November 6, 2023 • 28 mins
This episode features conversations with iHeart’s Loraine Ballard Morill, Philadelphia entrepreneur, Tony Luke and VP of Outpatient Services, Brian Haney from Recovery Centers of America who discuss recovery from both a personal and clinical perspective. Aiming to provide comprehensive insight into the many individualized paths to recovery, this episode delves into topics such as medication-assisted treatment, the continuum of care, 12-step recovery, DBT and more.
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This podcast episode and others are available to watch in video format here www.RCARecovery360.com
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844-25-RECOVERY
This podcast episode and others are available to watch in video format here www.RCARecovery360.com
Any views or comments provided by individuals other than RCA employees are their own and do not represent the official views of Recovery Centers of America.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
Hello, and welcome to Recovery threesixty, the podcast dedicated to exploring the
pathways to treatment and recovery, broughtto you by Recovery Centers of America.
I'm Lorraine Ballard Morrow, director ofNews and Community Affairs for iHeartMedia, Philadelphia,
and I am joined by Tony LukeJunior. Tony, Hello, Lorraine,
another show. This is amazing.Yes well. We are thrilled to
(00:26):
be your guide on this journey towardsbetter understanding the world of healing and the
many ways individuals find their way torecovery. In every episode, we'll sit
down with experts, survivors, andadvocates in the field of treatment and recovery.
We'll unravel the complexities of addiction,mental health, and physical wellness while
(00:47):
shedding light on the diverse range oftherapies, interventions, and approaches available.
In this podcast, we're going tobe taking a look at the range of
treatments available and there's a lot ofthose. There have been tremendous advances in
the treatment of substance use disorder.In this edition, we'll be talking to
experts about the latest treatment strategies fromRecovery Centers of America. We have doctor
(01:08):
Pete Vernick, VP of Clinical Servicesand Brian Haney, VP of Outpatient Services.
Substance use treatment options vary depending onthe severity of the addiction, the
specific substance being abused, and theindividual's need and preference. We'll discuss some
of the impatient outpatient medication assisted treatmentm AT, partial hospitalization programs also known
(01:33):
as PHP, Intensive Outpatient Programs IOP. Lot of initials here, and general
outpatient treatment GOP, not to beconfused with the political GOP. So let's
start with medical detoc absolutely, Andyou know, Tony, we love our
(01:55):
initials in healthcare. So I'm gladthat we're doing this to kind of break
it all down because I know howhard it is for people. You look
at all of these options and it'stough to kind of break them out and
see what would work for me.But when we talk about detox, and
a lot of people are starting tocall this withdrawal management instead of detox.
But what we're talking about is sortof that highest level of need where we
(02:15):
have somebody who is withdrawing from thesubstance, and that means the process of
the body removing that substance and filteringthe substance out and the effects of the
substance starting to be diminished. Butas a result of that, there's sort
of a rebound. So if youthink about the high that somebody gets when
they're on the substance, when thatdrug is withdrawn from the body, they
(02:38):
go through a low, and oftentimesthose are opposite symptoms to the high.
So if somebody is really active andfeels really good and euphoric and happy when
they're high, when they go throughwithdrawal, it's the opposite of that.
It can be feelings of depression andanxiety and physical pain in the body and
feeling just like somebody wants to crawlout of their skin. And importantly,
(03:00):
withdrawal can actually for some substances bephysically dangerous. So the idea of withdrawal
management or detox is medically managing thatwithdrawal period so that number one, the
person doesn't have to experience all ofthose symptoms or able to provide medication and
support around those symptoms, so thatit isn't you know, the old idea
of cold turkey or you know,you have to suffer to get through it.
(03:23):
That's not the case. It's helpingsomebody to be safe and comfortable during
that period of time, but alsomonitoring for safety. So you know,
a detoxification or withdrawal management program isgoing to be a twenty four hour program
with medical and nursing staff who aregoing to monitor the person for safety.
If somebody gets into a situation wherethey have a physical reaction that's potentially dangerous,
(03:44):
it's able to be treated and theperson's able to go through it more
comfortably. So basically this is youknow, anywhere from a few days to
a week to get somebody through thatinitial period as safely and comfortably as possible
so that they can get that starton their recovery. So that's that's what
this level of care is really allabout. You know, it's so interesting
that you talk about it's not likecold Turkey. And I think that we
(04:05):
all have this certain image in ourminds of movies like Lady Sings the Blues
with Billie Holliday wrapped up in oneof those padded cells and going through this
tremendous pain and agony, and you'resitting there watching this and you're thinking,
I would never want to go throughthat. And I'm sure a lot of
people who are in substance use disorder. Are also thinking that they're thinking,
(04:27):
oh my gosh, if I gooff this, I'm going to experience all
of the things that we see inpopular media that people go through when they
go quote unquote culte Turkey. Definitely, fear of withdrawal symptoms is one of
the initial barriers. Yeah, yeah, to somebody getting into recovery. Is
that fear that you know, Idon't want to go through that and it's
an awful, painful experience. Soyou know, I can imagine that being
(04:49):
such a barrier for folks. Brian, Let's talk about some other options.
In Patient rehabilitation is good for somepeople, and for others, outpatient treatment
is the best. So I wonderif you could kind of break it down
for us the difference between the twoand what are the pluses and mindset.
Sure, it all depends on thelevel of acuity that the individual is experiencing
at the time. Inpatient levels ofcare tend to be twenty four hours,
(05:14):
round the clock. Levels of carethat, as doctor Vernie alluded to,
often includes nursing support. Typical lengthto stay really varies. It could be
from on average, say one monthto really several months. Of care.
Within that level of care, theindividual is also receiving therapeutic supports in terms
of attending group individual therapy and reallyjust to stabilize that individual further if they
(05:38):
admit it initially to detox. Soyou can think of it as like a
progression of care where you're stepping downfrom say detox level of care, to
impatient and then ideally to outpatient levelsof care. Well, there have been
great strides in Medicaid assistant treatment.Tell us how it works and the medications
involved. In our next podcast we'regoing to do a deep dive into but
(06:00):
for now, give us some summaryof MAAT. So, medication for addiction
treatment is exactly what it sounds like. It's medication that's used to help to
treat the symptoms of a substance usedisorder. So, as we've talked about
a lot, there's such a physiologicalcomponent the effect that the drug or drugs
have on the body and mat sortof broadly speaking, is a group of
(06:23):
drugs that or group of medications,because these are prescription medications that are provided
under the supervision of a licensed prescriber. There are a group of medications that
will help to first of all managewithdrawal. As we talked about, help
on the longer term to reduce thecravings, the physiological desire for the drug
that people experience, and all ofthe psychological components that go along with that
(06:45):
and really help people to get inmeaningful, long term recoveries. So these
can be things. A lot oftimes people think about things like methadone,
which has been around for a verylong time and certainly helps a large number
of people, but there are manynewer medications, things like bieber and orphan
altrex own that can be a partof somebody's treatment. You know, it's
the same idea that somebody doesn't haveto go through the pain of withdrawal without
(07:06):
support, and you know, medicalassistance for many people a barrier to the
next phase of recovery or that phase. You know when somebody is in a
residential program or in an outpatient program, are the cravings that they'll get for
the substance, and you know theeffect that that substance had on their nervous
system, on their brain with theirbrain chemistry. You know, we're able
(07:29):
to give medication that's going to helpthem get through that as well. Now
there are some treatment options that aretailored to different levels of need, including
partial hospitalization, intensive outpatient program,and general outpatient program. I wonder,
Brian, if you could tell usthe difference between them and how they address
the needs of the patient. Sure. I think what makes this level of
(07:49):
service unique is that it allows theindividual to still be a meaningful participant within
their family and their community at large. Charge. When you're talking about partial
hospitalization level of care, typically speaking, it's about six hours a day,
five days a week, and withinthat model, the individual is participating in
(08:11):
group therapy, individual therapy. Andwhat's really unique about that is it allows
the individual to utilize the skills thatthey're learning throughout the treatment day within the
home environment or the community at large. And that's really the should be the
goal of any service providers to allowthe patient to generalize their skills in the
(08:33):
environment that really where it matters most. It's a less contrived setting, less
staff intensive, and really is settingthat patient up for success. It looks
a lot like an individual is goingto work and participating throughout the day and
really is setting them up for successto again reintegrate back into the workforce or
to the community at large. Iwonder if we can also talk about the
(08:56):
demographics sure of person that's going intotreatment, How does that who they are
and what they do impact what mightbe the best choice for them regarding outpatient
or inpatient. Yeah, great point. I think what we would want is
really some treatment is better than notreatment, right, and the outpatient level
of care allows the patient to meaningfullyparticipate within their community and individuals can still
(09:22):
be meaningfully employed. It could beyou could have childcare constraints, and really
those circumstances could be a barrier toan individual seeking a higher level of care.
And so really the outpatient level ofcare allows the individual to still receive
effective treatment towards their recovery and alsoallows them to still meaningfully participate in those
(09:48):
circumstances within their life. Well.Behavior therapy play a crucial role in substance
use treatment, addressing the physiological andbehavioral aspects of addiction. Cognitive behavioral therapy
again CBT, dialectical behavior therapy DBT, and a twelve step approach. Can
(10:11):
you break down what each one entails? Sure? So, CBT is something
that a lot of people have heardof before. Cognitive behavior therapy, Like
I said, we love our abbreviations, but CBT is an umbrella term for
a large group of interventions, andwhat they have in common is they're focused
on the way people think, theway they feel, and the way that
(10:35):
they act or their behavior, andmost importantly, the interactions between those.
So it's a very present, momentfocused treatment. I think people think a
lot of time about getting therapy,as you know, I'm going to lay
on the couch and talk a lotabout my childhood, and there certainly is
a place for that, and evenwithin CBT there may be a focus on
things that happen to a person intheir childhood. However, the focus in
(10:56):
CBT is on what's going on inthem. So what about my emotions is
impacting the thoughts that I have?And what about the way I think is
impacting how I feel? And howdo these impact my behavior? The example
that I like to give most oftenfor CBT is actually depression. So one
of the things that happens with depressionis oftentimes a lack of energy. So
(11:20):
imagine if when you woke up inthe morning, you just barely have the
energy to get out of bed,and the greatest struggle was just to get
up onto your two feet and getout of bed. What kind of thoughts
would you have related to that?Oh, I've absolutely been there. I
think we all have at one corneror another in our lives for sure.
Yeah, And so that causes aperson to have oftentimes will impact the way
(11:41):
a person thinks negatively and so youknow, what's going on, what's wrong
with me? Why do I feelthis way? And then that impacts the
way that a person feels, becauseif I'm having negative thoughts about myself,
if I'm telling myself that there's somethingwrong with me or that I'm making a
mistake or I can't succeed, that'sgoing to impact the way that we feel,
(12:01):
and the way that we feel ultimatelyimpacts our behavior. And so it's
working on the relationship between those threethings and kind of finding ways of you
know, learning new skills, newways of managing our emotions, new ways
of thinking about how we think.So if when I have a negative thought,
I can sort of catch that thoughtand be aware of the fact that,
(12:22):
you know, oh, that's thedepression talking, or that's the substance
use disorder talking, and maybe changethat, replace that with something more positive.
You know, that's one of thecore functions of cognitive behavior therapy.
Yeah, you know. I thinkwhat's interesting is that, as we've talked
about in other podcasts, really we'retalking about mental health, that we really
(12:43):
can't separate substance use disorder from people'smental wellness. So until we begin to
look at the factors that are causingthe behavior of self medicating, right,
then you really can't get to thenext step. It's important for us to
deal with that. Certainly, CBTis one way to do that. There's
(13:03):
also another set of initials, andthat is DBT. Tell us about DBT.
So dialectical behavior therapy is based onit's actually it's related to CBT.
It's a set of skills that's taughtin a very organized way. Now you
talked about self medication, and Ithink that's a really important piece that when
(13:26):
somebody is self medicating, as we'vetalked about a lot in here, how
people have underlying depression or anxiety ortrauma or other things going on, and
the drug is being used to managethat. What we're asking somebody to do
is take that thing away, takethat thing out of their life. That
is what they've found that helps themto manage how they're feeling. It's the
only way they've found to manage theirdepression, or to manage the struggles that
(13:48):
they have in their family, orto manage the experience of trauma that they
have in their life. We haveto give them something to replace that with.
We can't take away a coping skillwithout giving something new. So DBT
is a set of skills, avery organized set of skills related to our
interpersonal relationships, how we relate toour emotions, how we deal with stressors
(14:09):
and problems that come up that docome up all the time in our lives.
And it teaches people and helps peopleto practice these skills so that they're
able to find something to replace thatwith. And obviously, you know,
it sounds very easy the way thatI explain it, and it's not very
easy. It's actually very difficult andit takes a lot of work on the
part of the individual. But ifwe can try ten different things and one
(14:31):
of those things works, that's awin. We have one skill that's going
to help the person or that they'recomfortable trying in their life when they're experiencing,
you know, those strong emotions,or when they're having a craving and
you know again that integrated for somepeople with the medication for addiction treatment can
be so helpful, Tony. Iknow that you and I have certainly heard
(14:52):
about twelve step twelve step program issomething everyone is familiar with, But what
actually is a twelve step doctor Verneck? The twelve step approach is based upon
well, as you said, twelvesteps, So it is a progression of
steps that a person goes through towardstheir recovery that involves joining a fellowship of
(15:13):
others. I think that that's somethingwe've talked about as well. That's so
important is that it's not something somebodydoes themselves. It involves a group of
supportive individuals, people who, inthe case of a twelve step program,
generally have been through some of thesame things. I mean, nobody's life
looks like anybody else's, but they'veexperienced some of the similar struggles, some
of the similar issues that they have, and working through those steps, there's
(15:35):
active work, you know, similarto CBT and DBT. There's active work
that they're doing in order to moveforward in their life, looking at the
way that their disease has impacted them, looking at the way it's impacted their
family and their relationships, and ultimatelybringing in the spiritual component as well.
I think that that's one of thethings that twelve step models or twelve step
(15:56):
programs do so well that you know, maybe it isn't to focus in CBT
or is less of a focus inDBT, that it looks at the person's
spiritual wellness and the way that theyrelate to a higher power. That can
be spiritual or it can just besomething outside of themselves that's important that they
respect and that they believe in.So a twelve step approach, you know,
(16:18):
it can be anything from a groupthat a person attends at a treatment
program to twelve step meetings like AAor NA that exist. You know,
they're all over the place in thecommunity. That's one of the wonderful things
about the twelve step approach is thatit's available everywhere and that you know,
somebody who needs support, they canreach out in the moment and find that
support already willing and able to helpthem through a difficult time. And I
(16:41):
like the idea of having like amentor a sponsor. They can just always
be there for you when you needthem. Okay, so I'm going to
do it again. Do it.Go ahead, speak, speak your piece
again. Okay. I know manypeople where the twelve Step program and you
know, has been life changing.And I believe that what the twelve Steps
(17:03):
teaches is incredibly important. Taking responsibility, owning up to what you've done,
asking for forgiveness, forgiving others aswell. But there is a huge downside
to the basic structure that bothers me. I'm trying to compare for our listeners
(17:30):
to understand it so it doesn't getkind of technical. Let's go to food,
because everyone can relate to food.Okay, So when you go to
a popular food program and I won'tmention any names of the programs, okay,
so they'll make your meal for you. You'll eat this meal. It
has the amount of calories that you'resupposed to use. Okay, You're supposed
(17:52):
to go to the gym, You'resupposed to do these things, and you
do them. But what happens isyou can't. You can't survive the rest
of your life doing that structure becauseit becomes about will power, and will
power no matter how strong you are, will break down, which is why
(18:15):
people who's one hundred pounds, onehundred and fifty pounds, or get their
stomach stapled, or they do allof these things, and then you know,
they lose all of this weight,and then four years later they're as
big as they were, if notbigger, because you're relying on a group
and a system that is so structuredthat if any of those things in the
(18:37):
perfect storm get out of whack,we resort to what we know works for
us. For me, it's carbohydrates. I'm just being honest. So when
I do the diet and my mealsare made, of course, life is
easy when all the meals are madeand everyone is looking over my shoulder going
no, no, no, it'seight o'clock, don't do that, don't
(18:59):
eat that. And of course I'llstay thin the rest of my life if
there's an army of people around meforbidding me to do anything I want to
do. So, as much asI believe that the twelve step is vitally
important, it becomes a crutch again, and I'm vehemently against the crutch.
You have to find why you areself medicating. You have to find out
(19:23):
the reason that you're doing these thingsso that you can face that head on,
get through that and not need tohave all those support systems because it's
like, Okay, I see whyI'm doing this, I know why I'm
overeating. I know that I'm usingthis to self medicate. Let me try
music, let me try art,let me try whatever it is you want
(19:47):
to try. So again, I'mnot knocking the twe I want to be
very clear. I think that thetwelve steps are vitally important. I believe
though it becomes not a good thingwhen the twelve straps become the crotch of
your existence. You know. Ithink that that's really actually an excellent point.
And I think that that's why thiskind of discussion about the wide variety
(20:11):
of treatment modalities is so important toknow, because I think you're right when
it comes right down to it,we can't rely on externals to make changes.
We have to check inside first andfigure out inside what it is it's
been pushing us towards self medicating andall the different things that people do to
(20:32):
hide the pain. Right, Sothat Brian and doctor Vernig, that's really
why it's like one size does notfit all, Is that right? I
mean, Brian, we talked aboutall these different options because everybody's different.
Correct to Tony's point. You know, it's about it can't be solely twelve
step. It has to be acombination of ideally you know, kind of
(20:56):
empirically supported interventions, things that havebeen tested over time. Again like providing
patients with options. Again, it'sabout skill acquisition and the individual really learning
these different strategies, be it CBTor DBT, in concert with other modalities
to really provide the best options availableto patients. That's really what we should
(21:18):
be looking for in a service provider, right doctor Vernick. Yeah, I
mean you both hit the nail righton the head with that. It's no
one thing works for everyone, andyou know, the twelve step approach does
not work for everyone. CBTOR DBTprogram alone does not work for everyone,
which is why and in patient orout patient the same thing. Everyone is
different, Everyone's life circumstances are different. I think that Brian had talked about
(21:41):
the severity of the illness for somepeople. That's something that we've discussed in
here before is how far along peopleare and having that treatment as early as
possible available for people. So itdepends upon all of these factors, and
for some it could be a verytraditional inpatient detox followed by a rehab followed
by a step down throughout patient.For some people, it's going right into
(22:03):
an outpatient program. For some people, it is a twelve step program.
For some people, it's CBT orDBT. For some people it's both because
they actually fit together very well.A lot of people look at these options
as mutually exclusive, and you know, you're gonna have a CBT program,
or you can have DBT, youcan have twelve steps, you can have
MAT. They all fit together verywell, and it's really about that individual
(22:27):
I'll even call individual prescription for theperson because in the same way that in
any other part of healthcare, notwo people get the exact same treatment,
regardless of the illness, regardless ofthe injury. It's based upon the person's
risk factors, it's based upon theseverity of the case. It's based upon
so many different things, and thatfor the longest time, we haven't looked
(22:48):
at substance use disorder that way.But one of the exciting things is we're
starting to look at it as youknow, the rest of the healthcare system
does that we need individualized treatment.We need things for some people like music
and art and other outlets for themthat can also be a critical part of
that prescription. For tr you needan outlet. And it's funny because even
the medical community now like the newestthing that the medical because I have a
(23:15):
lot of friends who are medical doctors. The newest thing now they're trying to
do is work with people's DNA sothat when they get an illness, they
will prescribe medication based on your personalDNA so that the side effects are reduced
or eliminated. Because again, liketreatment, one size doesn't fit all,
(23:40):
one pill doesn't fit all, becausethe side effects sometimes of a medication is
worse than the illness that you're goingthrough. And I've said this before in
other podcasts that we have done together. I can't applaud you enough for constantly
saying that, hey, we needto look at the bigger picture, because
(24:06):
for years it wasn't. The picturewas here's the disease. This is what
we do. You're on your own, get some support, you know,
I'll see I'll see you back againand seeing my baby. No doctor wants
to give someone or treat them forcancer and go, oh, I'll see
you in six months with a newcancer. No who doesn't, No one,
but for years that's way it's beenlooked at. And I love the
(24:29):
fact that it is changing. Ilove the fact that you're advocating that addiction
is not cut and dry, thatthere is a mental and trauma component to
this that has to be as dressedas much, if not more than the
actual physical addiction to the drugs.Agree completely. And you know the other
(24:51):
thing too, And we've talked aboutthis before, but I think it bears
repeating, and that is you don'thave to wait till you hear rock bottom,
right. You don't. There asa continuum, and you can jump
into treatment at any point in thatcontinuum. It doesn't have to be when
there's absolutely no hope and you're neardeath and everyone's given up on you.
But there are different levels stages inwhich you could actually jump in and get
(25:15):
treatment. You don't have to waittill you're absolutely in the most desperate place
possible. Right, Agree completely.And I think that's what's unique, just
to kind of echo Tony sentiments,is that if we look at this,
if you had an underlying medical conditionand sought out a healthcare provider, you
would leave that office with a comprehensivefive year strategy to address that underlying medical
(25:38):
condition, and we have to lookat substance use to order and addiction in
the same light, and that itis truly a continuum in that, like
we've talked about, you don't necessarilymaybe maybe a higher level of care is
prohibitive, or for one reason oranother, you're just not willing to commit
to that level of care. Sothere is is options available to people out
(26:02):
there, and that a lesser optioncould be an intense about patient program that
is typically three hours a day,three days a week, or five days
a week, what have you.And then you have your general outpatient level
of care, which is typically meetingone on one with an individual therapist.
The point is is that entry intoa system or entry into a level of
care, and then you're able tokind of move up and down if you
(26:26):
will, as your needs change,as life circumstances change. And I think
that's really what's unique about the recoveryworld itself, is that there's a lot
of options out there available to people. Right. Personalized treatment plans developed in
collaboration with healthcare professionals can improve anindividual's chances of achieving and sustaining sobriety that's
(26:48):
just the bottom line. Yeah,well, Recovery three six isn't just about
stories of survival from substance use disorder. You know, we're hoping and our
goal is it is a resource forthose seeking answers, support and hope.
Whether you're personally navigating the terrain ofrecovery or you're here to learn how to
(27:08):
be a better ally. The podcastis a source of information, inspiration,
and empowerment. I mean, that'swhat we're trying to do here absolutely.
And I just have to tell you, Tony, I just love that we're
doing this together because everything that you'vehad to say and share from your personal
experience, I think really hits hometo anyone who's going through either substance use
(27:32):
disorder or lost somebody to that.And I think it's so important. And
the two of you, doctor PeterVernet, Vice president of Mental Health Services,
Brian Hainey, VP of outpatient Serviceswith Recovery Centers of America, you
bring a lot of information that Ithink a lot of the general public we're
not even aware. As we've doneeach podcast, I've learned something new,
(27:55):
I've learned something important that I canbring out into the world amongst the people
that I know and love as well, So thanks to all of you.
Doctor Peter Verne. If people wantmore information about Recovery Centers of America,
where do they go? If peoplewant more information about RCA, or they
want to learn about these different treatmentoptions which are available, whether it's at
RCA or not, we have alot of information on our website RCA Recovery
(28:18):
three sixty dot com, or youcan call us at eight four four two
five Recovery. I'm Lorraine Ballard Morrow, I'm Tony lu Junior. See you
next time.
Hello, and welcome to Recovery threesixty, the podcast dedicated to exploring the
pathways to treatment and recovery, broughtto you by Recovery Centers of America.
I'm Lorraine Ballard Morrow, director ofNews and Community Affairs for iHeartMedia, Philadelphia,
and I am joined by Tony LukeJunior. Tony, Hello, Lorraine,
another show. This is amazing.Yes well. We are thrilled to
(00:26):
be your guide on this journey towardsbetter understanding the world of healing and the
many ways individuals find their way torecovery. In every episode, we'll sit
down with experts, survivors, andadvocates in the field of treatment and recovery.
We'll unravel the complexities of addiction,mental health, and physical wellness while
(00:47):
shedding light on the diverse range oftherapies, interventions, and approaches available.
In this podcast, we're going tobe taking a look at the range of
treatments available and there's a lot ofthose. There have been tremendous advances in
the treatment of substance use disorder.In this edition, we'll be talking to
experts about the latest treatment strategies fromRecovery Centers of America. We have doctor
(01:08):
Pete Vernick, VP of Clinical Servicesand Brian Haney, VP of Outpatient Services.
Substance use treatment options vary depending onthe severity of the addiction, the
specific substance being abused, and theindividual's need and preference. We'll discuss some
of the impatient outpatient medication assisted treatmentm AT, partial hospitalization programs also known
(01:33):
as PHP, Intensive Outpatient Programs IOP. Lot of initials here, and general
outpatient treatment GOP, not to beconfused with the political GOP. So let's
start with medical detoc absolutely, Andyou know, Tony, we love our
(01:55):
initials in healthcare. So I'm gladthat we're doing this to kind of break
it all down because I know howhard it is for people. You look
at all of these options and it'stough to kind of break them out and
see what would work for me.But when we talk about detox, and
a lot of people are starting tocall this withdrawal management instead of detox.
But what we're talking about is sortof that highest level of need where we
(02:15):
have somebody who is withdrawing from thesubstance, and that means the process of
the body removing that substance and filteringthe substance out and the effects of the
substance starting to be diminished. Butas a result of that, there's sort
of a rebound. So if youthink about the high that somebody gets when
they're on the substance, when thatdrug is withdrawn from the body, they
(02:38):
go through a low, and oftentimesthose are opposite symptoms to the high.
So if somebody is really active andfeels really good and euphoric and happy when
they're high, when they go throughwithdrawal, it's the opposite of that.
It can be feelings of depression andanxiety and physical pain in the body and
feeling just like somebody wants to crawlout of their skin. And importantly,
(03:00):
withdrawal can actually for some substances bephysically dangerous. So the idea of withdrawal
management or detox is medically managing thatwithdrawal period so that number one, the
person doesn't have to experience all ofthose symptoms or able to provide medication and
support around those symptoms, so thatit isn't you know, the old idea
of cold turkey or you know,you have to suffer to get through it.
(03:23):
That's not the case. It's helpingsomebody to be safe and comfortable during
that period of time, but alsomonitoring for safety. So you know,
a detoxification or withdrawal management program isgoing to be a twenty four hour program
with medical and nursing staff who aregoing to monitor the person for safety.
If somebody gets into a situation wherethey have a physical reaction that's potentially dangerous,
(03:44):
it's able to be treated and theperson's able to go through it more
comfortably. So basically this is youknow, anywhere from a few days to
a week to get somebody through thatinitial period as safely and comfortably as possible
so that they can get that starton their recovery. So that's that's what
this level of care is really allabout. You know, it's so interesting
that you talk about it's not likecold Turkey. And I think that we
(04:05):
all have this certain image in ourminds of movies like Lady Sings the Blues
with Billie Holliday wrapped up in oneof those padded cells and going through this
tremendous pain and agony, and you'resitting there watching this and you're thinking,
I would never want to go throughthat. And I'm sure a lot of
people who are in substance use disorder. Are also thinking that they're thinking,
(04:27):
oh my gosh, if I gooff this, I'm going to experience all
of the things that we see inpopular media that people go through when they
go quote unquote culte Turkey. Definitely, fear of withdrawal symptoms is one of
the initial barriers. Yeah, yeah, to somebody getting into recovery. Is
that fear that you know, Idon't want to go through that and it's
an awful, painful experience. Soyou know, I can imagine that being
(04:49):
such a barrier for folks. Brian, Let's talk about some other options.
In Patient rehabilitation is good for somepeople, and for others, outpatient treatment
is the best. So I wonderif you could kind of break it down
for us the difference between the twoand what are the pluses and mindset.
Sure, it all depends on thelevel of acuity that the individual is experiencing
at the time. Inpatient levels ofcare tend to be twenty four hours,
(05:14):
round the clock. Levels of carethat, as doctor Vernie alluded to,
often includes nursing support. Typical lengthto stay really varies. It could be
from on average, say one monthto really several months. Of care.
Within that level of care, theindividual is also receiving therapeutic supports in terms
of attending group individual therapy and reallyjust to stabilize that individual further if they
(05:38):
admit it initially to detox. Soyou can think of it as like a
progression of care where you're stepping downfrom say detox level of care, to
impatient and then ideally to outpatient levelsof care. Well, there have been
great strides in Medicaid assistant treatment.Tell us how it works and the medications
involved. In our next podcast we'regoing to do a deep dive into but
(06:00):
for now, give us some summaryof MAAT. So, medication for addiction
treatment is exactly what it sounds like. It's medication that's used to help to
treat the symptoms of a substance usedisorder. So, as we've talked about
a lot, there's such a physiologicalcomponent the effect that the drug or drugs
have on the body and mat sortof broadly speaking, is a group of
(06:23):
drugs that or group of medications,because these are prescription medications that are provided
under the supervision of a licensed prescriber. There are a group of medications that
will help to first of all managewithdrawal. As we talked about, help
on the longer term to reduce thecravings, the physiological desire for the drug
that people experience, and all ofthe psychological components that go along with that
(06:45):
and really help people to get inmeaningful, long term recoveries. So these
can be things. A lot oftimes people think about things like methadone,
which has been around for a verylong time and certainly helps a large number
of people, but there are manynewer medications, things like bieber and orphan
altrex own that can be a partof somebody's treatment. You know, it's
the same idea that somebody doesn't haveto go through the pain of withdrawal without
(07:06):
support, and you know, medicalassistance for many people a barrier to the
next phase of recovery or that phase. You know when somebody is in a
residential program or in an outpatient program, are the cravings that they'll get for
the substance, and you know theeffect that that substance had on their nervous
system, on their brain with theirbrain chemistry. You know, we're able
(07:29):
to give medication that's going to helpthem get through that as well. Now
there are some treatment options that aretailored to different levels of need, including
partial hospitalization, intensive outpatient program,and general outpatient program. I wonder,
Brian, if you could tell usthe difference between them and how they address
the needs of the patient. Sure. I think what makes this level of
(07:49):
service unique is that it allows theindividual to still be a meaningful participant within
their family and their community at large. Charge. When you're talking about partial
hospitalization level of care, typically speaking, it's about six hours a day,
five days a week, and withinthat model, the individual is participating in
(08:11):
group therapy, individual therapy. Andwhat's really unique about that is it allows
the individual to utilize the skills thatthey're learning throughout the treatment day within the
home environment or the community at large. And that's really the should be the
goal of any service providers to allowthe patient to generalize their skills in the
(08:33):
environment that really where it matters most. It's a less contrived setting, less
staff intensive, and really is settingthat patient up for success. It looks
a lot like an individual is goingto work and participating throughout the day and
really is setting them up for successto again reintegrate back into the workforce or
to the community at large. Iwonder if we can also talk about the
(08:56):
demographics sure of person that's going intotreatment, How does that who they are
and what they do impact what mightbe the best choice for them regarding outpatient
or inpatient. Yeah, great point. I think what we would want is
really some treatment is better than notreatment, right, and the outpatient level
of care allows the patient to meaningfullyparticipate within their community and individuals can still
(09:22):
be meaningfully employed. It could beyou could have childcare constraints, and really
those circumstances could be a barrier toan individual seeking a higher level of care.
And so really the outpatient level ofcare allows the individual to still receive
effective treatment towards their recovery and alsoallows them to still meaningfully participate in those
(09:48):
circumstances within their life. Well.Behavior therapy play a crucial role in substance
use treatment, addressing the physiological andbehavioral aspects of addiction. Cognitive behavioral therapy
again CBT, dialectical behavior therapy DBT, and a twelve step approach. Can
(10:11):
you break down what each one entails? Sure? So, CBT is something
that a lot of people have heardof before. Cognitive behavior therapy, Like
I said, we love our abbreviations, but CBT is an umbrella term for
a large group of interventions, andwhat they have in common is they're focused
on the way people think, theway they feel, and the way that
(10:35):
they act or their behavior, andmost importantly, the interactions between those.
So it's a very present, momentfocused treatment. I think people think a
lot of time about getting therapy,as you know, I'm going to lay
on the couch and talk a lotabout my childhood, and there certainly is
a place for that, and evenwithin CBT there may be a focus on
things that happen to a person intheir childhood. However, the focus in
(10:56):
CBT is on what's going on inthem. So what about my emotions is
impacting the thoughts that I have?And what about the way I think is
impacting how I feel? And howdo these impact my behavior? The example
that I like to give most oftenfor CBT is actually depression. So one
of the things that happens with depressionis oftentimes a lack of energy. So
(11:20):
imagine if when you woke up inthe morning, you just barely have the
energy to get out of bed,and the greatest struggle was just to get
up onto your two feet and getout of bed. What kind of thoughts
would you have related to that?Oh, I've absolutely been there. I
think we all have at one corneror another in our lives for sure.
Yeah, And so that causes aperson to have oftentimes will impact the way
(11:41):
a person thinks negatively and so youknow, what's going on, what's wrong
with me? Why do I feelthis way? And then that impacts the
way that a person feels, becauseif I'm having negative thoughts about myself,
if I'm telling myself that there's somethingwrong with me or that I'm making a
mistake or I can't succeed, that'sgoing to impact the way that we feel,
(12:01):
and the way that we feel ultimatelyimpacts our behavior. And so it's
working on the relationship between those threethings and kind of finding ways of you
know, learning new skills, newways of managing our emotions, new ways
of thinking about how we think.So if when I have a negative thought,
I can sort of catch that thoughtand be aware of the fact that,
(12:22):
you know, oh, that's thedepression talking, or that's the substance
use disorder talking, and maybe changethat, replace that with something more positive.
You know, that's one of thecore functions of cognitive behavior therapy.
Yeah, you know. I thinkwhat's interesting is that, as we've talked
about in other podcasts, really we'retalking about mental health, that we really
(12:43):
can't separate substance use disorder from people'smental wellness. So until we begin to
look at the factors that are causingthe behavior of self medicating, right,
then you really can't get to thenext step. It's important for us to
deal with that. Certainly, CBTis one way to do that. There's
(13:03):
also another set of initials, andthat is DBT. Tell us about DBT.
So dialectical behavior therapy is based onit's actually it's related to CBT.
It's a set of skills that's taughtin a very organized way. Now you
talked about self medication, and Ithink that's a really important piece that when
(13:26):
somebody is self medicating, as we'vetalked about a lot in here, how
people have underlying depression or anxiety ortrauma or other things going on, and
the drug is being used to managethat. What we're asking somebody to do
is take that thing away, takethat thing out of their life. That
is what they've found that helps themto manage how they're feeling. It's the
only way they've found to manage theirdepression, or to manage the struggles that
(13:48):
they have in their family, orto manage the experience of trauma that they
have in their life. We haveto give them something to replace that with.
We can't take away a coping skillwithout giving something new. So DBT
is a set of skills, avery organized set of skills related to our
interpersonal relationships, how we relate toour emotions, how we deal with stressors
(14:09):
and problems that come up that docome up all the time in our lives.
And it teaches people and helps peopleto practice these skills so that they're
able to find something to replace thatwith. And obviously, you know,
it sounds very easy the way thatI explain it, and it's not very
easy. It's actually very difficult andit takes a lot of work on the
part of the individual. But ifwe can try ten different things and one
(14:31):
of those things works, that's awin. We have one skill that's going
to help the person or that they'recomfortable trying in their life when they're experiencing,
you know, those strong emotions,or when they're having a craving and
you know again that integrated for somepeople with the medication for addiction treatment can
be so helpful, Tony. Iknow that you and I have certainly heard
(14:52):
about twelve step twelve step program issomething everyone is familiar with, But what
actually is a twelve step doctor Verneck? The twelve step approach is based upon
well, as you said, twelvesteps, So it is a progression of
steps that a person goes through towardstheir recovery that involves joining a fellowship of
(15:13):
others. I think that that's somethingwe've talked about as well. That's so
important is that it's not something somebodydoes themselves. It involves a group of
supportive individuals, people who, inthe case of a twelve step program,
generally have been through some of thesame things. I mean, nobody's life
looks like anybody else's, but they'veexperienced some of the similar struggles, some
of the similar issues that they have, and working through those steps, there's
(15:35):
active work, you know, similarto CBT and DBT. There's active work
that they're doing in order to moveforward in their life, looking at the
way that their disease has impacted them, looking at the way it's impacted their
family and their relationships, and ultimatelybringing in the spiritual component as well.
I think that that's one of thethings that twelve step models or twelve step
(15:56):
programs do so well that you know, maybe it isn't to focus in CBT
or is less of a focus inDBT, that it looks at the person's
spiritual wellness and the way that theyrelate to a higher power. That can
be spiritual or it can just besomething outside of themselves that's important that they
respect and that they believe in.So a twelve step approach, you know,
(16:18):
it can be anything from a groupthat a person attends at a treatment
program to twelve step meetings like AAor NA that exist. You know,
they're all over the place in thecommunity. That's one of the wonderful things
about the twelve step approach is thatit's available everywhere and that you know,
somebody who needs support, they canreach out in the moment and find that
support already willing and able to helpthem through a difficult time. And I
(16:41):
like the idea of having like amentor a sponsor. They can just always
be there for you when you needthem. Okay, so I'm going to
do it again. Do it.Go ahead, speak, speak your piece
again. Okay. I know manypeople where the twelve Step program and you
know, has been life changing.And I believe that what the twelve Steps
(17:03):
teaches is incredibly important. Taking responsibility, owning up to what you've done,
asking for forgiveness, forgiving others aswell. But there is a huge downside
to the basic structure that bothers me. I'm trying to compare for our listeners
(17:30):
to understand it so it doesn't getkind of technical. Let's go to food,
because everyone can relate to food.Okay, So when you go to
a popular food program and I won'tmention any names of the programs, okay,
so they'll make your meal for you. You'll eat this meal. It
has the amount of calories that you'resupposed to use. Okay, You're supposed
(17:52):
to go to the gym, You'resupposed to do these things, and you
do them. But what happens isyou can't. You can't survive the rest
of your life doing that structure becauseit becomes about will power, and will
power no matter how strong you are, will break down, which is why
(18:15):
people who's one hundred pounds, onehundred and fifty pounds, or get their
stomach stapled, or they do allof these things, and then you know,
they lose all of this weight,and then four years later they're as
big as they were, if notbigger, because you're relying on a group
and a system that is so structuredthat if any of those things in the
(18:37):
perfect storm get out of whack,we resort to what we know works for
us. For me, it's carbohydrates. I'm just being honest. So when
I do the diet and my mealsare made, of course, life is
easy when all the meals are madeand everyone is looking over my shoulder going
no, no, no, it'seight o'clock, don't do that, don't
(18:59):
eat that. And of course I'llstay thin the rest of my life if
there's an army of people around meforbidding me to do anything I want to
do. So, as much asI believe that the twelve step is vitally
important, it becomes a crutch again, and I'm vehemently against the crutch.
You have to find why you areself medicating. You have to find out
(19:23):
the reason that you're doing these thingsso that you can face that head on,
get through that and not need tohave all those support systems because it's
like, Okay, I see whyI'm doing this, I know why I'm
overeating. I know that I'm usingthis to self medicate. Let me try
music, let me try art,let me try whatever it is you want
(19:47):
to try. So again, I'mnot knocking the twe I want to be
very clear. I think that thetwelve steps are vitally important. I believe
though it becomes not a good thingwhen the twelve straps become the crotch of
your existence. You know. Ithink that that's really actually an excellent point.
And I think that that's why thiskind of discussion about the wide variety
(20:11):
of treatment modalities is so important toknow, because I think you're right when
it comes right down to it,we can't rely on externals to make changes.
We have to check inside first andfigure out inside what it is it's
been pushing us towards self medicating andall the different things that people do to
(20:32):
hide the pain. Right, Sothat Brian and doctor Vernig, that's really
why it's like one size does notfit all, Is that right? I
mean, Brian, we talked aboutall these different options because everybody's different.
Correct to Tony's point. You know, it's about it can't be solely twelve
step. It has to be acombination of ideally you know, kind of
(20:56):
empirically supported interventions, things that havebeen tested over time. Again like providing
patients with options. Again, it'sabout skill acquisition and the individual really learning
these different strategies, be it CBTor DBT, in concert with other modalities
to really provide the best options availableto patients. That's really what we should
(21:18):
be looking for in a service provider, right doctor Vernick. Yeah, I
mean you both hit the nail righton the head with that. It's no
one thing works for everyone, andyou know, the twelve step approach does
not work for everyone. CBTOR DBTprogram alone does not work for everyone,
which is why and in patient orout patient the same thing. Everyone is
different, Everyone's life circumstances are different. I think that Brian had talked about
(21:41):
the severity of the illness for somepeople. That's something that we've discussed in
here before is how far along peopleare and having that treatment as early as
possible available for people. So itdepends upon all of these factors, and
for some it could be a verytraditional inpatient detox followed by a rehab followed
by a step down throughout patient.For some people, it's going right into
(22:03):
an outpatient program. For some people, it is a twelve step program.
For some people, it's CBT orDBT. For some people it's both because
they actually fit together very well.A lot of people look at these options
as mutually exclusive, and you know, you're gonna have a CBT program,
or you can have DBT, youcan have twelve steps, you can have
MAT. They all fit together verywell, and it's really about that individual
(22:27):
I'll even call individual prescription for theperson because in the same way that in
any other part of healthcare, notwo people get the exact same treatment,
regardless of the illness, regardless ofthe injury. It's based upon the person's
risk factors, it's based upon theseverity of the case. It's based upon
so many different things, and thatfor the longest time, we haven't looked
(22:48):
at substance use disorder that way.But one of the exciting things is we're
starting to look at it as youknow, the rest of the healthcare system
does that we need individualized treatment.We need things for some people like music
and art and other outlets for themthat can also be a critical part of
that prescription. For tr you needan outlet. And it's funny because even
the medical community now like the newestthing that the medical because I have a
(23:15):
lot of friends who are medical doctors. The newest thing now they're trying to
do is work with people's DNA sothat when they get an illness, they
will prescribe medication based on your personalDNA so that the side effects are reduced
or eliminated. Because again, liketreatment, one size doesn't fit all,
(23:40):
one pill doesn't fit all, becausethe side effects sometimes of a medication is
worse than the illness that you're goingthrough. And I've said this before in
other podcasts that we have done together. I can't applaud you enough for constantly
saying that, hey, we needto look at the bigger picture, because
(24:06):
for years it wasn't. The picturewas here's the disease. This is what
we do. You're on your own, get some support, you know,
I'll see I'll see you back againand seeing my baby. No doctor wants
to give someone or treat them forcancer and go, oh, I'll see
you in six months with a newcancer. No who doesn't, No one,
but for years that's way it's beenlooked at. And I love the
(24:29):
fact that it is changing. Ilove the fact that you're advocating that addiction
is not cut and dry, thatthere is a mental and trauma component to
this that has to be as dressedas much, if not more than the
actual physical addiction to the drugs.Agree completely. And you know the other
(24:51):
thing too, And we've talked aboutthis before, but I think it bears
repeating, and that is you don'thave to wait till you hear rock bottom,
right. You don't. There asa continuum, and you can jump
into treatment at any point in thatcontinuum. It doesn't have to be when
there's absolutely no hope and you're neardeath and everyone's given up on you.
But there are different levels stages inwhich you could actually jump in and get
(25:15):
treatment. You don't have to waittill you're absolutely in the most desperate place
possible. Right, Agree completely.And I think that's what's unique, just
to kind of echo Tony sentiments,is that if we look at this,
if you had an underlying medical conditionand sought out a healthcare provider, you
would leave that office with a comprehensivefive year strategy to address that underlying medical
(25:38):
condition, and we have to lookat substance use to order and addiction in
the same light, and that itis truly a continuum in that, like
we've talked about, you don't necessarilymaybe maybe a higher level of care is
prohibitive, or for one reason oranother, you're just not willing to commit
to that level of care. Sothere is is options available to people out
(26:02):
there, and that a lesser optioncould be an intense about patient program that
is typically three hours a day,three days a week, or five days
a week, what have you.And then you have your general outpatient level
of care, which is typically meetingone on one with an individual therapist.
The point is is that entry intoa system or entry into a level of
care, and then you're able tokind of move up and down if you
(26:26):
will, as your needs change,as life circumstances change. And I think
that's really what's unique about the recoveryworld itself, is that there's a lot
of options out there available to people. Right. Personalized treatment plans developed in
collaboration with healthcare professionals can improve anindividual's chances of achieving and sustaining sobriety that's
(26:48):
just the bottom line. Yeah,well, Recovery three six isn't just about
stories of survival from substance use disorder. You know, we're hoping and our
goal is it is a resource forthose seeking answers, support and hope.
Whether you're personally navigating the terrain ofrecovery or you're here to learn how to
(27:08):
be a better ally. The podcastis a source of information, inspiration,
and empowerment. I mean, that'swhat we're trying to do here absolutely.
And I just have to tell you, Tony, I just love that we're
doing this together because everything that you'vehad to say and share from your personal
experience, I think really hits hometo anyone who's going through either substance use
(27:32):
disorder or lost somebody to that.And I think it's so important. And
the two of you, doctor PeterVernet, Vice president of Mental Health Services,
Brian Hainey, VP of outpatient Serviceswith Recovery Centers of America, you
bring a lot of information that Ithink a lot of the general public we're
not even aware. As we've doneeach podcast, I've learned something new,
(27:55):
I've learned something important that I canbring out into the world amongst the people
that I know and love as well, So thanks to all of you.
Doctor Peter Verne. If people wantmore information about Recovery Centers of America,
where do they go? If peoplewant more information about RCA, or they
want to learn about these different treatmentoptions which are available, whether it's at
RCA or not, we have alot of information on our website RCA Recovery
(28:18):
three sixty dot com, or youcan call us at eight four four two
five Recovery. I'm Lorraine Ballard Morrow, I'm Tony lu Junior. See you
next time.
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