06.430 - depression, post-traumatic stress disorder may use drugs and alcohol as a form of self-medication. 00:41:07.042 --> 00:41:14.262 - However, although some drugs may temporarily help with some symptoms of mental health disorders, they 00:41:14.262 --> 00:41:21.695 - make the symptoms worse over time. And additionally, the brain, I lost my place. Additionally, the brain 00:41:21.695 --> 00:41:28.845 - changes in people with mental disorders and that may enhance the rewarding effects of the substance, 00:41:28.845 --> 00:41:36.702 - making it more likely that you're gonna continue to use substances. So because you have a mental health issue, 00:41:36.994 --> 00:41:43.549 - using substances feels even more rewarding than if I didn't have a mental health issue. And lastly, 00:41:43.549 --> 00:41:50.498 - substance use and substance use disorders can contribute to the development of other mental health issues 00:41:50.498 --> 00:41:57.315 - or other mental health disorders. Substance use may trigger changes in the brain structure and function 00:41:57.315 --> 00:42:04.067 - that make a person more likely to develop a mental health issue. And something else I'm going to throw 00:42:04.067 --> 00:42:06.558 - out there, it's not part of this, but 00:42:06.978 --> 00:42:16.122 - A lot of times using substances, you are frequently putting yourself in situations that are traumatic 00:42:16.122 --> 00:42:25.535 - in nature, which then can lead to mental health issues as well. So, oh my gosh, the numbers didn't fall. 00:42:25.535 --> 00:42:35.486 - So you're like, what is this? Yeah, this doesn't look like much without the numbers. So here in, this is 2015. 00:42:35.938 --> 00:42:49.416 - 8.1 million. And so AMI is any mental illness, SED, substance use disorder. Here is 8.1 million. 00:42:49.416 --> 00:43:03.589 - This is 2017, 8.2 million. 2019 here, this is 9.5 million. And then 2021, 17.9 million. Here in 2023, 00:43:03.589 --> 00:43:05.534 - 10.4 million. 00:43:06.050 --> 00:43:13.489 - You're like, Ashley, why? Why is there a huge difference? Well, one thing, from here to here, we had 00:43:13.489 --> 00:43:20.854 - a global pandemic. So there was that. Also, I would say there's a lot, we're doing a lot of work on 00:43:20.854 --> 00:43:28.735 - decreasing stigma and getting people help. And I do feel like while there's still some stigma that exists, 00:43:28.735 --> 00:43:35.806 - more people are getting the help that they need. So I would venture to say if you were in 2015, 00:43:35.938 --> 00:43:43.760 - We were still here. People just weren't getting as much help as they are now. But not to mention that 00:43:43.760 --> 00:43:51.429 - global pandemic really did impact people of all of their social supports were completely cut off or 00:43:51.429 --> 00:43:59.634 - significantly cut back when we had that. So withdrawal. Withdraw occurs when the body has become dependent 00:43:59.634 --> 00:44:00.478 - on a drug. 00:44:00.610 --> 00:44:07.977 - and when that drug is not used or available for use. So it might be like I'm choosing not to use, or 00:44:07.977 --> 00:44:16.000 - it could be my dealer is out of town or my dealer is out of the substance. And the severity of the withdrawal 00:44:16.000 --> 00:44:23.513 - is based on how much or how long an individual has been using. Some other factors, maybe age, physical 00:44:23.513 --> 00:44:28.254 - condition, genetics, the combination of the drugs they're using, 00:44:28.354 --> 00:44:36.060 - And also the presence or absence of a support network can impact withdrawal as well. If you don't remember 00:44:36.060 --> 00:44:43.405 - anything I say today, please remember this. When people are coming off of alcohol and benzodiazepine, 00:44:43.405 --> 00:44:45.566 - they can die from withdrawal. 00:44:46.370 --> 00:44:53.070 - they can die. Now, other substances can make you feel like you're going to die. And I'm sure in complicated 00:44:53.070 --> 00:44:59.521 - situations where somebody is like super dehydrated, that could then lead to that. However, with alcohol 00:44:59.521 --> 00:45:05.725 - and benzos, you can absolutely die. And if you don't die, you can also end up having like seizures, 00:45:05.725 --> 00:45:11.618 - really severe seizures. So if you're working with somebody or know somebody that is on alcohol 00:45:11.618 --> 00:45:15.774 - or benzodiazepine, and they say they're going to stop cold turkey, 00:45:16.034 --> 00:45:24.294 - tell them do not just stock cold turkey. You need to be evaluated to see if you need medical withdrawal. 00:45:24.294 --> 00:45:32.239 - And what happens is say somebody is using or drinking half gallon a day, they go into treatment into 00:45:32.239 --> 00:45:40.185 - inpatient to like to go through their medicated or their medicated withdrawal process. They're given 00:45:40.185 --> 00:45:45.534 - benzodiazepine to slowly come off of this. That's part of the plan. 00:45:45.634 --> 00:45:52.442 - So a lot of times when people think about the stages of withdrawal, when people say withdrawal, they're 00:45:52.442 --> 00:45:59.055 - almost always referring to the acute stage, which is the physical body symptoms. That duration lasts 00:45:59.055 --> 00:46:05.601 - anywhere from a few days to a few weeks, depending on the things we just talked about. The thing we 00:46:05.601 --> 00:46:12.606 - do not talk about enough in the recovery community is the post-acute stage, or you can also hear it called 00:46:13.026 --> 00:46:20.659 - post-acute withdrawal syndrome or PAUSE. There's emotional symptoms here. Most of the physical symptoms 00:46:20.659 --> 00:46:27.999 - have ended. However, there can be times where you do still have physical symptoms. Now, when you're 00:46:27.999 --> 00:46:35.999 - talking about the post-acute stage, the longer you have been in recovery and no longer using the substances, 00:46:35.999 --> 00:46:39.742 - the less frequent those episodes should be and the 00:46:40.354 --> 00:46:49.621 - less frequent and they should be shorter and shorter, but this can last up to two years because your 00:46:49.621 --> 00:46:59.346 - brain chemistry is messed up. Okay. All right. So we're going to talk about medicated assisted treatment. 00:46:59.346 --> 00:47:09.438 - And today we're going to focus on, um, we're going to focus on alcohol and, um, opioid use disorder, MAT. So, 00:47:09.570 --> 00:47:17.471 - These are medications that assist with the use of the combination of counseling and behavioral therapies 00:47:17.471 --> 00:47:24.996 - to provide that whole patient approach to treatment of substance use disorder. So yeah, we're gonna 00:47:24.996 --> 00:47:32.521 - focus on opioid use disorder, MAT, alcohol use disorder, MAT. What I will say is you're gonna hear, 00:47:32.521 --> 00:47:38.014 - we love to change up verbiage. I feel like personally, it's like to age, 00:47:38.402 --> 00:47:46.337 - the documents we have, like if you see chemical dependency, you know that was probably written in the 00:47:46.337 --> 00:47:53.961 - eighties or nineties, right? So instead of saying OUDMAT, which is a mouthful, you're gonna hear, 00:47:53.961 --> 00:48:01.974 - what is it? MOUD, medication for opiate use disorder. MOUD is what you're hearing more frequently now. 00:48:01.974 --> 00:48:05.630 - So we're gonna start with opioid use disorder. 00:48:05.730 --> 00:48:11.506 - or MOUD. And if you think about it in these three buckets, it's helpful. Again, I'm a visual person. 00:48:11.506 --> 00:48:17.511 - If you're not, this may not be as helpful, but you have the methadone bucket, you have the buprenorphine 00:48:17.511 --> 00:48:23.459 - bucket. There's a lot of stuff in this buprenorphine bucket. I feel like this bucket, every time I turn 00:48:23.459 --> 00:48:29.350 - around, this bucket's growing with different things that they have, different options of buprenorphine 00:48:29.350 --> 00:48:33.182 - products. Then you have like the Naltrexone slash Vivitrol bucket. 00:48:34.306 --> 00:48:41.347 - So when you're looking at those, you have methadone, which is an agonist, and on the flip side, you 00:48:41.347 --> 00:48:48.598 - have naltrexone or Vivitrol, which is an antagonist. So it completely blocks the opioid receptor. Now, 00:48:48.598 --> 00:48:55.850 - buprenorphine is kind of in the middle of those two. It's a partial agonist, which means it blocks the 00:48:55.850 --> 00:49:03.806 - opioid receptor, but it excites it. So there's still some dopamine release, which is why they have street value. 00:49:04.162 --> 00:49:12.144 - right, because you hear about people getting suboxone on the streets. This is part of the reason why. 00:49:12.144 --> 00:49:20.205 - So let's dive into each one of these. So methadone, what's really interesting, and I have to say, I'll 00:49:20.205 --> 00:49:28.344 - be honest, because I think that's important. As I've been in this field, my views on medicated assisted 00:49:28.344 --> 00:49:33.822 - treatment have drastically changed. Based on increasing my knowledge, 00:49:33.954 --> 00:49:40.596 - as well as seeing this play out in people's lives. Methadone, I'm gonna just say this, a lot of what 00:49:40.596 --> 00:49:47.435 - you know about methadone may be completely untrue, because that was the case for me. So with methadone, 00:49:47.435 --> 00:49:54.405 - it has been around the longest. It's frequently referred to as the gold standard for opiate use disorder. 00:49:54.405 --> 00:50:01.047 - It has the most research behind it, but out of these three buckets we just talked about, this is the 00:50:01.047 --> 00:50:02.494 - most stigmatized one. 00:50:03.778 --> 00:50:10.785 - And I think it's stigmatized mostly because of a lot of false information that people have about this. 00:50:10.785 --> 00:50:17.588 - So you've all heard of methadone clinics. We don't even call them methadone clinics anymore because 00:50:17.588 --> 00:50:24.528 - that word is so stigmatized. You hear them called OTPs, opioid treatment programs. So in the state of 00:50:24.528 --> 00:50:29.630 - Indiana, I can't speak to outside of Indiana, but in the state of Indiana, 00:50:29.922 --> 00:50:36.077 - opioid treatment programs do not give people pill forms of methadone. They don't. It's liquid. 00:50:36.077 --> 00:50:42.556 - And in fact, when you're learning about all these different ones, this is the hardest medication to 00:50:42.556 --> 00:50:49.034 - divert. What does diversion mean? Like to pretend like I'm taking, but not really, and then give it 00:50:49.034 --> 00:50:55.902 - to somebody else or store a whole bunch of it for myself and take a whole bunch at one time. It's liquid. 00:50:56.162 --> 00:51:03.654 - And in fact, it's mostly like a reddish liquid unless somebody has an allergy to that, in which case 00:51:03.654 --> 00:51:11.444 - it might actually be clear if they're allergic to that, whatever that red dye is that they use in there. 00:51:11.444 --> 00:51:19.085 - So and a lot of times people that are on methadone, I want you to think about this. So how many of you 00:51:19.085 --> 00:51:21.310 - guys take medicine every day? 00:51:22.018 --> 00:51:29.554 - you know, whether it's an antidepressant, blood pressure, cholesterol medication, think about this. 00:51:29.554 --> 00:51:37.843 - To get your medication to feel okay for the day, you had to drive to a place every single morning, regardless 00:51:37.843 --> 00:51:45.756 - of you're sick, your kid's sick, there's a blizzard, there's a tornado, you know, whatever, every single 00:51:45.756 --> 00:51:48.318 - day. That's what these people do. 00:51:49.250 --> 00:51:57.030 - And it's a lot of work. And at least in the state of Indiana, you have to be doing that for an entire 00:51:57.030 --> 00:52:04.887 - year with no negative, no positive drug screens, not even just for marijuana, no positive drug screens 00:52:04.887 --> 00:52:12.286 - at all to get a take home so that maybe you don't have to go on Saturday and Sunday to get that. 00:52:12.930 --> 00:52:21.078 - That's a lot of work. And there's not enough OTPs. And so there's some people that are driving an hour 00:52:21.078 --> 00:52:28.989 - and a half one way to get that medicine and get back. How much would that impede your ability to do 00:52:28.989 --> 00:52:34.526 - your regular life massively, right? So just something to think about. 00:52:34.946 --> 00:52:42.233 - Also, when you're looking at this, because I feel like this is part of the reason why a lot of people 00:52:42.233 --> 00:52:49.877 - are like, methadone is horrible. It's just substituting one substance for another. So looking at methadone 00:52:49.877 --> 00:52:57.021 - compared to heroin, methadone, you only need to take once every 24 to 36 hours. Whereas heroin, you 00:52:57.021 --> 00:53:04.094 - have to be taking it every four to six hours to not be sick, right? Heroin, you have a really high 00:53:04.290 --> 00:53:11.787 - overdose potential, methadone you don't. And like you get, in fact, let me just go to the next thing. 00:53:11.787 --> 00:53:19.137 - So like this is heroin. So it, when you take it, it shoots you up into this really toxic area where 00:53:19.137 --> 00:53:26.781 - you can get high. You go down, look how little time you're actually in a window of tolerance for heroin 00:53:26.781 --> 00:53:30.750 - to where it like, once you cross this line, you're in 00:53:30.914 --> 00:53:37.649 - overdose or overdose, I'm sorry, withdraw symptoms. This is where you're at risk for overdose. This 00:53:37.649 --> 00:53:44.586 - is where you have withdrawal symptoms. Whereas methadone, it keeps you in this window of tolerance the 00:53:44.586 --> 00:53:51.523 - entire time. Now, granted, you are going every day. So when you're starting, they're really monitoring 00:53:51.523 --> 00:53:59.134 - things about how you're responding. So every single day, you could have things altered based on what's going on. 00:54:00.866 --> 00:54:08.390 - Are there any questions about that I know I said I wouldn't stop for questions, but I feel like there's 00:54:08.390 --> 00:54:15.913 - usually a lot of questions about methadone. Okay, all right, the other thing i'll just say really quick 00:54:15.913 --> 00:54:21.918 - about methadone before we move on is in the state of indiana besides Center stone. 00:54:22.306 --> 00:54:29.014 - and Pinnacle or Recovery Works in Martinsville, there is no place that regularly, because occasionally 00:54:29.014 --> 00:54:35.982 - you hear of places doing a one-off, allow you to come to inpatient residential facility without completely 00:54:35.982 --> 00:54:42.755 - stopping your methadone. And methadone is only helping with opioids, right? How many people do you know 00:54:42.755 --> 00:54:48.030 - that only use one substance? You know, so a lot of times people are going to the 00:54:48.482 --> 00:54:55.199 - OTPs to get their methadone dose, but they're still struggling with alcohol. They're still struggling 00:54:55.199 --> 00:55:01.981 - with methamphetamine, whatever else. In the state of Indiana, they do not have regular places they can 00:55:01.981 --> 00:55:08.632 - go to go inpatient facility. And that is not okay. It's not okay. Centerstone, we started doing that 00:55:08.632 --> 00:55:14.558 - in 2021. We work with them. Is it a lot of work? Absolutely. Is it the right thing to do? 00:55:14.914 --> 00:55:22.774 - Absolutely. And those people are so grateful for having access to the full continuum of SUD services 00:55:22.774 --> 00:55:30.711 - because of that. So buprenorphine. So buprenorphine was approved by the FDA in 2002. And something to 00:55:30.711 --> 00:55:38.804 - like know is Suboxone has buprenorphine and Naloxone. You're like Naloxone, I hear about that. Naloxone 00:55:38.804 --> 00:55:42.462 - Narcan, that is part of what is in there. Now, 00:55:42.754 --> 00:55:49.630 - At least in the state of Indiana, when people, when you're working with a woman who's on Suboxone and 00:55:49.630 --> 00:55:56.977 - gets pregnant, they will frequently take her off of Suboxone and put her on a buprenorphine only medication. 00:55:56.977 --> 00:56:04.055 - And part of that is there's just not a lot of research about Naloxone's impact in the pregnancy, because 00:56:04.055 --> 00:56:09.246 - who wants to be like, I'll sign up to see if this messes my child up, right? 00:56:09.378 --> 00:56:16.211 - There's a lot of times not a lot of research about pregnant women with certain medications and Naloxone 00:56:16.211 --> 00:56:23.110 - is one of them. But in this bucket you have Sublicade, which is an injection that goes into your stomach 00:56:23.110 --> 00:56:29.680 - by your belly button. This is really great when like somebody can't trust themselves, like Suboxone 00:56:29.680 --> 00:56:36.250 - helps them with things, but they can't trust themselves to use it the way it's supposed to be used. 00:56:36.250 --> 00:56:38.878 - Get an injection once a month if that's 00:56:39.234 --> 00:56:46.251 - what's really helping you. There's also subsolve, there's subutex, there's a lot of different things. 00:56:46.251 --> 00:56:53.544 - There's, I think it's called Rickzalti now where you can get an injection. This supplicates once a month. 00:56:53.544 --> 00:57:00.424 - I think Rickzalti, you can do it once a month or you can do it like once a week or once every other 00:57:00.424 --> 00:57:04.414 - week. I think there's different dosage that you can pick. 00:57:05.218 --> 00:57:12.771 - And then we have naltrexone, vivitrol, and naloxone. So these medications completely block the activity 00:57:12.771 --> 00:57:20.106 - of the opioid receptors in the brain. So when you're talking about naloxone, it's like you have your 00:57:20.106 --> 00:57:22.430 - receptor and then you have like 00:57:23.010 --> 00:57:28.931 - little opiate on it it just comes and like kicks that off and like sits on the receptor for a while. 00:57:28.931 --> 00:57:34.852 - Now something to remember with Naloxone is people can re-overdose without taking more medication. So 00:57:34.852 --> 00:57:40.832 - the Naloxone can wear off and they can re-overdose which is why it's really important for people that 00:57:40.832 --> 00:57:47.222 - have overdosed to get medical treatment. Now they're not always willing but that's always the recommendation 00:57:47.222 --> 00:57:50.974 - because of that because what they end up doing is getting an IV 00:57:51.170 --> 00:57:58.987 - with Naloxone going into their system. So like they're able to keep Naloxone in their system until their 00:57:58.987 --> 00:58:06.505 - body's processed whatever opioids or whatever else is in their system. Now, Naltrexone is a pill you 00:58:06.505 --> 00:58:13.950 - take every day. So you could take a pill every day and that helps with opioid stuff. Or you can get 00:58:13.950 --> 00:58:21.022 - instead, if you're like, I don't wanna have to take a pill every day, Vivitrol is an injection 00:58:21.122 --> 00:58:28.541 - that is in your bottom. It's an inner muscular injection. So it's a pretty big needle. And I tell people 00:58:28.541 --> 00:58:36.173 - if they're really scared, you shouldn't look at it. If that's not not your thing, and it gives you anxiety. 00:58:36.173 --> 00:58:43.239 - And this can be really, really helpful. Now what I will say about Vivitol and Naltrexone is if they 00:58:43.239 --> 00:58:49.598 - stop and go back to use, they're at higher risk of going like having an overdose, because 00:58:50.018 --> 00:58:58.031 - It does not, they have no tolerance at all with that. Whereas with methadone or buprenorphine, you still 00:58:58.031 --> 00:59:05.968 - have a little bit of tolerance. Therefore you're less likely to, if you stop and go to use, you're less 00:59:05.968 --> 00:59:13.676 - likely to have an overdose. Okay. Alcohol use MAT. There's anabuse. Anabuse is a medication you take 00:59:13.676 --> 00:59:18.942 - and it makes you super sick if you drink on top of that. My grandpa, 00:59:19.074 --> 00:59:25.918 - My maternal grandpa got sober in like either the late 70s or early 80s using anabuse. And he actually 00:59:25.918 --> 00:59:32.762 - continued taking anabuse for years after he had been in recovery because he was scared. He was scared 00:59:32.762 --> 00:59:39.606 - that if he stopped taking it, he would convince himself he could have one drink again. And he knew he 00:59:39.606 --> 00:59:46.451 - couldn't have one drink. That wasn't his thing. So he stayed on that for a pretty long time. Then you 00:59:46.451 --> 00:59:47.390 - have Camprel. 00:59:48.482 --> 00:59:55.204 - And that is something you take three times a day. So I don't know about you guys, but I would have a 00:59:55.204 --> 01:00:02.326 - really hard time taking something three times a day. Your eyes do not deceive you. Naltrexone and Vivitrol 01:00:02.326 --> 01:00:09.181 - are also in this category. Now, this doesn't make you sick like the anabuse does. What I've heard from 01:00:09.181 --> 01:00:16.702 - people, and it wasn't as much Naltrexone, it was Vivitrol, is if they were to drink on top of it, they felt like 01:00:17.346 --> 01:00:23.828 - like the euphoria and those positive things they would get from drinking were like turned down. Now 01:00:23.828 --> 01:00:30.505 - what can make that dangerous is then they're like, well, I just have to drink that much more and I can 01:00:30.505 --> 01:00:37.052 - override it, right? And you could have alcohol poisoning. So something to keep in mind with that. So 01:00:37.052 --> 01:00:42.302 - some Medicaid assisted treatment truths. It's not trading one drug from another. 01:00:42.434 --> 01:00:50.108 - When used as prescribed, MAT can help stabilize brain chemistry and reduce cravings. The non-MAT medications 01:00:50.108 --> 01:00:57.501 - are short acting and create the euphoria. Methadone and buprenorphine are long lasting to treat symptoms 01:00:57.501 --> 01:01:04.753 - of addiction cravings and the addiction withdraws, and they don't create that euphoria high. Now, what 01:01:04.753 --> 01:01:09.822 - I will say to that is when somebody's starting MAT, they may look high. 01:01:10.114 --> 01:01:15.882 - There's a lot of times I would start working with somebody in the jail. I knew what they looked like 01:01:15.882 --> 01:01:21.650 - completely sober. They come to group and I'm like, did you start MAT or did you have a relapse? Like 01:01:21.650 --> 01:01:27.476 - I can tell in your eyes, something's not right. It usually takes like a week, two weeks for things to 01:01:27.476 --> 01:01:33.415 - like adjust, especially with the buprenorphine. Now with the methadone, they're going every single day. 01:01:33.415 --> 01:01:37.470 - So things can be tweaked more frequently than the buprenorphine. Okay. 01:01:37.858 --> 01:01:45.538 - MAT is well accepted as evidence-based treatment. MAT is not a crutch that prevents true recovery. Often 01:01:45.538 --> 01:01:52.926 - it's a central component for successful long-term recovery for many people with opiate use disorder. 01:01:52.926 --> 01:02:00.240 - It often makes recovery possible for individuals for the first time. I've worked with these people, 01:02:00.240 --> 01:02:05.214 - they tried their hardest to do this and then MAT was the thing that 01:02:05.826 --> 01:02:13.624 - was able for them to stay in recovery longer than they had when they had tried to do it without it. 01:02:13.624 --> 01:02:22.045 - So best results occur when MAT is taken for as long as it provides a benefit. So SAMHSA treatment protocols 01:02:22.045 --> 01:02:29.999 - advise against arbitrary time limits on the duration of treatment for opiate use disorder medication. 01:02:29.999 --> 01:02:34.366 - Evidence show that tapering or discontinuing medication 01:02:34.530 --> 01:02:41.778 - leads to very high rates of relapse and it also shows that research shows that somebody that's on MAT 01:02:41.778 --> 01:02:49.239 - for at least one to two years has the greatest rates of long-term success. There's currently no evidence 01:02:49.239 --> 01:02:56.345 - to support benefits from stopping MAT and if you think about when we're talking about withdrawal it 01:02:56.345 --> 01:02:59.614 - can take your brain about one to two years to 01:02:59.778 --> 01:03:06.290 - for the chemistry to get right back, right? And I worked with somebody who, he was taking 16 milligrams 01:03:06.290 --> 01:03:12.238 - of buprenorphine, eight in the morning, eight in the evening. He'd been on it for a long time. 01:03:12.238 --> 01:03:18.563 - And I was like, he's like, Ashley, I wanna try to stop. Now, I always train people, if somebody that 01:03:18.563 --> 01:03:24.949 - you're working with wants to stop MAT, the first reason, like the first thing you should say is like, 01:03:24.949 --> 01:03:27.454 - what's going on? Why? What's happening? 01:03:27.618 --> 01:03:34.569 - Cause a lot of times people want to stop because somebody shaming them about it. And I know this sounds 01:03:34.569 --> 01:03:41.453 - really dramatic, but shaming somebody about this could cause them to stop their MAT and go out and use 01:03:41.453 --> 01:03:48.738 - and die. Um, and so be really careful about all of this. Cause again, that person that was on 16 milligrams, 01:03:48.738 --> 01:03:55.422 - he, we had a whole plan. I had a plan with him. His prescriber had a plan with him. He got down to, 01:03:56.450 --> 01:04:02.632 - from four milligrams to two milligrams and two milligrams wasn't enough. He started having really bad 01:04:02.632 --> 01:04:08.814 - cravings, really bad withdrawal. And so he got bumps back up to four milligrams. But I was like, look 01:04:08.814 --> 01:04:15.117 - at best though. Like that's an improvement. You now know you don't need 16 milligrams. You're okay with 01:04:15.117 --> 01:04:18.814 - four milligrams a day. That's huge. And I'm like, that isn't 01:04:19.330 --> 01:04:25.360 - loss like in terms of because I think he was really beating himself up like I'm a failure I can't do 01:04:25.360 --> 01:04:31.390 - this I'm like again I'm gonna have to take antidepressants the rest of my life because of the trauma 01:04:31.390 --> 01:04:37.659 - that changed my brain chemistry you might need to take four milligrams the rest of your life and there's 01:04:37.659 --> 01:04:43.808 - nothing wrong with that. MAT does not increase overdose risk in fact research found that in comparison 01:04:43.808 --> 01:04:48.286 - to those who didn't receive any MAT deaths from overdose were decreased by 01:04:48.418 --> 01:04:56.105 - 38% in those taking buprenorphine and 59% in those receiving methadone. And long story short, there 01:04:56.105 --> 01:05:03.869 - are many paths to recovery. Everyone has their own journey and it's not our place to judge what that 01:05:03.869 --> 01:05:11.633 - journey is gonna look like. I wanted to talk just quickly about recovery meetings. Recovery meetings 01:05:11.633 --> 01:05:18.398 - are imperative and what I love is there's so many different types of recovery meetings. 01:05:18.594 --> 01:05:25.677 - out there now. You know, we have like the traditional 12 step AA and A. I think there's like crystal 01:05:25.677 --> 01:05:32.830 - meth anonymous. There's a lot of different anonymous meetings. We also have smart recovery now. Smart 01:05:32.830 --> 01:05:39.842 - recovery is really great in terms of like, first of all, I'm a smart recovery facilitator. It's the 01:05:39.842 --> 01:05:47.486 - best motivational interviewing training I've ever taken in my entire life. And I've taken a lot of those. So 01:05:48.002 --> 01:05:54.078 - it that's really helpful. The other thing about smart recovery is they don't talk about higher power. 01:05:54.078 --> 01:06:00.273 - I know sometimes people have had bad trauma with like church or other religious experiences and they're 01:06:00.273 --> 01:06:06.290 - like, I just I have no tolerance for people to talk about God or higher power. They while they admit 01:06:06.290 --> 01:06:12.247 - spirituality is a part of recovery, they're like, but we're just not going to talk about it in this 01:06:12.247 --> 01:06:17.310 - meeting. So that's a really great meeting for somebody that's like really put off by 01:06:17.442 --> 01:06:26.880 - that sort of thing. Then we have Recovery Out Loud, which was started by John Cunningham out in Columbus, 01:06:26.880 --> 01:06:35.428 - Indiana. They are very much about nutrition and exercise. They also live stream their meetings. 01:06:35.428 --> 01:06:44.510 - They're like, this isn't, I don't want to be anonymous. I want people to understand and be out there. 01:06:44.610 --> 01:06:52.425 - There's also Celebrate Recovery. Now this is a very Christian based program. The cool thing about Celebrate 01:06:52.425 --> 01:07:00.095 - Recovery is they don't just address substance use disorder, they address all behavioral addiction things. 01:07:00.095 --> 01:07:07.765 - So codependency, if you have issues with like pornography or sex, or I mean, there's just a lot of things 01:07:07.765 --> 01:07:11.166 - that they cover that a lot of these other ones 01:07:11.394 --> 01:07:18.280 - don't. A traditional Celebrate Recovery Meeting is you meet for an hour for dinner, you have dinner 01:07:18.280 --> 01:07:25.373 - together, you eat, and the first hour is the main topic everyone's at, and the third hour is you break 01:07:25.373 --> 01:07:31.846 - up into groups. Most of the time it's women, men, and teens. So Recovery Meetings are really, 01:07:31.846 --> 01:07:37.630 - really helpful, and this is where they can change their people, places, and things. 01:07:39.458 --> 01:07:45.870 - And support, virtual support meetings, in the room app is really great. Any of the anonymous meetings, 01:07:45.870 --> 01:07:52.592 - they have their own websites. You can look up and find different meetings, whether it's in person, virtual, 01:07:52.592 --> 01:07:59.066 - all that. Facebook groups, especially with Recovery Out Loud, that would be a great place. That's where 01:07:59.066 --> 01:08:05.416 - they stream their meetings. There's also YouTube. I always tell people, I was like, if it's 2 a.m. in 01:08:05.416 --> 01:08:08.030 - the morning and you're really struggling, 01:08:08.162 --> 01:08:15.330 - Go onto YouTube, there's all kinds of speaker videos on there. Also, I tell people, you know, there 01:08:15.330 --> 01:08:22.570 - may be another English speaking stuff. You could, at 2 a.m., I don't know the exact time difference, 01:08:22.570 --> 01:08:29.954 - but you could go to a meeting in Australia. They're up, it's not 2 a.m. in Australia. So there's a lot 01:08:29.954 --> 01:08:34.398 - of different options. And I did wanna just real quick hit on, 01:08:34.594 --> 01:08:41.792 - addiction as a family disease because we don't talk about this enough. It impacts everyone. I always 01:08:41.792 --> 01:08:49.061 - joke with my clients saying, I can be just as crazy as somebody in active addiction, and I don't even 01:08:49.061 --> 01:08:56.473 - have a substance to blame it on. When I'm in my Ashley control freak mode, it's not pretty. Again, this 01:08:56.473 --> 01:09:03.742 - is not an exhaustive list by any means, but the whole entire family and their friends are impacted by 01:09:03.906 --> 01:09:11.398 - the substance use themselves, maybe more than what they even know. And so those are some of the things 01:09:11.398 --> 01:09:18.890 - that can happen. And we need our own support group. I personally myself have been going to Al-Anon for 01:09:18.890 --> 01:09:26.164 - seven years. It's a game changer. And I know I will need Al-Anon the rest of my life. I pretty much 01:09:26.164 --> 01:09:33.438 - needed to go straight from birth into an Al-Anon meeting, and that wasn't possible. But I know that 01:09:33.986 --> 01:09:41.119 - These are my people. And then there's also Alateen, which is just a spinoff of Al-Anon for teens. There's 01:09:41.119 --> 01:09:48.050 - some meetings that even have children there as young as like eight years old. There's a smart recovery 01:09:48.050 --> 01:09:55.048 - friends and family piece as well, which I feel like is very similar to Al-Anon. I would say the biggest 01:09:55.048 --> 01:10:02.046 - difference is because it's all motivational, entertaining based. There is a piece about how do you have 01:10:02.242 --> 01:10:08.364 - a conversation with your loved one if you're wanting them to get into treatment. Apparently yelling 01:10:08.364 --> 01:10:14.609 - and shaming doesn't work. I know because I've tried it. It actually has the opposite effect. There is 01:10:14.609 --> 01:10:20.976 - also adult children, alcoholics and dysfunctional families. I kind of gave you the outline of celebrate 01:10:20.976 --> 01:10:27.404 - recovery. That could be part of their recovery too with the family. There's also codependency anonymous. 01:10:27.404 --> 01:10:31.934 - There's a lot of different things out there for people. And I have links. 01:10:32.130 --> 01:10:43.650 - for other things. Oh, there we go. All right, let me stop. Do you guys have questions? That is a great 01:10:43.650 --> 01:10:55.505 - question. How do we access that? If you guys are wanting the slide deck because of our whole registration 01:10:55.505 --> 01:10:57.854 - process not working, 01:10:58.018 --> 01:11:04.333 - I would go ahead and just stick your email in the chat and then I will make sure that you get a link 01:11:04.333 --> 01:11:10.898 - to the slide deck as well as the recording of this. And then Lee, were you going to say something? Cause 01:11:10.898 --> 01:11:17.150 - we also have cats. No, I was just going to address. I was going to ask about that. Yeah. Great. And 01:11:17.150 --> 01:11:23.464 - I'll be sending out, if people need a proof that they attended, I'm collecting those emails. I will, 01:11:23.464 --> 01:11:27.966 - if you email me, then I will send out something probably later tonight. 01:11:30.402 --> 01:11:42.496 - Great, thank you for that, Lee. No questions at all? Everyone's like, I know that was a lot of information. 01:11:42.496 --> 01:11:53.695 - So much information. I threw at you. Yeah, it's a lot to digest. Yeah. Yeah, I'll just put my email 01:11:53.695 --> 01:11:59.742 - in the comments again. If you need any kind of proof, 01:12:00.002 --> 01:12:08.203 - of attending, just email me. But for the slides and the recording, email, or Ashley will get your emails. 01:12:08.203 --> 01:12:16.094 - And then this will be up on Cats at some point. They're so good about a pretty short turnaround time. 01:12:16.094 --> 01:12:24.062 - So you should be able to find that on Cats pretty soon. And again, thanks for Cats for that. Kathleen. 01:12:24.226 --> 01:12:32.066 - So you have people returning from treatment. And I'm assuming when you say that, is it like a 28 day 01:12:32.066 --> 01:12:39.905 - stay? Is that what you're? Yes. Yeah. So it kind of depends on things. I feel like most of the time, 01:12:39.905 --> 01:12:47.823 - I would say regardless, it's usually good to be in like some kind of like IOP, some kind of intensive 01:12:47.823 --> 01:12:54.110 - thing that's like, you know, three times a week or so is usually really helpful. 01:12:54.242 --> 01:13:01.360 - There are some times where there's people that have been in recovery for years, something happens, they 01:13:01.360 --> 01:13:08.204 - return to use. They may not need something as intensive, but I would say for most people who've not 01:13:08.204 --> 01:13:15.185 - had a lot of recovery time coming out of residential, the more intensive, the better because they can 01:13:15.185 --> 01:13:22.782 - really struggle going from that 28 day where everything's happening right there where they're sleeping to then 01:13:23.074 --> 01:13:29.393 - when they leave, they don't really have that external accountability as much. So providing that with 01:13:29.393 --> 01:13:35.587 - as much structure as possible is usually a really positive thing. Is that helpful, Kathleen? Well, 01:13:35.587 --> 01:13:42.032 - sort of. I have a mother who just was released yesterday, and we texted back and forth when she showed 01:13:42.032 --> 01:13:48.351 - me her certificate. Then when I talked to her last night, I said, oh, I thought you were going to go 01:13:48.351 --> 01:13:49.790 - to aftercare. And then 01:13:49.954 --> 01:13:55.852 - They would help you find housing. They would help you find a job, all of that. She said, well, there 01:13:55.852 --> 01:14:01.750 - was a girl in the program with me that I didn't really like, and she was scheduled to go to the same 01:14:01.750 --> 01:14:07.823 - place I was going to go. And so I chose not to go. So again, we're back into excuses rather than really 01:14:07.823 --> 01:14:13.604 - trying to deal with the situation. Yeah. And that's really common, Kathleen. I always tell people, 01:14:13.604 --> 01:14:18.334 - I'm like, I don't know how many people are like, I did it. I did my 28 day stay. 01:14:18.658 --> 01:14:25.176 - I'm done. I'm like, oh, yes, let's celebrate this accomplishment because this is an accomplishment. 01:14:25.176 --> 01:14:31.693 - But you were at the beginning of your journey and to think that you go to 28 day things when you've 01:14:31.693 --> 01:14:38.276 - had 15 years of a lifestyle, 28 day like isn't going to do it. You have to like start living it. You 01:14:38.276 --> 01:14:45.054 - have to start intertwining that. And it's really easy to go to a 28 day program, get plopped right back 01:14:45.054 --> 01:14:48.574 - in that same environment and go right back into like, 01:14:48.706 --> 01:14:55.874 - Those old ways of doing things and thinking about things and everything. And yeah, there there's a lot 01:14:55.874 --> 01:15:03.180 - of times where I'm like, there will be people you don't like everywhere. That doesn't mean that avoiding 01:15:03.180 --> 01:15:10.974 - them is worth your recovery. Right. And I always tell people to, because you get a lot of people that are like. 01:15:11.266 --> 01:15:18.390 - Well, my job is really important. And so I'm missing like my meetings and my treatment because I'm working 01:15:18.390 --> 01:15:25.048 - 50, 60 hours. I had somebody tell me this, who was in a jail program treatment and he's, and he had 01:15:25.048 --> 01:15:31.706 - graduated and was doing well. He's like, anything you put above your recovery, you're going to lose 01:15:31.706 --> 01:15:38.430 - when you lose your recovery anyways. Whether that's your job, your kid, this relationship, whatever, 01:15:38.562 --> 01:15:45.611 - you will lose it all anyways when you lose your recovery. And I think sometimes that helps in like, 01:15:45.611 --> 01:15:52.660 - oh, I need a perspective shift, so to speak. Well, and that's good. And part of the reason she went 01:15:52.660 --> 01:15:59.921 - to recovery when she did was because we're up to terminating her parental rights. So, okay, she needed 01:15:59.921 --> 01:16:05.278 - to go to treatment, came out back with the guy who she was with beforehand, 01:16:06.210 --> 01:16:14.003 - He came out of treatment as well. We'll see. Yeah, I'm skeptic. Yeah. And that's really hard. I worked 01:16:14.003 --> 01:16:21.645 - for the Department of Child Services for five and a half years. And so I understand. And I think the 01:16:21.645 --> 01:16:29.666 - piece that really sucks is because we want permanency for the kiddos. And the DCS timeline doesn't always 01:16:29.666 --> 01:16:35.870 - jive up with a realistic recovery timeline. Right. And I always tell parents that 01:16:36.130 --> 01:16:42.161 - that were going down that road, because I feel like that's the piece where it's really easy for them 01:16:42.161 --> 01:16:48.371 - to just completely give up, right? Like, well, you're gonna terminate my parental rights. So like, what 01:16:48.371 --> 01:16:54.342 - else do I have to live for, right? I'm like, regardless of your parental rights being terminated or 01:16:54.342 --> 01:17:00.851 - not, your child will want to know you when they get older. And in every situation I've ever seen, regardless 01:17:00.851 --> 01:17:06.046 - of how atrocious the abuse or neglect was, that kid wants to come back when they're 18 01:17:06.338 --> 01:17:14.067 - to figure out what happens right they're trying to put all the pieces together and you need to be in 01:17:14.067 --> 01:17:21.720 - a healthy place for that to happen, because no matter what something says on a legal piece of paper 01:17:21.720 --> 01:17:27.230 - you're their biological parent forever you know. Well, thank you. yeah. 01:17:39.138 --> 01:17:52.335 - Okay, L Lopez. What, I think it depends on like what's going on, how much are they using? Can you tell 01:17:52.335 --> 01:18:06.558 - me a little bit more info? Oh, I guess her or his microphone is not working. How much is drug use? I think it, 01:18:06.658 --> 01:18:15.138 - It's hard for me to say generally, I think it requires assessing what's all going on. If they're regularly 01:18:15.138 --> 01:18:23.460 - using, they need to be assessed for residential to go inpatient for a 28 day stay. They might, depending 01:18:23.460 --> 01:18:31.781 - on what they're using, if they're using alcohol or benzos, they might need medical detoxification before 01:18:31.781 --> 01:18:34.238 - they can go to residential. If 01:18:34.722 --> 01:18:43.525 - you know, if maybe they've been sober for a long time and they went back to use, I think we could definitely 01:18:43.525 --> 01:18:51.682 - plug them into some outpatient things and assess how that's going. Yeah. And, and I also want to say 01:18:51.682 --> 01:18:59.759 - drug screenings, drug screens have typically been used as punishment. Right now, the drug supply is 01:18:59.759 --> 01:19:03.070 - so tainted. I think of drug screening as 01:19:04.738 --> 01:19:10.436 - a safety thing. Because a lot of times people don't know what they're using. We've had people come into 01:19:10.436 --> 01:19:16.079 - a residential facility saying, I'm only using benzodiazepine. We drug screen them straight up fentanyl 01:19:16.079 --> 01:19:21.613 - in their system. They're using things that look like benzodiazepine. They're pressed to make it look 01:19:21.613 --> 01:19:27.256 - like that, but it's not. And so you absolutely, I think drug screens are really helpful. Like they may 01:19:27.256 --> 01:19:32.790 - really think they're only using marijuana. They may think they're only using this one substance. And 01:19:32.790 --> 01:19:33.502 - it turns out 01:19:34.018 --> 01:19:50.021 - they're using significantly more than what they realize. Did that help? Yes, drug screens are helpful 01:19:50.021 --> 01:19:55.198 - because that can also, you know, 01:19:55.842 --> 01:20:02.767 - A lot of times they lie to you about how much they're using they're downplaying how much they're using 01:20:02.767 --> 01:20:09.491 - so I do feel like drug screens sometimes give you a better picture of what of what's happening. And 01:20:09.491 --> 01:20:16.214 - it can be very informative to them of what's actually in their system because they don't they don't 01:20:16.214 --> 01:20:18.366 - know right now. you're welcome. 01:20:28.066 --> 01:20:33.991 - had a question. Um, this was great. I, I oversee family preservation with my agency. So we're all we 01:20:33.991 --> 01:20:40.150 - do home based with the families who have a lot of substance use referrals and domestic violence, I would 01:20:40.150 --> 01:20:46.309 - say is probably what we see the most. But what curriculum I'm looking at adding some more evidence based 01:20:46.309 --> 01:20:52.292 - curriculum for my therapist and skills coaches. What would you recommend because I know there's a lot 01:20:52.292 --> 01:20:56.926 - out there, but a lot of it is for groups and we don't do groups. It's all just 01:20:57.122 --> 01:21:04.335 - individual, either one parent or both parents. And sometimes we work with teenagers with SUD as well. 01:21:04.335 --> 01:21:11.618 - But I didn't know what you have found to be helpful. We use we do have that like MI, we do CBT seeking 01:21:11.618 --> 01:21:19.184 - safety, but I wasn't sure. Yeah. And, and this is generally used in a group setting, not that you couldn't 01:21:19.184 --> 01:21:26.750 - use it otherwise. I really love Stephanie Covington stuff, because she intertwines that stuff with trauma. 01:21:27.138 --> 01:21:33.378 - because trauma is almost always at the root of that. And I feel like there's a lot of curriculums that 01:21:33.378 --> 01:21:39.436 - never get to the bottom of that. There's helping men recover and there's helping women recover. And 01:21:39.436 --> 01:21:45.857 - those are amazing curriculum because it really digs into stuff. Now, you have to have people facilitating 01:21:45.857 --> 01:21:52.158 - that whether you're doing it individually or in group that are gonna be okay talking about those things 01:21:52.158 --> 01:21:55.550 - too. Because that's what I see a lot of times I'm like, 01:21:55.778 --> 01:22:02.390 - I knew this one person, cause it goes over yourself, like relationships, spirituality and sexual out, 01:22:02.390 --> 01:22:09.131 - like sexual stuff. That person would completely cut out the sexual stuff because they're like, we don't 01:22:09.131 --> 01:22:15.743 - want to talk about that. That's too hard. Yeah. But you have to talk about it. You have to talk about 01:22:15.743 --> 01:22:22.615 - it. I was like, so when I trained that now I'm like, you absolutely have to talk about this. And I always 01:22:22.615 --> 01:22:25.726 - tell people, I'm like, if you're going to have, 01:22:26.114 --> 01:22:31.960 - a client write a letter to their mom and share that and bear their soul, you should be willing to write 01:22:31.960 --> 01:22:37.581 - a letter and share that with their peers. In fact, when I teach those curriculums here, I have them 01:22:37.581 --> 01:22:43.483 - do that beforehand. I'm like, you're going to write a letter to your dad, you're going to write a letter 01:22:43.483 --> 01:22:49.161 - to your mom, and you're going to share it. And if you can't share it, maybe you shouldn't facilitate 01:22:49.161 --> 01:22:50.622 - this stuff because that's 01:22:50.786 --> 01:23:02.378 - that's my number one rule as a clinician is I'm never going to ask somebody to do something that I haven't 01:23:02.378 --> 01:23:13.646 - done myself. Yeah, absolutely. I jot it down. Thank you. Yeah, of course. Well, I think everyone's like 01:23:13.646 --> 01:23:18.846 - maybe you have full bellies and you're ready to 01:23:19.330 --> 01:23:26.669 - Take on your afternoon now. Well, thank you guys so much. Yeah, of course. Thanks for being here. Thanks 01:23:26.669 --> 01:23:33.659 - for sharing all your knowledge and your wisdom. And thanks to everyone for being here and taking it 01:23:33.659 --> 01:23:40.648 - in. And you know where to reach, Ashley. Yeah, and I'll stick my email in the chat. Great, great. I 01:23:40.648 --> 01:23:47.358 - know it was on the thing, but you're very welcome. Great. Yeah, thanks again. Thanks, everyone.