All right, so without further ado, Ashley Collins, so thank you so much for being here. This is a spring
care, Monroe County CARES community meeting. I'm Lee Muser, the CARES coordinator, and Ashley Collins
is giving her time today to present to us on substance use disorder 101, what you didn't know. All right,
thanks Ashley.
Thanks. Yeah, of course. Thanks, everyone. If any of you guys already know me, know I love like nerding
out about the topic of substance use disorder is one of my topics I love to nerd out about. So my name
is Ashley Collins. I am a
I'm a licensed clinical social worker and the director of adult and family services here at Centerstone.
I'm over the West region, which includes Monroe and then the Spoke counties around it, which are Morgan,
Owen, Lawrence and Brown. So I'm going to dive into this and so yeah, definitely jot down your questions
as you have them so that I can get to them, but I'm going to be talking kind of fast.
What is addiction? It is a chronic, often relapsing brain disease that causes compulsive drug seeking
and using despite those harmful consequences to the person using the substances and those around them.
Drug use changes the structure and function of the brain. And you're going to hear me repeat that frequently.
And so a lot of times people are like, well, they had a choice. Initially,
they, most of the time people have a choice, although I have definitely worked with people that their
first use was not their choice. But most of the time it is. However, what ends up happening is that
use then changes the structure and function of their brain and it's no longer a choice anymore. Their
brain's telling them they're going to die without that substance. And we're going to dive a little bit
deeper into how addiction affects the brain in a little bit. And so what
is a drug. A drug, it's important to realize there are legal and illegal drugs. So it's really any substance
that is absorbed into your body that results in psychological and physiological changes. So I'm going
to go over a little bit in terms of like the categories that this falls into. So we're going to review
a little bit of each one of those. So depressants
do what it kind of says, it depresses, it slows down your central nervous system and reduces arousal
or stimulation. One of the most common legal ones is alcohol. We also have benzodiazepine, which are
generally prescription drugs, although we're going to go over something that
there are now benzos that are not pharmaceutical grade. But historically, benzodiazepines have always
been pharmaceutical grade medications generally prescribed to treat anxiety. I refer to people, I refer
to benzos to people as alcohol in a pill form. It's very similar. If you like one of the substances,
you pretty much like the other. And while there's no research on this,
whatever reason, when you combine the two, people rack up a lot of theft charges. Something
about benzodiazepine and alcohol giving people sticky fingers. There's no research that shows this,
but if you're in this field long enough, you will absolutely see that correlation. There's also GHB,
kava, other things that fall into that category. Then we have stimulants. So that's
The other side of the spectrum in terms of depressants are depressing your central nervous system, stimulants
are speeding up your central nervous system. So we have amphetamines, which are pharmaceutical grade
medications that are generally prescribed for ADHD. Then you have methamphetamine, you have crack and cocaine,
and then nicotine and caffeine, which are completely legal substances. I do want to take time to talk
a little bit about methamphetamine here. Methamphetamine, the way it's being made now is very different
than how it was. When I first came in in this field, methamphetamine was frequently being cooked in
people's backyards, in their homes, and that. So what ended up happening, how this
Why is it cooked differently and this is this is the chain reaction of events well. One of the things
that where people were able to make it in their backyards and stuff was access to pseudo ephedrine.
Pharmaceutical like you get it at the pharmacy.
They're all over the counter now. Now you have to like give them your license and all of that. So we
put things in place where people cannot unlimitedly access pseudo phedrine any longer. Because what
they would do with the pseudo phedrine is they cook it and do chemical reactions to cook it down into
a phedrine. So what we had was methamphetamine that was a phedrine based.
Now, that's not the case because we put things in place in the United States to stop people from having
access. Well, folks in Mexico were like, this is great. They can't make all of their own stuff. So we're
going to make it for them. So then we saw that there was that shift. Right. So the United States works
with the Mexican government to be like, hey, we need to work on stopping to allow people to have either
accessing precursors to make ephedrine or ephedrine itself. So they crack down on that. Then the people
that are cooking the methamphetamine are like, well, what do we do now? They went back to using a cooking
method called P2P method. This used to be used back in the 80s and 90s when biker gangs were in charge
of the methamphetamine distribution in our country.
What you get when you do this 2P2, there's some perks in terms of cooking it like this. A, using the
P2P method, you can make significantly more amounts of methamphetamine. And two, you can interchange
different ingredients. So say if like one of the ingredients you're using, they put stop gaps so you're
not able to access that, you can change that out for some other chemical to
do the same thing. So what happens when you're cooking it this way is you have two products at the end.
Those names are really, really long. But basically you have the stuff that gives you that euphoric high
that people, why they like to use methamphetamine. And then you have this garbage that just really super
speeds up your central nervous system. And that is the crap that's causing skyrocketing rates
of methamphetamine induced psychosis right now.
there's a lot of issues that are occurring with that, but you see that shift. In fact, in a book, I
read somebody who was in the military, he had
been using methamphetamine it actually he had trauma before he went to the military when the military
had more trauma than when he came out he would use methamphetamine to be able to socialize with people
because if he wasn't on methamphetamine he was locked in his apartment not talking to other people so
he went from using methamphetamine as a way to socialize with other people to one day he's using it
and he's like I know exactly the date that the meth changed and
He went from being able to socialize with people to a little bit further down the road. He's ripping
out the drywall in his apartment because he's convinced his girlfriend has hidden a man in the walls.
That is the difference in how it's responding to the same person being cooked in those different manners.
So I did want to talk about that because I get a lot of questions about that and that's helpful to understand
that background. So we have opioids.
One of the things I want to talk about here is the word opiate versus opioid. So opioid is this umbrella
term that includes having semi-synthetic, synthetic, and then opiates, which are natural opioids such
as heroin, morphine, and codeine. So these come from the opium poppy plant. So it includes all of them.
So when you hear opiates, you're talking mostly about heroin, morphine, codeine.
If you say opioids, you also have like fentanyl, any of the semi-synthetic things are also included
in that. So there's a lot of knowledge out there about opioids, so I'm not going to spend a whole lot
of time on this, but know like this is really serious, especially with fentanyl, carfentanil, all the
different opioids that are coming out. Psychedelics and hallucinogens.
have their class of psychoactive substance that produce change in perception, mood, and cognitive processes.
So the primary purpose is to trigger a non-ordinary state of consciousness, which people frequently
refer to as TRIPS. And again, you have multiple different things that fall under that. Cannabinoids,
I think everyone knows about marijuana.
What I want to take a moment to talk about here is spice, is synthetic marijuana. It started out as
synthetic marijuana. What it is now, I don't feel like it should be called cannabinoid anything. A lot
of times people are having really crazy reactions. They're similar to people being on bath salts. You
guys remember bath salts for a while.
Spice anything that's like considered Synthetic marijuana is now frequently causing really high fevers
like lots lots of issues that we're seeing with this and what I will say is I feel like I the active
ingredient the most active ingredient I've been aware of is they're using like hornet insect Killer
on this like on this stuff like that's awful for sure and so
What I will say is there's some people that have been heavily using spice that I feel like they never
return to the same person because of the chemicals that are in there. And I see some people nodding
their heads as like anyone that's experienced this. I think this is long lasting brain damage that it's causing.
So then we also have dissociatives. So this is characterized by distorting sensory perceptions and feelings
of disconnection or detachment from the environment or self. So ketamine, PCP, DXM, nitrous oxide are
some of those dissociatives.
And lastly, we have empathogens. So these really increase an individual's feelings of empathy and benevolence
towards others and increase those feelings of wanting to be social, feeling connected to others. You
have the EM or ED, I'm sorry, blah, MDMA. And now, you know, seeing how that
all spelled out. That's why they call it MDMA. Could you imagine if you had to say that whole word that
whole time? So there's lots of different street names for this. Ecstasy, Molly, E, Flippers, Caps, Ekis,
M&Ms. Some people like a certain brand with a certain, a lot of times as you see in the picture, there's
certain stamps that are put in there and be like, this is the Bluebird. So like also you have different
variations called that based on like what it is. I'm sure like these things are called dominoes. This
is probably called skull, you know, so on and so forth. We also have bath salts and PMA, PMMA, and things
like that. So I also wanted to
to touch on some of these more emerging drug trends that you're seeing. So everyone knows about fentanyl.
What I want to hit on in this slide is historically when we're talking about naloxone, we were always
trained you give naloxone to somebody that's using opioids. I tell people now you're giving naloxone
to anyone that's using any substance you don't know
what is in it. So there's a lot of times we've had overdose deaths with people who were intending to
just use methamphetamine, but fentanyl was in it. And so you're seeing more and more fentanyl is pretty
much in any substance that's out there right now. Warning, this is graphic. Xylazine, also known as
Trank Dope, Benzo Dope. This is
really horrible stuff. Number one, it's bad because this is not an opioid. This is a veterinarian
tranquilizer. It was never meant for human consumption. There's no studies on human consumption. Therefore,
we weren't really sure what we were going to see. Now we know one of the worst side effects is the fact
that you have this kind of flesh grossness that's causing skin ulcers.
that can become necrotic requiring amputation. People that are using xylazine are losing their hands,
their feet, their legs, their arms. Now, one of the things to know about this is I think a lot of times
people just assume that, like for instance, this person must have been shooting up in their legs. That's
not necessarily accurate. In fact, a lot of times, regardless of where you're shooting up,
It's showing up on your limbs, on your arms, on your hands, on your legs, on your feet. It's very rare
for it to show up in the trunk of your body. If it is showing up, that may in fact be an injection site
where that's happening. And I wanted to show you, this is somebody that went into one of our facilities.
And as you can see, this gets like really hard and
It goes down deep too, because it's almost like eating you from the inside out. This is what these two
indicators here, this is what it looks like before it becomes an open wound. So I would say within 24
hours, this is going to be an open wound. So it almost looks like kind of like a little bruise, a small
abrasion, but that will in fact turn into an open wound.
In taking care of these things, the guidance really is to avoid alcohol, rubbing alcohol and hydrogen
peroxide because those two things dry it out. What you want when you have these wounds is to keep them
covered and keep them moist because as you see, this person wasn't putting any kind of protection on there.
infection is an issue but also when it becomes hard like this it becomes harder for your body to heal
so it almost is like that scab and again it goes in deep becomes almost like a cork and your body can
only heal so far because as you can see there's like pink granular tissue it's healing however it may
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
body to heal that piece
So really clean it with soap and water, clean water. And I know like you and I are like, of course,
clean water. Tell your clients use clean water. If it's dirty water, then that increases chances of
infection. Cover it with something that isn't going to actually stick to it. So non-adhesive and then
wrapping it.
And if you do want to put something on it, they recommend using vitamin A and D ointment instead of
like neosporin. So if that's not bad enough, we also have metatomidine, which is very similar to xylazine
in the fact that A, it was never intended for human consumption. This is only veterinarian-based use
that's approved of.
This is less likely to cause wounds. However, it is found to be stronger and longer lasting sedative
than xylazine. And it's here. It's here in the state of Indiana. What I tell people when we're talking
about xylazine, metatomidine, and in a minute we're going to talk about some novel benzodiazepines that
are out there, if somebody looks like they're overdosing,
still give them naloxone. The likelihood that there's some kind of opioid in their system is really
high. What you might find, though, if they have xylazine, metatomidine, and any of these novel benzos,
they may not be coming like two.
The only thing you may be getting back is their breathing. They may still be unconscious because of
the sedative effect. So that's really important for you to know, which makes it even more important
for us to be getting medical personnel there to them immediately. And then we have Bro Mazelam. So.
This first appeared in the United States in 2019 since then it's skyrocketed in fact of like it's it's
being mixed into a lot of different things. It can be sold as tablets, powders, gummies, it's frequently
mixed with other opioids such as fentanyl. It's very similar like how it
reacts as other benzodiazepine. The effect occurs about 15 to 45 minutes after you've taken it. It lasts
about five to eight hours. All of these are very similar to any other benzodiazepine. But this is not
pharmaceutical grade. That's something that's really important to know about this. These are benzodiazepines
that are being made in drug cartel labs. This is not something that is
pharmaceutical grade whatsoever. And there's a whole bunch of other ones. So these are some of the other
ones we're starting to see in there. Now, what is really important to know about these things that I
just went over? All of these things, benzodiazepine, xylazine, metatomidine, and then opioids, all of
those have respiratory depressing impacts.
on something. So the more respiratory depressants you're putting in your body, the higher likelihood
you are to have an overdose. Something else that I just want to throw out there that's not really part
of this presentation, but something I've seen in, I sit on the Monroe County Suicide and Overdose Fatality
Review, is a lot of people take Benadryl not as prescribed.
You see a lot of people that die of overdoses that have a bunch of things in their system, some of which
is Benadryl. Benadryl, you can take enough to die. That's really important for people to understand
because I think some people are like, oh, that's over the counter. That Benadryl causes respiratory
depression as well. So the more things you're putting into your body that are respiratory depressants,
the higher likelihood of
of having an overdose. So what causes addiction? I wish it would be a simple answer. It's not, it's
complicated. So firstly, we have kind of the, oops, no, I'm looking at the right one. Okay, biology.
So this is more of like the nature piece of it, right? So we're looking at genetics. Children with parents
that have substance use disorder are
eight times more likely to be biologically predisposed to addiction. And that's not even taking into
consideration the environmental factors that they would be experiencing as well. Then you have your
brain structure. Substance use rewires your brain. If you have chemical imbalances before you start
substance use, that can impact addiction happening or not happening.
Then we have here, this is more of the nurture piece of things. So the age of experimentation, individuals
who tried marijuana or alcohol before the age of 15 were almost four times more likely to suffer a substance
use disorder than those that wait until 18 or older. And I know there's that good old
like fashion, like, oh, they're kids, they're going to experiment. You're like, yeah, don't experiment.
If you want to experiment, wait until your brain is more fully developed to do that. Because the earlier
you do that, the higher likelihood of developing a substance use disorder will be. You have peer pressure,
right? Family, friends, community, and even work environments can expose or protect you from substance
use. And then trauma history.
teens who've had experienced physical or sexual trauma were three times more likely to report substance
use. Behavioral patterns, right? We all have different behavioral patterns and that can either put us
on the side of protecting us or putting us at more risk based on what those are. Then this, I feel like
your psychology, that's kind of the combination of nurture and nature. Some individuals have more positive
or negative coping skills than others.
And a lot of times that's the caregivers you're around, whether it's your primary or not, are people
giving you healthy tools or negative tools to deal with issues. Whether or not you have a mental health
issue or not can contribute to whether or not you develop a substance use disorder. There's definitely
people that are more impulsive and thrill seeking than others.
Also looking at them at the locus of control. Is this somebody that constantly blames everything on
everyone else and takes no responsibility at all? Or the flip side where you blame everything on yourself
and taking on responsibility that is not yours and not putting the responsibility back on somebody else
that is their responsibility. The expectation of what drug use will lead to. This is something I'm not
necessarily proud of, but
My family, ironically, I will say this, there's a lot of alcohol use disorder in my family. But one
of the things they taught me was like drug use. It's horrible. It's awful. Little did I know until I
was much older, I was like, you guys were doing drugs too. It was just legal. So you thought it was
okay. But they're like,
drugs will lead to bad things, you will be homeless, you won't accomplish anything in your life, you
won't have a job, you know, all of these things. That is what I was taught that drug use would lead
to. That did not sound appealing to me. There's a lot of people I work with that their drug use is a
rite of passage in their family. A lot of times the first time they use is with their mom, with their
dad, with their siblings, with their cousins,
All family events are surrounded by substance use things as well. There's a lot of times where I work
with people that going to jail is also kind of a rite of passage in their family. Everyone in their
family goes to jail. That's just something that happens. And then some people have more motivation in
terms of like goals and all of that sort of thing that they're kind of just more driven in that way.
I'm going to show you this little video and then let's see. If you're visual, this will really help
you. The question is often asked, why do some people use drugs and never get addicted? People are extremely
complex and complexity creates diversity.
Each of us is a unique collection of different layers, representing our genes, brain development, parents'
influence, social environment, diet, and many more. Each layer is like a slice of Swiss cheese. The
areas with holes are the dangerous areas of the slice because they can let risks go through. The areas
without holes protect us.
because they can block risks. For example, hanging out with friends who abuse drugs punches a huge hole
in our social slice. While playing sports, learning a second language, or hanging out with friends who
don't use drugs can shrink the holes in the social slice. For drug abuse behavior to become an addiction,
the risk must cross through a lot of slices.
Usually, a few of our slices are solid enough to stop the addiction before it's too late. Thinking about
addiction in this way helps us understand it is impossible to predict who will become addicted. However,
recognizing the risks that can lead to addiction creates many opportunities to protect our future and
build a healthier society.
Right, so why do people use drugs? This is not an exhaustive list by any means, but basically in our
brains, we are rewarded with dopamine.
for doing the things that keep us alive. This is why you eat that delicious cheeseburger, you get dopamine
release. You have sex, you have dopamine release. You do the things that you need to do to survive,
you get dopamine release. What addiction does is basically hijack that. And then it makes us think that
we're gonna die without that specific substance. So I've been in the field for a pretty long time
I can usually boil it down to one or two reasons, and sometimes it's the combination of both, of why
people use drugs. One is they self-medicate for mental health, physical health problems not otherwise
treated. Two, they're using to numb, to escape, to avoid dealing with problems. And this is almost always
related to underlying trauma. And what I will say just
quickly about trauma is there's a lot of times I'm working with individuals and they don't recognize
that what they've been through is trauma. And I think part of that has to do with the context of when
we started talking about trauma in our country. It was mostly in the context of PTSD and military settings,
right? They're like, well, I didn't have my best friend shot next to me. I wasn't in an explosion. What
do you mean I had trauma?
Well, if you grew up feeling as though nobody loved you or you were unlovable or you were broken or
something was inherently wrong with you, that is trauma. It changed the way your brain developed having
those things happen to us and those absolutely play out in our adult lives.
Whether we want them to or not, so I think a lot of times people are in denial about how much some of
those things are still impacting them today because we would rather just pretend like it wasn't affecting
us. Right? So we're going to dive into addiction and brain. So a little neuro.
biology brush up. So your brain, it's made of billions of cells called neurons. And then those neurons
are organized into circuits and networks. And each neuron acts as a switch controlling the
flow of information. So how does this work in your brain? So one way is drugs interfere with the way
the neurons send, receive, and process signals
via those neurotransmitters. So those are the chemicals messengers in our brains that transmit a signal
from a neuron across the synapse, which is this little space in between, which can, it can be like through
the synapse to either target cell, which could be another neuron. It could be a muscle cell,
a gland cell. They're all made of neurons or they all are made of neurons. Yeah.
And so sometimes it's interfering with those signals, sending it, receiving, processing it. Other times
drugs mimic natural neurotransmitters in our body. We have opioid receptors in our body because we release
naturally occurring opioids in our body. When we get hurt,
signal stuff, but that is why an opioid that's outside of our body that's made from the poppy plant
or fentanyl, we have opioid receptors because of that. So it mimics those natural opioids that we have
in our body, which is, you know, and then there's a lot of different drugs that mimic those. Now, before
I get into this third point, I'm going to give you guys a little information about how an antidepressant, an SSN
SSRI, a selective serotonin reuptake inhibitor is what that stands for. So let's just say these little
balls here are serotonin. So what happens when you're on an SSRI is, well, what would happen if you,
regardless of being on it. So this is serotonin and it hangs out here and then it gets absorbed into
this next cell.
Well, what happens when it doesn't get absorbed, it doesn't just hang out there, it gets sucked back
up into here and kind of recycled. So what an SSRI does is it prevents, it kind of puts an X on these.
And so it doesn't allow it to be sucked back up. So it does have to stay out in the synapse. So you
have more serotonin in your synapse for the receptor of this other cell to be able to suck up when needed.
So that's definitely how it works. And sometimes some drugs do something similar. So some drugs cause
neurons to release abnormally large amounts of a natural neurotransmitter, dopamine. Almost all substances
work on dopamine. And then they sometimes also prevent that normal recycling process based on that.
And what neurotransmitter is
impacting kind of depends on the substance that it is. So in short, those are like a few different ways
that it impacts the brain. And what, and we're going to highlight these three things, but the truth
is, is like what parts are affected by drug use? All of the parts of your brain are affected by drug
use. However, we're going to touch on these three things. So the basal ganglia
which is this like teal right here, that is our, it activates this reward circuit. So this is where
our reward circuit kind of sits, where we're getting natural neurotransmitters released for doing the
thing that keeps us alive. But in this case, it's doing the substance that then our body thinks we need
to keep us alive. We also have the extended amygdala,
And so this plays, this is the purple right here, that plays a role in withdrawal that motivates the
person to use again. In fact, when you work with people who, or know people who have been using for
a really long time, a lot of times they'll tell you, I'm not using to get high anymore, I'm using to
not be sick. And that withdrawal, you feel like crap when the
drugs coming out of your system, so you want more so you don't feel sick again. And that is what the
extended amygdala keeps you in that vicious circle. Then we have the prefrontal cortex, which is kind
of our executive center of our brain. That's where, you know, we reason out right from wrong consequences
and effects of like making this decision. It
It doesn't completely pull it totally offline, but it's offline enough that you're, you have a decreased
self-control over your impulses. Um, cause that's the part that's like, okay, this is a bad idea because
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,
this is your brain survival hierarchy.
one food, two water, three sleep, four social interactions. Now if you're talking about somebody who
is an active addiction, you may have fentanyl, methamphetamine, marijuana, alcohol, all before you get
to food, water, sleep, and social interactions. So I've had a lot of people tell me like, hey, so
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
instead of food. Why? This is why. This is why. And this is the nucleus accumbens. And that's the part
of your brain that's triggered like you are going to die without this substance. Now, when I first got
into this field and having had experience with substance use in my own family,
I would get really angry when people would lie to me and I knew they were lying to me. A lot of people
do, right? Like, it's not cool to be lied to. However, when you're thinking about it in this context
of what's happening in their brain, if I need to lie to you to make sure I get that substance that I
need or I'm going to die, I'll tell you anything you want to hear, right? And that makes a lot more
sense when you're thinking about it in this context.
Alright, so this is very interesting. So this is dopamine release when you're eating food. Not somebody
that has a dictionary thing. This is dopamine release if you're on cocaine. So and something that we're
going to talk about in a little bit when we talk about withdrawal is
Here's the thing is like, it can take up to two years after somebody stops using for their brain chemistry
to get back to normal. And sometimes I would argue, sometimes it may never go back to normal. Just like
for me, because of the trauma I went through as a child, I will always need antidepressants for the
rest of my life.
And sometimes for them, like when they're in those two years, so like, let's say you're working with
somebody that just stopped using and like, let's say they stopped for six months right now. When they
eat food, they're not going to have as much dopamine release as this. And part of that is because your
body gets used to you putting chemicals in your body to be able to have those releases, right? So your
brain is depleted
by a lot of the, and you're not having normal chemical stuff that's going on for quite some time. And
if somebody has been using for like 20 years and they stop, I don't know that two years is enough for
that to get completely back to normal. So when you think about it in that context of like, you know,
when people are in early recovery, it can be really challenging, really tough. Life is not nearly as
exciting. Look at all that excitement with cocaine. And now they even have less,
excitement eating food than the rest of us do. So that's really important thing to understand as well.
I don't have time to do this, but I highly recommend you guys going and you can probably just even Google
mouse party. This is the site and you can go there. It's like a terrarium of all these different
cartoon mice that are on all these different substances. Alcohol, marijuana, heroin, methamphetamine,
cocaine, ecstasy, and LSD. And whichever one you want to learn about, you pick up that mouse, you click
on them, and it like puts them into centrifugin. It shows you on like a chemical level what's happening
in your body when you're using that substance. It's very informative. I've definitely used this with
When I'm teaching staff also with clients as well, it's like, do you want to understand how this impacted
your body? Some clients are really into that. Some clients are like, no, I'm fine. I trust you. Let's
just move on. Okay, so co-occurring disorders. What is that? So according to SAMHSA, the coexistence
of both a mental health issue and a substance use disorder is referred
to co-occurring disorders. Not to be confused with comorbidity. Comorbidity is when you have a medical
issue as well as a mental health and substance use disorder. Now, hear me when I say this, a lot of
the people I work with have co-occurring and comorbidity, right? Because a lot of times when you're
an active addiction, you're not taking care of yourself. You're not going to the dentist, getting your
eyes checked, going to your regular checkups, that sort of thing.
So what are the reasons why they occur frequently together? So the National Institute of Mental Health,
they say that research suggests about these three different possibilities of why. So common risk factors
can contribute to both a substance use disorder and other mental health disorders. So both substance
use disorders and other mental health disorders can run in families, suggesting
that genes can be a risk factor. There's also environmental factors such as stress or trauma that can
cause genetic changes that are passed down through generations and may contribute to the development
of mental disorders or substance use disorder. So I wanna say that again, we now know through studying
epigenetics, we can pass down trauma to our offspring, to our children.
So I'm like, I'm sorry, I apologize to my daughter all the time. I'm sorry I have passed down my trauma.
So that's a real thing. And then secondly, we have mental disorders can contribute to substance use
and substance use disorder. So studies have found that people with mental health issues such as anxiety,
depression, post-traumatic stress disorder may use drugs and alcohol as a form of self-medication.
However, although some drugs may temporarily help with some symptoms of mental health disorders, they
make the symptoms worse over time. And additionally, the brain, I lost my place. Additionally, the brain
changes in people with mental disorders and that may enhance the rewarding effects of the substance,
making it more likely that you're gonna continue to use substances. So because you have a mental health issue,
using substances feels even more rewarding than if I didn't have a mental health issue. And lastly,
substance use and substance use disorders can contribute to the development of other mental health issues
or other mental health disorders. Substance use may trigger changes in the brain structure and function
that make a person more likely to develop a mental health issue. And something else I'm going to throw
out there, it's not part of this, but
A lot of times using substances, you are frequently putting yourself in situations that are traumatic
in nature, which then can lead to mental health issues as well. So, oh my gosh, the numbers didn't fall.
So you're like, what is this? Yeah, this doesn't look like much without the numbers. So here in, this is 2015.
8.1 million. And so AMI is any mental illness, SED, substance use disorder. Here is 8.1 million.
This is 2017, 8.2 million. 2019 here, this is 9.5 million. And then 2021, 17.9 million. Here in 2023,
10.4 million.
You're like, Ashley, why? Why is there a huge difference? Well, one thing, from here to here, we had
a global pandemic. So there was that. Also, I would say there's a lot, we're doing a lot of work on
decreasing stigma and getting people help. And I do feel like while there's still some stigma that exists,
more people are getting the help that they need. So I would venture to say if you were in 2015,
We were still here. People just weren't getting as much help as they are now. But not to mention that
global pandemic really did impact people of all of their social supports were completely cut off or
significantly cut back when we had that. So withdrawal. Withdraw occurs when the body has become dependent
on a drug.
and when that drug is not used or available for use. So it might be like I'm choosing not to use, or
it could be my dealer is out of town or my dealer is out of the substance. And the severity of the withdrawal
is based on how much or how long an individual has been using. Some other factors, maybe age, physical
condition, genetics, the combination of the drugs they're using,
And also the presence or absence of a support network can impact withdrawal as well. If you don't remember
anything I say today, please remember this. When people are coming off of alcohol and benzodiazepine,
they can die from withdrawal.
they can die. Now, other substances can make you feel like you're going to die. And I'm sure in complicated
situations where somebody is like super dehydrated, that could then lead to that. However, with alcohol
and benzos, you can absolutely die. And if you don't die, you can also end up having like seizures,
really severe seizures. So if you're working with somebody or know somebody that is on alcohol
or benzodiazepine, and they say they're going to stop cold turkey,
tell them do not just stock cold turkey. You need to be evaluated to see if you need medical withdrawal.
And what happens is say somebody is using or drinking half gallon a day, they go into treatment into
inpatient to like to go through their medicated or their medicated withdrawal process. They're given
benzodiazepine to slowly come off of this. That's part of the plan.
So a lot of times when people think about the stages of withdrawal, when people say withdrawal, they're
almost always referring to the acute stage, which is the physical body symptoms. That duration lasts
anywhere from a few days to a few weeks, depending on the things we just talked about. The thing we
do not talk about enough in the recovery community is the post-acute stage, or you can also hear it called
post-acute withdrawal syndrome or PAUSE. There's emotional symptoms here. Most of the physical symptoms
have ended. However, there can be times where you do still have physical symptoms. Now, when you're
talking about the post-acute stage, the longer you have been in recovery and no longer using the substances,
the less frequent those episodes should be and the
less frequent and they should be shorter and shorter, but this can last up to two years because your
brain chemistry is messed up. Okay. All right. So we're going to talk about medicated assisted treatment.
And today we're going to focus on, um, we're going to focus on alcohol and, um, opioid use disorder, MAT. So,
These are medications that assist with the use of the combination of counseling and behavioral therapies
to provide that whole patient approach to treatment of substance use disorder. So yeah, we're gonna
focus on opioid use disorder, MAT, alcohol use disorder, MAT. What I will say is you're gonna hear,
we love to change up verbiage. I feel like personally, it's like to age,
the documents we have, like if you see chemical dependency, you know that was probably written in the
eighties or nineties, right? So instead of saying OUDMAT, which is a mouthful, you're gonna hear,
what is it? MOUD, medication for opiate use disorder. MOUD is what you're hearing more frequently now.
So we're gonna start with opioid use disorder.
or MOUD. And if you think about it in these three buckets, it's helpful. Again, I'm a visual person.
If you're not, this may not be as helpful, but you have the methadone bucket, you have the buprenorphine
bucket. There's a lot of stuff in this buprenorphine bucket. I feel like this bucket, every time I turn
around, this bucket's growing with different things that they have, different options of buprenorphine
products. Then you have like the Naltrexone slash Vivitrol bucket.
So when you're looking at those, you have methadone, which is an agonist, and on the flip side, you
have naltrexone or Vivitrol, which is an antagonist. So it completely blocks the opioid receptor. Now,
buprenorphine is kind of in the middle of those two. It's a partial agonist, which means it blocks the
opioid receptor, but it excites it. So there's still some dopamine release, which is why they have street value.
right, because you hear about people getting suboxone on the streets. This is part of the reason why.
So let's dive into each one of these. So methadone, what's really interesting, and I have to say, I'll
be honest, because I think that's important. As I've been in this field, my views on medicated assisted
treatment have drastically changed. Based on increasing my knowledge,
as well as seeing this play out in people's lives. Methadone, I'm gonna just say this, a lot of what
you know about methadone may be completely untrue, because that was the case for me. So with methadone,
it has been around the longest. It's frequently referred to as the gold standard for opiate use disorder.
It has the most research behind it, but out of these three buckets we just talked about, this is the
most stigmatized one.
And I think it's stigmatized mostly because of a lot of false information that people have about this.
So you've all heard of methadone clinics. We don't even call them methadone clinics anymore because
that word is so stigmatized. You hear them called OTPs, opioid treatment programs. So in the state of
Indiana, I can't speak to outside of Indiana, but in the state of Indiana,
opioid treatment programs do not give people pill forms of methadone. They don't. It's liquid.
And in fact, when you're learning about all these different ones, this is the hardest medication to
divert. What does diversion mean? Like to pretend like I'm taking, but not really, and then give it
to somebody else or store a whole bunch of it for myself and take a whole bunch at one time. It's liquid.
And in fact, it's mostly like a reddish liquid unless somebody has an allergy to that, in which case
it might actually be clear if they're allergic to that, whatever that red dye is that they use in there.
So and a lot of times people that are on methadone, I want you to think about this. So how many of you
guys take medicine every day?
you know, whether it's an antidepressant, blood pressure, cholesterol medication, think about this.
To get your medication to feel okay for the day, you had to drive to a place every single morning, regardless
of you're sick, your kid's sick, there's a blizzard, there's a tornado, you know, whatever, every single
day. That's what these people do.
And it's a lot of work. And at least in the state of Indiana, you have to be doing that for an entire
year with no negative, no positive drug screens, not even just for marijuana, no positive drug screens
at all to get a take home so that maybe you don't have to go on Saturday and Sunday to get that.
That's a lot of work. And there's not enough OTPs. And so there's some people that are driving an hour
and a half one way to get that medicine and get back. How much would that impede your ability to do
your regular life massively, right? So just something to think about.
Also, when you're looking at this, because I feel like this is part of the reason why a lot of people
are like, methadone is horrible. It's just substituting one substance for another. So looking at methadone
compared to heroin, methadone, you only need to take once every 24 to 36 hours. Whereas heroin, you
have to be taking it every four to six hours to not be sick, right? Heroin, you have a really high
overdose potential, methadone you don't. And like you get, in fact, let me just go to the next thing.
So like this is heroin. So it, when you take it, it shoots you up into this really toxic area where
you can get high. You go down, look how little time you're actually in a window of tolerance for heroin
to where it like, once you cross this line, you're in
overdose or overdose, I'm sorry, withdraw symptoms. This is where you're at risk for overdose. This
is where you have withdrawal symptoms. Whereas methadone, it keeps you in this window of tolerance the
entire time. Now, granted, you are going every day. So when you're starting, they're really monitoring
things about how you're responding. So every single day, you could have things altered based on what's going on.
Are there any questions about that I know I said I wouldn't stop for questions, but I feel like there's
usually a lot of questions about methadone. Okay, all right, the other thing i'll just say really quick
about methadone before we move on is in the state of indiana besides Center stone.
and Pinnacle or Recovery Works in Martinsville, there is no place that regularly, because occasionally
you hear of places doing a one-off, allow you to come to inpatient residential facility without completely
stopping your methadone. And methadone is only helping with opioids, right? How many people do you know
that only use one substance? You know, so a lot of times people are going to the
OTPs to get their methadone dose, but they're still struggling with alcohol. They're still struggling
with methamphetamine, whatever else. In the state of Indiana, they do not have regular places they can
go to go inpatient facility. And that is not okay. It's not okay. Centerstone, we started doing that
in 2021. We work with them. Is it a lot of work? Absolutely. Is it the right thing to do?
Absolutely. And those people are so grateful for having access to the full continuum of SUD services
because of that. So buprenorphine. So buprenorphine was approved by the FDA in 2002. And something to
like know is Suboxone has buprenorphine and Naloxone. You're like Naloxone, I hear about that. Naloxone
Narcan, that is part of what is in there. Now,
At least in the state of Indiana, when people, when you're working with a woman who's on Suboxone and
gets pregnant, they will frequently take her off of Suboxone and put her on a buprenorphine only medication.
And part of that is there's just not a lot of research about Naloxone's impact in the pregnancy, because
who wants to be like, I'll sign up to see if this messes my child up, right?
There's a lot of times not a lot of research about pregnant women with certain medications and Naloxone
is one of them. But in this bucket you have Sublicade, which is an injection that goes into your stomach
by your belly button. This is really great when like somebody can't trust themselves, like Suboxone
helps them with things, but they can't trust themselves to use it the way it's supposed to be used.
Get an injection once a month if that's
what's really helping you. There's also subsolve, there's subutex, there's a lot of different things.
There's, I think it's called Rickzalti now where you can get an injection. This supplicates once a month.
I think Rickzalti, you can do it once a month or you can do it like once a week or once every other
week. I think there's different dosage that you can pick.
And then we have naltrexone, vivitrol, and naloxone. So these medications completely block the activity
of the opioid receptors in the brain. So when you're talking about naloxone, it's like you have your
receptor and then you have like
little opiate on it it just comes and like kicks that off and like sits on the receptor for a while.
Now something to remember with Naloxone is people can re-overdose without taking more medication. So
the Naloxone can wear off and they can re-overdose which is why it's really important for people that
have overdosed to get medical treatment. Now they're not always willing but that's always the recommendation
because of that because what they end up doing is getting an IV
with Naloxone going into their system. So like they're able to keep Naloxone in their system until their
body's processed whatever opioids or whatever else is in their system. Now, Naltrexone is a pill you
take every day. So you could take a pill every day and that helps with opioid stuff. Or you can get
instead, if you're like, I don't wanna have to take a pill every day, Vivitrol is an injection
that is in your bottom. It's an inner muscular injection. So it's a pretty big needle. And I tell people
if they're really scared, you shouldn't look at it. If that's not not your thing, and it gives you anxiety.
And this can be really, really helpful. Now what I will say about Vivitol and Naltrexone is if they
stop and go back to use, they're at higher risk of going like having an overdose, because
It does not, they have no tolerance at all with that. Whereas with methadone or buprenorphine, you still
have a little bit of tolerance. Therefore you're less likely to, if you stop and go to use, you're less
likely to have an overdose. Okay. Alcohol use MAT. There's anabuse. Anabuse is a medication you take
and it makes you super sick if you drink on top of that. My grandpa,
My maternal grandpa got sober in like either the late 70s or early 80s using anabuse. And he actually
continued taking anabuse for years after he had been in recovery because he was scared. He was scared
that if he stopped taking it, he would convince himself he could have one drink again. And he knew he
couldn't have one drink. That wasn't his thing. So he stayed on that for a pretty long time. Then you
have Camprel.
And that is something you take three times a day. So I don't know about you guys, but I would have a
really hard time taking something three times a day. Your eyes do not deceive you. Naltrexone and Vivitrol
are also in this category. Now, this doesn't make you sick like the anabuse does. What I've heard from
people, and it wasn't as much Naltrexone, it was Vivitrol, is if they were to drink on top of it, they felt like
like the euphoria and those positive things they would get from drinking were like turned down. Now
what can make that dangerous is then they're like, well, I just have to drink that much more and I can
override it, right? And you could have alcohol poisoning. So something to keep in mind with that. So
some Medicaid assisted treatment truths. It's not trading one drug from another.
When used as prescribed, MAT can help stabilize brain chemistry and reduce cravings. The non-MAT medications
are short acting and create the euphoria. Methadone and buprenorphine are long lasting to treat symptoms
of addiction cravings and the addiction withdraws, and they don't create that euphoria high. Now, what
I will say to that is when somebody's starting MAT, they may look high.
There's a lot of times I would start working with somebody in the jail. I knew what they looked like
completely sober. They come to group and I'm like, did you start MAT or did you have a relapse? Like
I can tell in your eyes, something's not right. It usually takes like a week, two weeks for things to
like adjust, especially with the buprenorphine. Now with the methadone, they're going every single day.
So things can be tweaked more frequently than the buprenorphine. Okay.
MAT is well accepted as evidence-based treatment. MAT is not a crutch that prevents true recovery. Often
it's a central component for successful long-term recovery for many people with opiate use disorder.
It often makes recovery possible for individuals for the first time. I've worked with these people,
they tried their hardest to do this and then MAT was the thing that
was able for them to stay in recovery longer than they had when they had tried to do it without it.
So best results occur when MAT is taken for as long as it provides a benefit. So SAMHSA treatment protocols
advise against arbitrary time limits on the duration of treatment for opiate use disorder medication.
Evidence show that tapering or discontinuing medication
leads to very high rates of relapse and it also shows that research shows that somebody that's on MAT
for at least one to two years has the greatest rates of long-term success. There's currently no evidence
to support benefits from stopping MAT and if you think about when we're talking about withdrawal it
can take your brain about one to two years to
for the chemistry to get right back, right? And I worked with somebody who, he was taking 16 milligrams
of buprenorphine, eight in the morning, eight in the evening. He'd been on it for a long time.
And I was like, he's like, Ashley, I wanna try to stop. Now, I always train people, if somebody that
you're working with wants to stop MAT, the first reason, like the first thing you should say is like,
what's going on? Why? What's happening?
Cause a lot of times people want to stop because somebody shaming them about it. And I know this sounds
really dramatic, but shaming somebody about this could cause them to stop their MAT and go out and use
and die. Um, and so be really careful about all of this. Cause again, that person that was on 16 milligrams,
he, we had a whole plan. I had a plan with him. His prescriber had a plan with him. He got down to,
from four milligrams to two milligrams and two milligrams wasn't enough. He started having really bad
cravings, really bad withdrawal. And so he got bumps back up to four milligrams. But I was like, look
at best though. Like that's an improvement. You now know you don't need 16 milligrams. You're okay with
four milligrams a day. That's huge. And I'm like, that isn't
loss like in terms of because I think he was really beating himself up like I'm a failure I can't do
this I'm like again I'm gonna have to take antidepressants the rest of my life because of the trauma
that changed my brain chemistry you might need to take four milligrams the rest of your life and there's
nothing wrong with that. MAT does not increase overdose risk in fact research found that in comparison
to those who didn't receive any MAT deaths from overdose were decreased by
38% in those taking buprenorphine and 59% in those receiving methadone. And long story short, there
are many paths to recovery. Everyone has their own journey and it's not our place to judge what that
journey is gonna look like. I wanted to talk just quickly about recovery meetings. Recovery meetings
are imperative and what I love is there's so many different types of recovery meetings.
out there now. You know, we have like the traditional 12 step AA and A. I think there's like crystal
meth anonymous. There's a lot of different anonymous meetings. We also have smart recovery now. Smart
recovery is really great in terms of like, first of all, I'm a smart recovery facilitator. It's the
best motivational interviewing training I've ever taken in my entire life. And I've taken a lot of those. So
it that's really helpful. The other thing about smart recovery is they don't talk about higher power.
I know sometimes people have had bad trauma with like church or other religious experiences and they're
like, I just I have no tolerance for people to talk about God or higher power. They while they admit
spirituality is a part of recovery, they're like, but we're just not going to talk about it in this
meeting. So that's a really great meeting for somebody that's like really put off by
that sort of thing. Then we have Recovery Out Loud, which was started by John Cunningham out in Columbus,
Indiana. They are very much about nutrition and exercise. They also live stream their meetings.
They're like, this isn't, I don't want to be anonymous. I want people to understand and be out there.
There's also Celebrate Recovery. Now this is a very Christian based program. The cool thing about Celebrate
Recovery is they don't just address substance use disorder, they address all behavioral addiction things.
So codependency, if you have issues with like pornography or sex, or I mean, there's just a lot of things
that they cover that a lot of these other ones
don't. A traditional Celebrate Recovery Meeting is you meet for an hour for dinner, you have dinner
together, you eat, and the first hour is the main topic everyone's at, and the third hour is you break
up into groups. Most of the time it's women, men, and teens. So Recovery Meetings are really,
really helpful, and this is where they can change their people, places, and things.
And support, virtual support meetings, in the room app is really great. Any of the anonymous meetings,
they have their own websites. You can look up and find different meetings, whether it's in person, virtual,
all that. Facebook groups, especially with Recovery Out Loud, that would be a great place. That's where
they stream their meetings. There's also YouTube. I always tell people, I was like, if it's 2 a.m. in
the morning and you're really struggling,
Go onto YouTube, there's all kinds of speaker videos on there. Also, I tell people, you know, there
may be another English speaking stuff. You could, at 2 a.m., I don't know the exact time difference,
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
of different options. And I did wanna just real quick hit on,
addiction as a family disease because we don't talk about this enough. It impacts everyone. I always
joke with my clients saying, I can be just as crazy as somebody in active addiction, and I don't even
have a substance to blame it on. When I'm in my Ashley control freak mode, it's not pretty. Again, this
is not an exhaustive list by any means, but the whole entire family and their friends are impacted by
the substance use themselves, maybe more than what they even know. And so those are some of the things
that can happen. And we need our own support group. I personally myself have been going to Al-Anon for
seven years. It's a game changer. And I know I will need Al-Anon the rest of my life. I pretty much
needed to go straight from birth into an Al-Anon meeting, and that wasn't possible. But I know that
These are my people. And then there's also Alateen, which is just a spinoff of Al-Anon for teens. There's
some meetings that even have children there as young as like eight years old. There's a smart recovery
friends and family piece as well, which I feel like is very similar to Al-Anon. I would say the biggest
difference is because it's all motivational, entertaining based. There is a piece about how do you have
a conversation with your loved one if you're wanting them to get into treatment. Apparently yelling
and shaming doesn't work. I know because I've tried it. It actually has the opposite effect. There is
also adult children, alcoholics and dysfunctional families. I kind of gave you the outline of celebrate
recovery. That could be part of their recovery too with the family. There's also codependency anonymous.
There's a lot of different things out there for people. And I have links.
for other things. Oh, there we go. All right, let me stop. Do you guys have questions? That is a great
question. How do we access that? If you guys are wanting the slide deck because of our whole registration
process not working,
I would go ahead and just stick your email in the chat and then I will make sure that you get a link
to the slide deck as well as the recording of this. And then Lee, were you going to say something? Cause
we also have cats. No, I was just going to address. I was going to ask about that. Yeah. Great. And
I'll be sending out, if people need a proof that they attended, I'm collecting those emails. I will,
if you email me, then I will send out something probably later tonight.
Great, thank you for that, Lee. No questions at all? Everyone's like, I know that was a lot of information.
So much information. I threw at you. Yeah, it's a lot to digest. Yeah. Yeah, I'll just put my email
in the comments again. If you need any kind of proof,
of attending, just email me. But for the slides and the recording, email, or Ashley will get your emails.
And then this will be up on Cats at some point. They're so good about a pretty short turnaround time.
So you should be able to find that on Cats pretty soon. And again, thanks for Cats for that. Kathleen.
So you have people returning from treatment. And I'm assuming when you say that, is it like a 28 day
stay? Is that what you're? Yes. Yeah. So it kind of depends on things. I feel like most of the time,
I would say regardless, it's usually good to be in like some kind of like IOP, some kind of intensive
thing that's like, you know, three times a week or so is usually really helpful.
There are some times where there's people that have been in recovery for years, something happens, they
return to use. They may not need something as intensive, but I would say for most people who've not
had a lot of recovery time coming out of residential, the more intensive, the better because they can
really struggle going from that 28 day where everything's happening right there where they're sleeping to then
when they leave, they don't really have that external accountability as much. So providing that with
as much structure as possible is usually a really positive thing. Is that helpful, Kathleen? Well,
sort of. I have a mother who just was released yesterday, and we texted back and forth when she showed
me her certificate. Then when I talked to her last night, I said, oh, I thought you were going to go
to aftercare. And then
They would help you find housing. They would help you find a job, all of that. She said, well, there
was a girl in the program with me that I didn't really like, and she was scheduled to go to the same
place I was going to go. And so I chose not to go. So again, we're back into excuses rather than really
trying to deal with the situation. Yeah. And that's really common, Kathleen. I always tell people,
I'm like, I don't know how many people are like, I did it. I did my 28 day stay.
I'm done. I'm like, oh, yes, let's celebrate this accomplishment because this is an accomplishment.
But you were at the beginning of your journey and to think that you go to 28 day things when you've
had 15 years of a lifestyle, 28 day like isn't going to do it. You have to like start living it. You
have to start intertwining that. And it's really easy to go to a 28 day program, get plopped right back
in that same environment and go right back into like,
Those old ways of doing things and thinking about things and everything. And yeah, there there's a lot
of times where I'm like, there will be people you don't like everywhere. That doesn't mean that avoiding
them is worth your recovery. Right. And I always tell people to, because you get a lot of people that are like.
Well, my job is really important. And so I'm missing like my meetings and my treatment because I'm working
50, 60 hours. I had somebody tell me this, who was in a jail program treatment and he's, and he had
graduated and was doing well. He's like, anything you put above your recovery, you're going to lose
when you lose your recovery anyways. Whether that's your job, your kid, this relationship, whatever,
you will lose it all anyways when you lose your recovery. And I think sometimes that helps in like,
oh, I need a perspective shift, so to speak. Well, and that's good. And part of the reason she went
to recovery when she did was because we're up to terminating her parental rights. So, okay, she needed
to go to treatment, came out back with the guy who she was with beforehand,
He came out of treatment as well. We'll see. Yeah, I'm skeptic. Yeah. And that's really hard. I worked
for the Department of Child Services for five and a half years. And so I understand. And I think the
piece that really sucks is because we want permanency for the kiddos. And the DCS timeline doesn't always
jive up with a realistic recovery timeline. Right. And I always tell parents that
that were going down that road, because I feel like that's the piece where it's really easy for them
to just completely give up, right? Like, well, you're gonna terminate my parental rights. So like, what
else do I have to live for, right? I'm like, regardless of your parental rights being terminated or
not, your child will want to know you when they get older. And in every situation I've ever seen, regardless
of how atrocious the abuse or neglect was, that kid wants to come back when they're 18
to figure out what happens right they're trying to put all the pieces together and you need to be in
a healthy place for that to happen, because no matter what something says on a legal piece of paper
you're their biological parent forever you know. Well, thank you. yeah.
Okay, L Lopez. What, I think it depends on like what's going on, how much are they using? Can you tell
me a little bit more info? Oh, I guess her or his microphone is not working. How much is drug use? I think it,
It's hard for me to say generally, I think it requires assessing what's all going on. If they're regularly
using, they need to be assessed for residential to go inpatient for a 28 day stay. They might, depending
on what they're using, if they're using alcohol or benzos, they might need medical detoxification before
they can go to residential. If
you know, if maybe they've been sober for a long time and they went back to use, I think we could definitely
plug them into some outpatient things and assess how that's going. Yeah. And, and I also want to say
drug screenings, drug screens have typically been used as punishment. Right now, the drug supply is
so tainted. I think of drug screening as
a safety thing. Because a lot of times people don't know what they're using. We've had people come into
a residential facility saying, I'm only using benzodiazepine. We drug screen them straight up fentanyl
in their system. They're using things that look like benzodiazepine. They're pressed to make it look
like that, but it's not. And so you absolutely, I think drug screens are really helpful. Like they may
really think they're only using marijuana. They may think they're only using this one substance. And
it turns out
they're using significantly more than what they realize. Did that help? Yes, drug screens are helpful
because that can also, you know,
A lot of times they lie to you about how much they're using they're downplaying how much they're using
so I do feel like drug screens sometimes give you a better picture of what of what's happening. And
it can be very informative to them of what's actually in their system because they don't they don't
know right now. you're welcome.
had a question. Um, this was great. I, I oversee family preservation with my agency. So we're all we
do home based with the families who have a lot of substance use referrals and domestic violence, I would
say is probably what we see the most. But what curriculum I'm looking at adding some more evidence based
curriculum for my therapist and skills coaches. What would you recommend because I know there's a lot
out there, but a lot of it is for groups and we don't do groups. It's all just
individual, either one parent or both parents. And sometimes we work with teenagers with SUD as well.
But I didn't know what you have found to be helpful. We use we do have that like MI, we do CBT seeking
safety, but I wasn't sure. Yeah. And, and this is generally used in a group setting, not that you couldn't
use it otherwise. I really love Stephanie Covington stuff, because she intertwines that stuff with trauma.
because trauma is almost always at the root of that. And I feel like there's a lot of curriculums that
never get to the bottom of that. There's helping men recover and there's helping women recover. And
those are amazing curriculum because it really digs into stuff. Now, you have to have people facilitating
that whether you're doing it individually or in group that are gonna be okay talking about those things
too. Because that's what I see a lot of times I'm like,
I knew this one person, cause it goes over yourself, like relationships, spirituality and sexual out,
like sexual stuff. That person would completely cut out the sexual stuff because they're like, we don't
want to talk about that. That's too hard. Yeah. But you have to talk about it. You have to talk about
it. I was like, so when I trained that now I'm like, you absolutely have to talk about this. And I always
tell people, I'm like, if you're going to have,
a client write a letter to their mom and share that and bear their soul, you should be willing to write
a letter and share that with their peers. In fact, when I teach those curriculums here, I have them
do that beforehand. I'm like, you're going to write a letter to your dad, you're going to write a letter
to your mom, and you're going to share it. And if you can't share it, maybe you shouldn't facilitate
this stuff because that's
that's my number one rule as a clinician is I'm never going to ask somebody to do something that I haven't
done myself. Yeah, absolutely. I jot it down. Thank you. Yeah, of course. Well, I think everyone's like
maybe you have full bellies and you're ready to
Take on your afternoon now. Well, thank you guys so much. Yeah, of course. Thanks for being here. Thanks
for sharing all your knowledge and your wisdom. And thanks to everyone for being here and taking it
in. And you know where to reach, Ashley. Yeah, and I'll stick my email in the chat. Great, great. I
know it was on the thing, but you're very welcome. Great. Yeah, thanks again. Thanks, everyone.