November 9, 2025 • 39 mins
11/09/25
The Healthy Matters Podcast
S05_E03 - Addiction Recovery in Real Time - LIVE!
With Special Guests: Dr. Lauren Graber and Dr. Charlie Reznikoff
Addiction can come in a lot of different forms, and although the opioid epidemic has been at the fore of the conversation, we often forget that cigarettes and alcohol continue to claim the most lives. Truth is, 1 in 3 Americans is affected in one way or another by someone with a substance use disorder, which is to say that it's not just a problem for the individual with the condition. But how does one get addicted in the first place? Who's most at risk? And what can be done to help them?
Addiction is not about willpower or a moral shortcoming, it's actually a complex medical condition that can affect the brain and body, and on the next episode of our show, we'll be joined by addiction medicine specialists Dr. Lauren Graber and Dr. Charlie Reznikoff to help us detangle the matter. Join us for an insightful conversation (in front of a live studio audience!) with two experts who have helped countless people find help and hope in recovery.
Got healthcare questions or ideas for future shows?
Email - healthymatters@hcmed.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:01):
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_04 (00:18):
Hey everybody, it's your host, David Hilden, and
welcome to a special episode ofthe Healthy Matters Podcast.
This is episode three of seasonfive, and today we're gonna talk
about addiction.
But this is a special episodebecause there is a room full of
people sitting in front of me.
This is our very first livestudio recording of a podcast.
(00:40):
And so today we're gonna talkabout addiction medicine.
For a long time, addictionmedicine was seen kind of as a
personal failure from a lack ofwillpower, maybe bad choices,
maybe even a moral characterflaw.
But as it turned out, that couldnot be further from the truth.
Addiction is a medicalcondition.
(01:00):
It deserves the same attention,the same treatment, compassion,
diagnosis, the same hope, thesame support for patients and
their families as any othermedical condition.
So today we're gonna dive intoaddiction medicine, what it is,
why it matters, and how science,innovation, and humanity are
helping people in their recoveryevery single day.
So today I am joined by two ofthe best in the business, Dr.
(01:24):
Lauren Graber and Dr.
Charlie Resnikov from HennepinHealthcare's Addiction Medicine
Program.
So as I said, we're recordinglive here with a studio audience
in Hennepin Healthcare.
And trust me, you're gonna walkaway with a whole new
understanding of what recoveryreally looks like.
So let's get started.
Charlie, Lauren, thanks forbeing here.
SPEAKER_02 (01:42):
So glad to be here.
SPEAKER_03 (01:43):
Yeah, I'm honored to be here.
SPEAKER_04 (01:45):
So I've known you guys a great long time, and I
appreciate you being herehelping us out through this
super important topic.
So let's start us off, if youcould.
Let's talk about the scope ofaddiction medicine in the United
States.
How common is it?
Who wants to take that one?
SPEAKER_03 (01:58):
Uh I'll I'll start with this.
I think there's a simple answer,and then there's a slightly more
complex answer.
The simple answer is 10% ofadults struggle or are at risk
for addiction.
It's a ballpark figure.
So I think that's a simple wayof answering.
How common is it?
One out of 10 of us are gonnaeither struggle with addiction
or be vulnerable to it.
But there's a more complexversion of the answer.
(02:20):
That's like us and our risk.
Society creates risks ofaddiction.
I mean, you could imagine in the1950s when sophisticated
celebrities were smoking onfilms, and you could smoke in a
in a restaurant in an airplane,and your doctor told you uh it
was okay to smoke.
Uh your doctor probably wassmoking.
You probably, yeah.
Go get a cigarette.
Smoking was way more prevalentthen because society was
(02:42):
different then.
And now society views tobaccosmoking differently, and rates
have changed.
So part of it is within us, 10%risk, and part of it exists
within the society.
And is this drug available?
Uh, how does the society viewthe drug?
What is the perception of thedrug use within that society?
And it's it's more narrow thanthe society, could even be the
(03:05):
community, could be theneighborhood.
SPEAKER_02 (03:07):
I was gonna say the one thing I'll add that I think
is more like more generallyspeaking, we could talk about
trends too.
But one thing that's amazingabout now, while we say 10% of
people are susceptible or moreat risk of having substance use
disorders, a research study cameout this last year that said one
in three Americans is personallytouched and affected by someone
who is experiencing a substanceuse disorder.
(03:27):
So I think for me in my trainingas a family physician, we're
thinking about this larger unit.
Each person who is having astruggle is affecting this
larger, this larger group ofindividuals in their family, in
their community.
And how real and felt that is.
That it's not even, it's notjust this one person struggling,
it's this whole network ofhumans affected and really
feeling that struggle together.
(03:48):
So that's a really importantthing to think about, like even
though it's one in ten, it's theimpact of how this impacts all
of us is so much deeper.
SPEAKER_04 (03:55):
Before I let you go from that, Dr.
Graber, so that is, I am aninternal medicine doctor.
I do a lot of diabetes, I dointernal medicine.
I wouldn't say that be the casefor all my patients with heart
disease.
Why does it affect so manypeople outside of just the
person who is living with anaddiction?
SPEAKER_02 (04:10):
It's so, so nuanced and so like dear for in how you
care for somebody.
When you in a system, you know,when someone is struggling with
substance use, they are oftenthe caregiver of other people,
their elders, their children,they're and or having different
responsibilities.
And substance use puts you inthis tunnel where it's so hard
to see any other, any other pathto make another decision because
(04:32):
the desperation and the andreally like if this shroud of
where you are, it feels likeyour options are so limited.
And so, in order for you tofunction in society and build
those networks and care fordifferent people, like it, it's
just not, you're not able to dothat.
And the people around you, ofcourse, see that.
It means are, you know, how areyou nurturing your children?
How are you, how are you caringfor your family?
How are you showing up to work?
(04:52):
All of those things become morechallenging.
SPEAKER_04 (04:54):
Yeah, thanks for that.
Thanks for that.
Okay, trends.
SPEAKER_03 (04:56):
What are you seeing?
Well, I mean, I think a good, avery interesting good trend is
that young people are abstainingfrom drugs at surprising rates.
Alcohol, cannabis, a variety ofother drugs.
So that's a good trend.
Um, I think there's also beenyear after year of bad trends
with opioid overdoses, fentanyloverdoses that improved or maybe
(05:21):
plateaued a bit.
So I think those are goodtrends.
Bad, worrisome trends, verypotent purified cannabis, very
potent synthetic drugs.
I should say the young peoplewho are using cannabis are using
very strong cannabis.
Marijuana.
Marijuana.
Synthetic drugs likemethamphetamine and fentanyl are
(05:42):
very hard to stop getting intoour communities, and they're
causing a lot of problems forthose people who are exposed to
them using them.
Multi-drug people not just usingone drug, but multiple drugs at
once.
So poly substance use, those areworrisome trends, I'd say.
SPEAKER_04 (05:59):
What about overdoses?
Um, we heard about the opioidpandemic, really.
We heard about fentanyl.
Fentanyl's been around for ages,but we've only been hearing
about it in the last decade or15 years about that.
Is fentanyl and opioids stillthe primary overdose problem, or
is it other things?
SPEAKER_03 (06:16):
Yes.
Well, you know, we should talkabout alcohol and people
overdose in a way on alcohol,and people get injured and even
die because of alcohol for avariety of ways, and that takes
more lives.
That'd be the biggest one.
That'd be the biggest.
Tobacco and alcohol are the bigones uh in terms of lives lost,
(06:36):
even with all the improvementsin tobacco.
I think it's still number oneand alcohol number two.
But for other substances,opioids are still involved in
the majority of overdoses, andthey had gotten, like I said,
worse and worse and worse.
And then they got a littlebetter, and now maybe they're
plateaued.
It's still an unacceptably highrate of death.
(06:56):
But, you know, if the good news,if we can take any good news, is
a lot of our efforts seem tohave slowed the rise in death.
SPEAKER_02 (07:04):
And I would, as a the slight cynic in me, would
also say that I think that whilewe want to credit a lot of the
work that we that we do andinterventions that we have and
the amount of narcan or naloxonewhich reverses opioid overdose,
I think there's also a huge partof the supply that really
changes what people'sexperiences, the drug supply, I
mean, and what people haveaccess to.
(07:25):
And so part of really beingnimble in our field is being
able to really adapt and try toreconcile and understand like
what are people having accessto?
And how do we listen hard,change what we're doing to make
sure that we're giving them thesupport that's really going to
be effective with thatever-evolving picture?
SPEAKER_04 (07:41):
It's changing really fast.
Lauren, are you seeing differentcommunities affected
differently, or how doesaddiction manifest in the
various communities we see?
SPEAKER_02 (07:50):
I mean, the amazing thing about addiction, and
something especially when I whenI moved to working at Hennepin
Healthcare that I found juststriking, is that it is truly
hitting all communities atsimilar rates.
And so we see in our office atany given time, uh, we take care
of nurses, lawyers, and folkswho are unhoused, and people who
are working construction and IT.
It's amazing the swath of lifeexperiences that people are
(08:13):
experiencing, who've who've havesubstance use and people who've
lost those, who've who no longerare able to continue those lines
of work because of their wheretheir substance use has led to.
I think it's across what we seeis it's incredibly diverse in
terms of racial and ethnicidentities, incredibly diverse
in terms of ages.
I think, you know, we know andcall addiction a developmental
(08:34):
disease.
It truly is because peopledevelop this, this happens and
starts in adolescence.
We we can see that that 99% ofpeople start using and having
difficulty with their use priorto age 25.
But it is a lifelong chronicdisease that people continue to
struggle with and have differentmoments of success and struggle.
(08:56):
That is kind of how it goes.
And I'm never, you know, it'sit's an amazing thing of all
languages, all backgrounds inwhich we see people.
And I think this hospital inparticular, we we get that full
range and diversity.
SPEAKER_04 (09:08):
Could you talk about the connection, either one of
you, between trauma or childhoodevents or your your growing up
situation and the risk fordeveloping an addiction?
SPEAKER_03 (09:17):
Oh, it's it's complicated.
The connection is there.
Um, and it's a more than just atwo-way street.
Those who use substances, thosewho get intoxicated are more
likely to experience trauma.
Those who have trauma,especially unresolved trauma,
are more likely to seeksubstances to help manage their
(09:38):
some of the internal painthey're feeling.
And addiction is genetic.
So the parents may haveaddiction, they may have trauma,
and the child grows up in thatcontext as well.
They both experienced sometrauma as a sort of the second
generation from their parents,but they also have inherited the
genetic risk.
(09:59):
So there it's very complicatedinvolving multiple things.
I'm, you know, I don't know,Lauren, you could probably make
more sense of it than me, but Ithink addiction causes trauma,
trauma causes addiction, andpeople that live together
struggle together.
I guess is how I would say it.
SPEAKER_04 (10:14):
What about what we used to call the social
determinants of health?
I've I've heard it called thesocial um conditions of health
or whatever, becausedeterminants sounds so like it's
a predetermined thing.
But what about the situationsthat people find themselves in?
Does that affect how addictionshows up with them?
SPEAKER_02 (10:31):
My, I mean, honestly, in terms of
statistics, that doesn'tnecessarily mean there are
higher rates among among thosedifferent populations.
What it does mean is there aregreater consequences of ongoing.
SPEAKER_04 (10:41):
That is a great point.
So it sounds like addictionaffects all communities, but is
there any connection between thesocial determinants of health or
the conditions which people liveand their addictions?
SPEAKER_02 (10:52):
I think you're spot on, Dr.
Hilden, because it is, whileaddiction is across all swathes
of humans, those who experiencethe most detriment from it and
who have the long-termconsequences are certainly folks
who are less represented in ourin our communities and who have
less access to care.
Um, it is amazing, even acrossall socioeconomic classes, how
(11:13):
few people get the medicationsthat are shown to be effective
in reducing alcohol use andshown to be effective in
reducing opioid use.
It's something like 10%.
Even after having an overdose orhaving a hospital encounter,
getting medications to people isone of those terrible things
that we're trying to try toshare out in the world about how
to get those connections becauseit's so, so challenging to find
(11:34):
people who are willing andcomfortable to prescribe, talk
about it, offer support, andalso like share what could
another path look like.
SPEAKER_04 (11:41):
Here's a super easy question.
If we were to treat addiction asa public health crisis, which it
is, how should we be respondingdifferently as a society than we
are now?
SPEAKER_03 (11:54):
Well, I I would look to other countries that have
effectively turned the tide ofdrug epidemics in their in their
own country.
And what they have donesuccessfully is number one,
integrated non-stigmatizedaddiction care into all aspects
of healthcare.
So there's like open doorpolicy.
You can go into any clinic andtalk about your struggles, feel
(12:18):
not judged, and be offeredoptions.
And number two, as much as theycan, remove legal consequences
from addiction and so that youdon't go to jail for addiction.
That is probably symbolic of alarger movement in society to
destigmatize addiction, treat itas a disease, and give access
everywhere for the disease.
(12:39):
And countries like France,Vietnam, Portugal have
dramatically changed death ratesby doing those things.
And we have a ways to go to getuniversal access to
non-stigmatized treatment in ourcommunity.
Yeah.
I love that.
SPEAKER_04 (12:54):
Okay, I'm gonna switch a little bit to talk
about the medicine of addiction.
You know, like what's going onin the body?
At the beginning of this thing,we said, well, it's not a
character flaw, it's a medicalcondition.
Okay, so let's talk about itlike a bunch of doctors.
What causes addiction in somepeople?
SPEAKER_02 (13:08):
I think it it's a lot of different things.
I mean, it's specifically when Italk and teach about opioid use
disorder.
I often talk about the fact thatour bodies, you know, even from
the moment we're born, aredeveloped to create this like
natural level of natural opioidendorphins that we have in our
body that keep us steady, keepus stable, help us cope with the
(13:28):
world.
And there are moments when thoselevels go up a little higher.
And, you know, that's that maybewas a time as a young person
where you had a fabulous, afabulous memory, a really great
day.
And the time when they're lower,when you're more isolated,
lonely as a teenager.
You can imagine some of thosethings.
And so that there's this normalvariation with it, but like we
have this general level ofopioids in our body.
And then for some people, noteverybody, but for some people,
(13:51):
when you first try an opioid,it's an outsized, like hugely
different response.
Like a heck yeah, like totallydifferent experience, far higher
than that moment of like of joythat you'd had before.
And especially if you've beenthrough bad things, that might
be the first blanket that you'veever had to help you felt like
you could be safe and okay.
(14:11):
And it's just this, it's avastly different experience.
And so I tell people, like, youknow, when you have an
experience like that, everyhuman, every animal is like, I'm
gonna do that again.
And and you do, but it's notusually quite as good.
And so then you're like, well,just take a little bit more and
try to get back to that heckyeah moment.
But what happens then is yourbody, when you when your body's
been making its own opioids allthose years and suddenly you're
(14:33):
getting it from another place,your body stops making those
natural opioids.
So in the times when you're notusing, suddenly you are lower
than that low feeling as anisolated teenager.
Your system is, your body isaching, you are devastatingly in
pain, you can't stay still,can't get comfortable,
overwhelmed by anxiety.
(14:54):
And suddenly using becomesdifferent in that you are using
to try to get your body up tothat normal baseline that you
established your whole lifebefore, so that you can go to
school, go to work, get yourkid, you know, take care of your
family.
Like it's about how do I feelnormal again?
And it comes nowhere, you're notgoing anywhere near that heck
(15:14):
yeah moment of that moment thatwe people call feeling high or
feeling.
That's not, it becomes veryquickly like, how do I get back
to normal?
And I think that that's reallylike when I think about like
what does this feel like and howdoes this happen?
I think it's very much like it'sa body deficiency and people
trying to take care ofthemselves, similar to how you
know we know about people whohave low thyroid levels, right?
(15:34):
Hypothyroidism, take a thyroidsupplement to so that they get
back to those normal levels.
People with type 1 diabetesdon't have enough insulin.
We give them insulin so thattheir body has that.
In this way, I really see opioiduse disorder in particular, but
also similarly with a lot ofdifferent use disorders, is that
people are trying to take careof themselves and fill that
deficiency.
(15:55):
And so that's where medicines inparticular, like methadone or
buprenorphine or suboxone, arelife-changing medicines because
they get you back to thatbaseline again.
So you can be your human self,do the things that you need to
do to be successful and to tryto navigate that world.
SPEAKER_04 (16:10):
So, Lauren, it's not volitional or it is.
I mean, people can choose to ornot.
SPEAKER_02 (16:15):
You know, do you know what I'm getting at?
I do.
I mean, I think nobody choosesto have a substance use
disorder, undoubtedly.
I mean, are there moments ofchoice in the beginning when
you're experimenting and andthinking of different things, or
honestly, in that moment whereyou're just trying to take care
of yourself in an extremelyoverwhelming and hard world?
I mean, there's so manydifferent reasons that people
initiate.
But when you develop a truesubstance use disorder, there is
(16:38):
no choice.
It is almost like primaldesperation of how to, of how to
take care of yourself.
So I think people are reallytrying to make the best
decisions with the with thestage in front of them.
But it's a desperate,non-decisional, extremely
brain-changed condition.
SPEAKER_04 (16:53):
So that was like the best description of addiction
I've ever heard in the last twominutes.
That was really helpful to me.
I've been practicing for 25years.
That was good.
I mean, that was very helpful.
You used a few words.
You use substance use disorder,and you've used the word of
addiction.
What's the right terms to use?
Is addiction the word we'resupposed to use?
In medicine, we use substanceuse disorder.
We use we got there's 35acronyms in these guys.
SPEAKER_03 (17:17):
Yeah, what other words?
I think well, what I do, andwhat I would recommend for a
family member is toopen-endedly, sort of
non-judgmentally, ask anindividual how they define their
own use.
Uh, so I will sometimes say, Isyour relationship with alcohol
healthy?
So you have an unhealthyrelationship with alcohol, and
that may be how they want todefine it for themselves, just
(17:40):
because I want to have an openconversation, non-threatening
conversation.
So, I mean, the technicalscientific term is substance use
disorder.
Uh, and that is the sort of, andit sounds technical.
S U D.
S U D.
It's very technical, but I thinka good way to communicate is to
let them lead with the languageand then match their language.
SPEAKER_04 (17:59):
So, what do you guys do for a living?
What does an addiction medicinespecialist physician do?
I've heard it said, Yeah, thereain't enough of you on planet
Earth to care for that.
The scope of the world.
SPEAKER_02 (18:10):
I'm really glad for you to hear that.
SPEAKER_03 (18:13):
Yeah, I I love my work, and it is part of what I
love about my work is that it'shighly diverse.
And not just the types of peopleI see, but the situation they're
in.
And there are many people who Isee who are experiencing severe
consequences from theirsubstance use disorder, from
alcohol, for example.
They're just not ready tochange.
And I go in and I talk to themand I express concern, and I am
(18:36):
concerned, and they're not readyto take the step.
So all I'm doing there isplanting seeds for the future.
Uh, and that could bedisheartening to some.
That's not disheartening to mebecause I've been around long
enough that I see that sometimesthose seeds grow.
All the way to the other end ofthe spectrum.
Last week I saw someone I'veknown for 19 years and is in
(18:58):
recovery and is doing great.
And 19 years ago, I could nothave predicted that this person
would have done so well.
And now he's helping, he's amanager at work.
He's helping his employees whohe identifies are drinking on
the job.
So he's now helping others.
All the way from someone notready to change to someone
helping others change,everything in between.
(19:19):
And so it's it is bothchallenging at times, but really
affirming at other times.
And so there's some days I walkout of work and I am so almost
giddy with having theopportunity to be involved in
patients who are doing thatwell.
And there's some days I workwalk out of work and I'm worried
uh for someone's health.
So it's the whole spectrum.
I don't know how you feel aboutit.
SPEAKER_02 (19:39):
I just I love I love talking about my work because I
think people come up to me andthey're like, how do you do
that?
And I always, it's like we weget the joy of seeing people
through hard times and seeingthe hope that there is on the
other side.
I mean, it's exhilarating.
And I think what is my job on aday-to-day basis?
It's it's so joyful because Ijust get to care and care hard
(20:00):
wherever somebody is in thatmoment, you know.
And I think it's a time, it's awe've created as a society an
experience for our communitymembers who have substance use
disorders, a really, really,really horrible space.
You know, they are our patientsthat we care for are used to, we
drive by people in our cars.
We, you know, walk over them onthe streets.
(20:22):
These are people who are so usedto being ignored by society and
they're so used to being treatedhorribly by healthcare providers
and being asked, like, oh,you're just drug seeking, oh,
you're looking for thesedifferent things.
I mean, the way patients areused to being treated is just
unbelievably hard.
And so the joy that I have in myjob to be able to be like, can I
just take care of you right now?
(20:43):
You're feeling miserable.
Can I offer you an idea ofsomething that might make it
better?
And maybe that's a cup of tea.
Maybe that's like it's startingwherever they need me to be to
help them get to that nextplace.
And it's exactly, you see somepeople who are like, you know,
you express care and you'reworried, and they're like, I'm
not gonna do anything.
And you're like, great, I'mgonna see you tomorrow in
clinic.
Let's like part of me is like,we need to work.
(21:04):
This is a relationship then.
And I need to show you that I amtrustworthy and that we can do
this together.
And then the other folks who arelike, I just have a
life-threatening situation thatI'm here in the hospital.
Like, this change needs tohappen now, and I need, I need
this next path to be different,and walking that with people for
them to see how how their worlddoesn't have to be in that
tunnel that we talked aboutbefore, that there's so many
(21:24):
other paths that you can do.
SPEAKER_03 (21:26):
Lauren, can I ask you a question?
I I think, and I think youhinted at this.
I feel that there is a uniqueform of, excuse me for saying
this, almost intimacy betweenmyself and my patients where
they can be honest with me in away about what's happening and
what they're feeling.
They sometimes can't tell theirspouses these things and they
sometimes can't tell their bestfriends these things or other
(21:47):
doctors these things, but theycan tell me.
And I think that is a reallypowerful experience for me.
SPEAKER_02 (21:52):
I think you're right.
I do think there's times, youknow, I walk into a room and I
usually sometimes if I just say,Hey, I'm an addiction doctor,
people are like, Oh, that's me.
You know, there's thisdefensive, like, do I have
addiction?
Sometimes that people have.
And so often I'll, you know,I'll be like, well, you know,
I'm the alcohol and addictiondoctor, and I support people and
how they feel, how how they'redoing in the hospital to make
sure that you're not feelingsick here in the hospital,
because that's hard.
(22:13):
And usually that's likesomething that we can use to
connect with people is like,nobody wants to feel sick in the
hospital.
You can help me with that?
Okay, let's let's start talkingabout that, even before we start
thinking about like what's thatnext step.
But I do think that the forpeople who are so used to being
who just have this idea thatthey're gonna be so stigmatized
by their healthcare providers,be for me to come in and say
that, they're like, you're gonnaget it.
You're gonna understand, you'regonna understand what I'm
(22:35):
needing to talk about right now.
And I think it's really it's ait's such a privilege.
SPEAKER_03 (22:38):
And I bet you make eye contact in a way that some
other doctors are a littlenervous about.
SPEAKER_02 (22:42):
Right.
Well, and I and I can be like, Ican be like, you're not grumpy
and irritable, you know, becauseyou're a miserable person.
You're because you're inwithdrawal and you feel sick.
We can do something about that.
I see you, you know, and we canlike what what works for you?
Let's do that.
And giving the rest of ourhospital team the permission,
like, you can take care of thisperson.
You can.
SPEAKER_04 (23:02):
So we are going to take a short break.
We are talking with addictionmedicine specialist Dr.
Lauren Graeber and Dr.
Charlie Resnikoff from thegarden spot of the country in
downtown Minneapolis on thecampus of Hennepin Healthcare,
where we are all privileged towork.
When we come back, we're goingto talk about innovations in
addiction medicine, what'sworking, what the future looks
(23:23):
like in this space.
So stick around.
We'll be right back.
SPEAKER_00 (23:30):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare as ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(23:52):
chiropractic care.
Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_04 (24:07):
And we're back talking with Dr.
Charlie Resnakoff and Dr.
Lauren Graber, two addictionmedicine specialists at Hennepin
Healthcare in downtownMinneapolis.
Dr.
Graber, I was gonna ask you,could you talk us through one of
your patient encounters?
What is it like to be one ofyour patients?
Or maybe what's it like to carefor one of your patients, is a
better way to put it.
SPEAKER_02 (24:25):
I was gonna say I can express my my side of the
story with that.
I think, you know, I wasthinking about a couple of
patients that I worked with thisweek.
I have one patient who came intolabor and delivery triage.
She's 26 weeks pregnant.
And but I'd heard about her.
I think I've I'd heard about herfor about eight weeks before
because her care team in thecommunity, not related to
hennepin, knew that this was aplace where we're really working
(24:48):
on, especially caring forpregnant and parenting people
with substance use disorders.
So I'd heard that there's thisperson, and you know, we're
trying to get into care.
And so I just say that becausethat's so common that people
really want to get care, want toget treatment, want to have
medication open options.
And just because of how hard itis, life, all of the different
pieces, like that takes time.
(25:10):
And so the fact that she walkedin this door, the OB team paged
me, and I said, You tell herwe're so glad you're here.
And so I got to meet her.
She just arrived in thehospital.
I think I probably got there anhour afterwards, and she was
really, really not feeling good,really not trusting of me, not
trusting, really nervous aboutwhat medications options they
(25:31):
were.
And then as I dug a little bitdeeper, really, really scared
about how her baby might betaken away from her.
And again, she's 26 weekspregnant, so she's halfway, over
halfway through the pregnancy,but like still pretty far from
delivery.
And just like that was the thingthat's on her mind.
And like, and I think a lot ofthe pregnant people I work with
really have that.
Like, I can't believe this hashappened to me.
(25:52):
I can't believe I'm doing thiswhile I'm pregnant.
Like, you know, all of thisself-blame, shame, and really
hard place.
And so that's the joy I have incoming in and being like, let me
tell you the fact that youshowed up here right now and
that you're open and interestedin taking medications and
talking with the team about someof the different treatment
options and community supports,like, you're showing how hard
(26:14):
you're working.
That is what's child protectiveservices, CPS.
That's what those folks want tosee.
They want to know that you aretrying, you are open to
medicines, and you are trying tofind a better path.
And that's a nice part of my jobis really this is, you know, I
work a lot with childprotection.
We talk a lot about how to keepfamilies together, how to
support families that arewanting to parent together and
(26:34):
really giving her that momentand that light.
SPEAKER_04 (26:36):
What a privilege that you're doing that work
here.
Like so I've been here forever,you know, and a day, and we
haven't been doing that work, tomy knowledge, it with at least
that intentionality, that wehave a specialist who is
treating new parents.
How did you get into that?
SPEAKER_02 (26:49):
Oh, I mean, isn't it just like life that you kind of
tumble and roll into differentthings?
SPEAKER_04 (26:53):
I totally, I'm doing a podcast.
Never saw that coming.
SPEAKER_02 (26:57):
I, in my prior life as a family physician, I did a
lot of mom-baby care and wellmom-baby group visits and
primary care, really thinkingabout like how do all of us be
the parents for our childrenthat they need us to be?
How do we go forward and reallychange all of us wanting to
change what's the life of thatnext generation gonna be?
And so I really that reallyresonated with me.
(27:18):
And for years, my patients weretalking about substance use and
I had no tools.
I didn't know what to do aboutit.
You know, I try to connectpeople in different places.
But honestly, it was when Imoved to Minnesota and I was
like, and I was like, okay,where's the team taking care of
pregnant people with substanceuse disorders?
It's really crickets.
Minnesota, we have so much workto do in this area.
And and I felt, you know, andand with some like fabulous
(27:39):
colleagues at the university andalso I was like just really
putting together like what likewhat would it mean like for me
to really take on then get thatexpertise in a different way?
It's been that evolution thatreally like brought me to
Hennepin and now is allowing meto develop and create this team
and work with those across thestate.
I lead one of the Project Echoseries on perinatal substance
use, really trying to educatehealthcare providers across the
(28:00):
state, like, how do we all dothis better?
So that no matter where ourpatients are ending up in
hospital, because I tell you, inthis city too, like my patients
are at every single hospital.
And so, how do I support andassure that they're gonna get
great care no matter where theyland, and at least care that
respects who they are and treatsthem with dignity and helps like
look towards that space of hope.
(28:21):
And so this patient that I sawthis last week, you know, she
was coming in a really darkplace and she's still, you know,
we're still working on gettingher on the it's not perfect.
It doesn't, it doesn't workright away in these first couple
of days, but starting her onmethadone, helping her
transition so that she's able tofinally feel better so that she
can get to a treatment programand have some more secure
housing, which is a part of herstory in terms of how she's
getting help.
SPEAKER_04 (28:42):
Do you work with our primary care teams?
Do you work with other otherteams as well?
Full disclosure, I remember zerofrom medical school on substance
use.
I don't even know if we had aclass on it.
Maybe we did.
SPEAKER_02 (28:52):
You know, I think it's a real deficit in medical
school education.
It's really like there's reallya day dedicated to substance use
and how to address and supportpeople.
And it's so nuanced, you know,because it's so much about
conversation and differentpieces and often embedded like
within our psychiatry trainingin different places.
But so I do think that's adeficit.
And that's part of what's beenreally exciting for us at
Hennepin is to really be able tocollaborate and work much more
(29:13):
broadly across the state andeducation efforts.
We do a lot of course with themedical school.
We have rotating residents andfellows in our on our team all
the time, really trying to likeget people to be comfortable to
have that conversation.
And I think that we're trying tomake inroads in how to do that.
There's so much more for us todo.
I mean, that's why when I when Italk about like, you know, how
do we take better care ofpregnant and parenting people?
(29:34):
Well, it's like, well, you know,we can't do much worse.
Why don't we try to pullourselves together to do even a
little bit better?
And how do we do that in a spacecollectively and using each
other's shared knowledge that wecan really build that different
vision?
SPEAKER_04 (29:47):
So, Charlie, I've known you for 20 years.
What are you doing now that isdifferent from what you were
doing 10, 15, 20 years ago?
SPEAKER_03 (29:55):
Well, I I think one of the good things that came
from COVID.
Is that we really examinedtelehealth, telemedicine, even
telephone visits with patients.
And by doing that, we loweredbarriers so that people who
couldn't get to the clinicphysically or who have mobility
issues or just forgot theirappointment can still have their
(30:18):
appointment by telemedicine.
And it is so much fun.
Every Wednesday afternoon, Ihave a telemedicine clinic.
It is so much fun to call orhave a video chat with people.
And so I think that is a hugeinnovation.
And it's it's actually oldtechnology.
It's the telephone.
Um, but it's used in a new way,and it improves their engagement
(30:39):
in the healthcare system and itimproves their outcomes.
And it's really meaningful, Ithink.
SPEAKER_02 (30:43):
So there's a lot of new innovations in terms of
medicines.
And I'm, but one in particular Iwanted to highlight is the
sublicade injection, some ofthese long-acting injections,
right?
What's that injection?
The med, there are a lot ofdifferent medicines that we use
for addiction medicine.
One of the primary ones isbuprenorphine or suboxone, which
usually is taken under thetongue.
Actually, it dissolves.
(31:04):
You don't even swallow it.
So that's strange already.
So educating patients aboutthat.
But in the last several years,there's these long-acting
injectable forms of it, um,where you actually give an
injection under the skin and itlasts for ready for it?
30 days.
30 days at therapeutic doses andit hangs out in your body for
much longer.
(31:25):
That in a world where substanceuse is often really chaotic,
there's so many different thingsgoing on.
Whether you're an early parent,whether you're a fresh
adolescent who's very impulsiveanyway, having a medication that
you don't have to remember totake all the time that's in your
body already is life-savinglydifferent.
It's life-saving too becauseremember, this medicine, if you
have bubinorphine in your bodyand you take any other type of
(31:48):
opioid, it bounces it off.
So it really reduces people'srisk of overdose.
So even in that impulsiveteenager who's like, okay, maybe
I'll try it again and see whatit feels like, it doesn't have
the same reward.
And it protects them fromoverdose.
I mean, that's an amazing giftthat you have for people who are
potentially in impulsive spaces.
So those long-acting injectableshave transformed my practice and
(32:08):
really, and now, especially withresearch coming out about how
safe it is for pregnant people,how safe it is for young kids,
like this is, and I say kids, Imean adolescents, this is a
really, really transformativeoption for meds.
I think the second thing that Ithink is a really innovative
space for innovation, I wouldsay, and I hope we can make this
happen, is that methadone, weknow, is an incredibly effective
(32:29):
medicine in the era of fentanyl.
And a lot of studies show evenmore effective than Suboxone and
buprenorphine, that people stayengaged in care longer and have
longer periods of abstinence.
And so my wish and innovation isthat we can get better access
for people to methadone, that itisn't just the few places, you
know, in the state of Minnesota,we've got we've got a handful of
methadone clinics here in theTwin Cities.
(32:50):
But I tell you, you driveoutward, it's impossible to get
people from all differentcommunities to access to
methadone.
So it would be my dream ininnovation.
And there's even a study thatwe're doing here at HCMC that's
allowing, like piloting this tohave clinic-based methadone
distribution and working withour pharmacy partners will mean
that more people around thisbigger state will be able to
(33:11):
have access.
SPEAKER_04 (33:12):
So I can I ask you to respond to this.
Our addiction medicine clinic isin a building that was built
during the, I was gonna say theEisenhower administration, but I
think it was more like theCalvin Coolidge administration.
It's old.
It's in a back alley.
Literally.
The patients have to walk in aback alley to get their
substance use disorders treated.
Where we have plans.
We have great plans, and we havewe have blueprints now.
(33:35):
We have a new space thatliterally used to house the CEO
of the hospital.
That is where the hospitaladministration used to be.
Faces the park.
It's gonna have windows, it'sgonna have glass, it's gonna
have a beautiful entrance thatis dignified.
What do you see as one of thephysicians who's gonna work
there as what we need to bedoing in a clinic?
(33:56):
And what has henna been doing tobetter serve the needs of our
patients in that clinicalsetting?
SPEAKER_02 (34:01):
I feel, I mean, it's a golden time to be working as
an addiction physician at thishospital right now, because I
think the priority that thehospital sees in being able to
treat people with dignity isreally coming through in these
new, in the new plans of where anew building will be.
The fact that it is going to beclose to, I mean, that really
the epicenter of where peopleare entering the hospital, that
this is a place that you arewelcome, you are respected, and
(34:22):
that we're gonna care for you.
It makes a huge difference.
You know, I think that where ourclinic has been and the tours
that we've given for peoplearound, like people come through
and and like scrunch their nose.
SPEAKER_04 (34:32):
It's like you have US Congress members looking at
the place and they scrunch theirnose.
SPEAKER_02 (34:37):
It's true.
I mean, and it's like, and butand and in many ways, I'm I'm so
grateful that they feel thatway.
Guess what?
Our patients do too.
And so, how do we create a spaceif we want people to feel
welcome, to feel cared for?
That physical space means somuch.
I mean, you were saying likeit's gonna have windows.
Our current place has nowindows.
So this is like that's a bigdeal to be able to do this and
to be able to do it in a waythat's so centralized and be
(34:59):
able to really help us accessand connect our patients to care
in the larger places.
It's very, very, very exciting.
SPEAKER_04 (35:06):
I can't wait to see a hammer flying and nails going
and paint going on the wall.
That's gonna happen soon.
This Hennepin Center forAddiction is gonna happen soon.
So, Charlie, what do you see forthe future?
What is your hope for the futureof addiction medicine?
SPEAKER_03 (35:23):
It's two answers.
Number one, we have excellenttools.
We are just not consistentlyapplying them throughout our
system.
So there's part of the future isjust using the tools we have in
a better way so that people haveaccess to them wherever they go,
so that people have reallyrefined access to the best
(35:44):
treatments and tools that wealready have in place.
So I think we would go reallyfar if we just did that.
If we just took our existingtreatments and used them better.
But there is a lot of researchinto new medications, new
treatments.
Um, there's a lot of excitementon the horizon.
And, you know, they're just sortof throwing everything at the
(36:06):
wall and seeing what works.
And dozens and dozens of newpharmaceuticals are being tested
for addiction.
And I think we're gonna havesome exciting breakthroughs in
the next five to 10 years.
Really game-changingbreakthroughs.
I'm I'm hopeful for that.
So that's kind of where I seethings going.
SPEAKER_04 (36:21):
I'm gonna ask you both the same question.
What do you wish every personlistening to this episode would
understand about addiction andrecovery?
SPEAKER_03 (36:29):
I think anyone struggling with chemical use,
substance use, you don't have todefine yourself as addiction.
Find a professional you can talkto honestly and explore your
options.
I guess I would say that.
And anyone who's a loved one ofsomeone struggling with
substance use, help them to theextent they're ready to be
helped in a non-judgmental wayto do the same.
(36:51):
Find a professional who can hearthem non-judgmentally and offer
them options.
And I think that that would bemy message.
What a great message.
SPEAKER_04 (36:59):
Okay, I'd like to get your thoughts on it, Dr.
Graeber, just like Dr.
Reznikov.
SPEAKER_02 (37:03):
I think if every person listening to this
podcast, I think consideredaddiction with compassion and
understanding of how it is amedical condition, so similar in
some ways to long-term cancer,hypertension, diabetes, and that
people are able to weave in andout of good times and bad times
and times where theirmedications and are working
(37:25):
really well, and times when itdoesn't, that this is a place
that ultimately it's anincredibly human space to be,
and to hold that flame forpeople is incredibly, incredibly
powerful.
SPEAKER_04 (37:35):
I think that's a great message to leave us with.
At Hennepin Healthcare here inMinneapolis, we have some of the
finest physicians, advancedpractice providers, addiction
counselors, nurses,administrators who are helping
us to achieve a future ofaddiction medicine.
This is where it is happeningclinically, scientifically, in
research, and the communities ofour state are gonna be all the
(37:57):
better for it.
I want to thank you both forbeing on the show today.
Glorin, thanks for being here.
Thanks so much for having me.
Charlie, thanks for being here.
Thank you.
And thank you to our live studioaudience.
You have sat through.
You have sat through our firstefforts at doing this, and so I
appreciate you coming out.
And listeners, I hope you'vepicked up something that you
(38:19):
found informative, and I hopeyou join us for our next
episode, which will drop in twoweeks' time.
And in the meantime, be healthyand be well.
SPEAKER_01 (38:29):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org.
Or call 612-873-talk.
There's also a link in the shownotes.
(38:50):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(39:12):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_04 (00:18):
Hey everybody, it's your host, David Hilden, and
welcome to a special episode ofthe Healthy Matters Podcast.
This is episode three of seasonfive, and today we're gonna talk
about addiction.
But this is a special episodebecause there is a room full of
people sitting in front of me.
This is our very first livestudio recording of a podcast.
(00:40):
And so today we're gonna talkabout addiction medicine.
For a long time, addictionmedicine was seen kind of as a
personal failure from a lack ofwillpower, maybe bad choices,
maybe even a moral characterflaw.
But as it turned out, that couldnot be further from the truth.
Addiction is a medicalcondition.
(01:00):
It deserves the same attention,the same treatment, compassion,
diagnosis, the same hope, thesame support for patients and
their families as any othermedical condition.
So today we're gonna dive intoaddiction medicine, what it is,
why it matters, and how science,innovation, and humanity are
helping people in their recoveryevery single day.
So today I am joined by two ofthe best in the business, Dr.
(01:24):
Lauren Graber and Dr.
Charlie Resnikov from HennepinHealthcare's Addiction Medicine
Program.
So as I said, we're recordinglive here with a studio audience
in Hennepin Healthcare.
And trust me, you're gonna walkaway with a whole new
understanding of what recoveryreally looks like.
So let's get started.
Charlie, Lauren, thanks forbeing here.
SPEAKER_02 (01:42):
So glad to be here.
SPEAKER_03 (01:43):
Yeah, I'm honored to be here.
SPEAKER_04 (01:45):
So I've known you guys a great long time, and I
appreciate you being herehelping us out through this
super important topic.
So let's start us off, if youcould.
Let's talk about the scope ofaddiction medicine in the United
States.
How common is it?
Who wants to take that one?
SPEAKER_03 (01:58):
Uh I'll I'll start with this.
I think there's a simple answer,and then there's a slightly more
complex answer.
The simple answer is 10% ofadults struggle or are at risk
for addiction.
It's a ballpark figure.
So I think that's a simple wayof answering.
How common is it?
One out of 10 of us are gonnaeither struggle with addiction
or be vulnerable to it.
But there's a more complexversion of the answer.
(02:20):
That's like us and our risk.
Society creates risks ofaddiction.
I mean, you could imagine in the1950s when sophisticated
celebrities were smoking onfilms, and you could smoke in a
in a restaurant in an airplane,and your doctor told you uh it
was okay to smoke.
Uh your doctor probably wassmoking.
You probably, yeah.
Go get a cigarette.
Smoking was way more prevalentthen because society was
(02:42):
different then.
And now society views tobaccosmoking differently, and rates
have changed.
So part of it is within us, 10%risk, and part of it exists
within the society.
And is this drug available?
Uh, how does the society viewthe drug?
What is the perception of thedrug use within that society?
And it's it's more narrow thanthe society, could even be the
(03:05):
community, could be theneighborhood.
SPEAKER_02 (03:07):
I was gonna say the one thing I'll add that I think
is more like more generallyspeaking, we could talk about
trends too.
But one thing that's amazingabout now, while we say 10% of
people are susceptible or moreat risk of having substance use
disorders, a research study cameout this last year that said one
in three Americans is personallytouched and affected by someone
who is experiencing a substanceuse disorder.
(03:27):
So I think for me in my trainingas a family physician, we're
thinking about this larger unit.
Each person who is having astruggle is affecting this
larger, this larger group ofindividuals in their family, in
their community.
And how real and felt that is.
That it's not even, it's notjust this one person struggling,
it's this whole network ofhumans affected and really
feeling that struggle together.
(03:48):
So that's a really importantthing to think about, like even
though it's one in ten, it's theimpact of how this impacts all
of us is so much deeper.
SPEAKER_04 (03:55):
Before I let you go from that, Dr.
Graber, so that is, I am aninternal medicine doctor.
I do a lot of diabetes, I dointernal medicine.
I wouldn't say that be the casefor all my patients with heart
disease.
Why does it affect so manypeople outside of just the
person who is living with anaddiction?
SPEAKER_02 (04:10):
It's so, so nuanced and so like dear for in how you
care for somebody.
When you in a system, you know,when someone is struggling with
substance use, they are oftenthe caregiver of other people,
their elders, their children,they're and or having different
responsibilities.
And substance use puts you inthis tunnel where it's so hard
to see any other, any other pathto make another decision because
(04:32):
the desperation and the andreally like if this shroud of
where you are, it feels likeyour options are so limited.
And so, in order for you tofunction in society and build
those networks and care fordifferent people, like it, it's
just not, you're not able to dothat.
And the people around you, ofcourse, see that.
It means are, you know, how areyou nurturing your children?
How are you, how are you caringfor your family?
How are you showing up to work?
(04:52):
All of those things become morechallenging.
SPEAKER_04 (04:54):
Yeah, thanks for that.
Thanks for that.
Okay, trends.
SPEAKER_03 (04:56):
What are you seeing?
Well, I mean, I think a good, avery interesting good trend is
that young people are abstainingfrom drugs at surprising rates.
Alcohol, cannabis, a variety ofother drugs.
So that's a good trend.
Um, I think there's also beenyear after year of bad trends
with opioid overdoses, fentanyloverdoses that improved or maybe
(05:21):
plateaued a bit.
So I think those are goodtrends.
Bad, worrisome trends, verypotent purified cannabis, very
potent synthetic drugs.
I should say the young peoplewho are using cannabis are using
very strong cannabis.
Marijuana.
Marijuana.
Synthetic drugs likemethamphetamine and fentanyl are
(05:42):
very hard to stop getting intoour communities, and they're
causing a lot of problems forthose people who are exposed to
them using them.
Multi-drug people not just usingone drug, but multiple drugs at
once.
So poly substance use, those areworrisome trends, I'd say.
SPEAKER_04 (05:59):
What about overdoses?
Um, we heard about the opioidpandemic, really.
We heard about fentanyl.
Fentanyl's been around for ages,but we've only been hearing
about it in the last decade or15 years about that.
Is fentanyl and opioids stillthe primary overdose problem, or
is it other things?
SPEAKER_03 (06:16):
Yes.
Well, you know, we should talkabout alcohol and people
overdose in a way on alcohol,and people get injured and even
die because of alcohol for avariety of ways, and that takes
more lives.
That'd be the biggest one.
That'd be the biggest.
Tobacco and alcohol are the bigones uh in terms of lives lost,
(06:36):
even with all the improvementsin tobacco.
I think it's still number oneand alcohol number two.
But for other substances,opioids are still involved in
the majority of overdoses, andthey had gotten, like I said,
worse and worse and worse.
And then they got a littlebetter, and now maybe they're
plateaued.
It's still an unacceptably highrate of death.
(06:56):
But, you know, if the good news,if we can take any good news, is
a lot of our efforts seem tohave slowed the rise in death.
SPEAKER_02 (07:04):
And I would, as a the slight cynic in me, would
also say that I think that whilewe want to credit a lot of the
work that we that we do andinterventions that we have and
the amount of narcan or naloxonewhich reverses opioid overdose,
I think there's also a huge partof the supply that really
changes what people'sexperiences, the drug supply, I
mean, and what people haveaccess to.
(07:25):
And so part of really beingnimble in our field is being
able to really adapt and try toreconcile and understand like
what are people having accessto?
And how do we listen hard,change what we're doing to make
sure that we're giving them thesupport that's really going to
be effective with thatever-evolving picture?
SPEAKER_04 (07:41):
It's changing really fast.
Lauren, are you seeing differentcommunities affected
differently, or how doesaddiction manifest in the
various communities we see?
SPEAKER_02 (07:50):
I mean, the amazing thing about addiction, and
something especially when I whenI moved to working at Hennepin
Healthcare that I found juststriking, is that it is truly
hitting all communities atsimilar rates.
And so we see in our office atany given time, uh, we take care
of nurses, lawyers, and folkswho are unhoused, and people who
are working construction and IT.
It's amazing the swath of lifeexperiences that people are
(08:13):
experiencing, who've who've havesubstance use and people who've
lost those, who've who no longerare able to continue those lines
of work because of their wheretheir substance use has led to.
I think it's across what we seeis it's incredibly diverse in
terms of racial and ethnicidentities, incredibly diverse
in terms of ages.
I think, you know, we know andcall addiction a developmental
(08:34):
disease.
It truly is because peopledevelop this, this happens and
starts in adolescence.
We we can see that that 99% ofpeople start using and having
difficulty with their use priorto age 25.
But it is a lifelong chronicdisease that people continue to
struggle with and have differentmoments of success and struggle.
(08:56):
That is kind of how it goes.
And I'm never, you know, it'sit's an amazing thing of all
languages, all backgrounds inwhich we see people.
And I think this hospital inparticular, we we get that full
range and diversity.
SPEAKER_04 (09:08):
Could you talk about the connection, either one of
you, between trauma or childhoodevents or your your growing up
situation and the risk fordeveloping an addiction?
SPEAKER_03 (09:17):
Oh, it's it's complicated.
The connection is there.
Um, and it's a more than just atwo-way street.
Those who use substances, thosewho get intoxicated are more
likely to experience trauma.
Those who have trauma,especially unresolved trauma,
are more likely to seeksubstances to help manage their
(09:38):
some of the internal painthey're feeling.
And addiction is genetic.
So the parents may haveaddiction, they may have trauma,
and the child grows up in thatcontext as well.
They both experienced sometrauma as a sort of the second
generation from their parents,but they also have inherited the
genetic risk.
(09:59):
So there it's very complicatedinvolving multiple things.
I'm, you know, I don't know,Lauren, you could probably make
more sense of it than me, but Ithink addiction causes trauma,
trauma causes addiction, andpeople that live together
struggle together.
I guess is how I would say it.
SPEAKER_04 (10:14):
What about what we used to call the social
determinants of health?
I've I've heard it called thesocial um conditions of health
or whatever, becausedeterminants sounds so like it's
a predetermined thing.
But what about the situationsthat people find themselves in?
Does that affect how addictionshows up with them?
SPEAKER_02 (10:31):
My, I mean, honestly, in terms of
statistics, that doesn'tnecessarily mean there are
higher rates among among thosedifferent populations.
What it does mean is there aregreater consequences of ongoing.
SPEAKER_04 (10:41):
That is a great point.
So it sounds like addictionaffects all communities, but is
there any connection between thesocial determinants of health or
the conditions which people liveand their addictions?
SPEAKER_02 (10:52):
I think you're spot on, Dr.
Hilden, because it is, whileaddiction is across all swathes
of humans, those who experiencethe most detriment from it and
who have the long-termconsequences are certainly folks
who are less represented in ourin our communities and who have
less access to care.
Um, it is amazing, even acrossall socioeconomic classes, how
(11:13):
few people get the medicationsthat are shown to be effective
in reducing alcohol use andshown to be effective in
reducing opioid use.
It's something like 10%.
Even after having an overdose orhaving a hospital encounter,
getting medications to people isone of those terrible things
that we're trying to try toshare out in the world about how
to get those connections becauseit's so, so challenging to find
(11:34):
people who are willing andcomfortable to prescribe, talk
about it, offer support, andalso like share what could
another path look like.
SPEAKER_04 (11:41):
Here's a super easy question.
If we were to treat addiction asa public health crisis, which it
is, how should we be respondingdifferently as a society than we
are now?
SPEAKER_03 (11:54):
Well, I I would look to other countries that have
effectively turned the tide ofdrug epidemics in their in their
own country.
And what they have donesuccessfully is number one,
integrated non-stigmatizedaddiction care into all aspects
of healthcare.
So there's like open doorpolicy.
You can go into any clinic andtalk about your struggles, feel
(12:18):
not judged, and be offeredoptions.
And number two, as much as theycan, remove legal consequences
from addiction and so that youdon't go to jail for addiction.
That is probably symbolic of alarger movement in society to
destigmatize addiction, treat itas a disease, and give access
everywhere for the disease.
(12:39):
And countries like France,Vietnam, Portugal have
dramatically changed death ratesby doing those things.
And we have a ways to go to getuniversal access to
non-stigmatized treatment in ourcommunity.
Yeah.
I love that.
SPEAKER_04 (12:54):
Okay, I'm gonna switch a little bit to talk
about the medicine of addiction.
You know, like what's going onin the body?
At the beginning of this thing,we said, well, it's not a
character flaw, it's a medicalcondition.
Okay, so let's talk about itlike a bunch of doctors.
What causes addiction in somepeople?
SPEAKER_02 (13:08):
I think it it's a lot of different things.
I mean, it's specifically when Italk and teach about opioid use
disorder.
I often talk about the fact thatour bodies, you know, even from
the moment we're born, aredeveloped to create this like
natural level of natural opioidendorphins that we have in our
body that keep us steady, keepus stable, help us cope with the
(13:28):
world.
And there are moments when thoselevels go up a little higher.
And, you know, that's that maybewas a time as a young person
where you had a fabulous, afabulous memory, a really great
day.
And the time when they're lower,when you're more isolated,
lonely as a teenager.
You can imagine some of thosethings.
And so that there's this normalvariation with it, but like we
have this general level ofopioids in our body.
And then for some people, noteverybody, but for some people,
(13:51):
when you first try an opioid,it's an outsized, like hugely
different response.
Like a heck yeah, like totallydifferent experience, far higher
than that moment of like of joythat you'd had before.
And especially if you've beenthrough bad things, that might
be the first blanket that you'veever had to help you felt like
you could be safe and okay.
(14:11):
And it's just this, it's avastly different experience.
And so I tell people, like, youknow, when you have an
experience like that, everyhuman, every animal is like, I'm
gonna do that again.
And and you do, but it's notusually quite as good.
And so then you're like, well,just take a little bit more and
try to get back to that heckyeah moment.
But what happens then is yourbody, when you when your body's
been making its own opioids allthose years and suddenly you're
(14:33):
getting it from another place,your body stops making those
natural opioids.
So in the times when you're notusing, suddenly you are lower
than that low feeling as anisolated teenager.
Your system is, your body isaching, you are devastatingly in
pain, you can't stay still,can't get comfortable,
overwhelmed by anxiety.
(14:54):
And suddenly using becomesdifferent in that you are using
to try to get your body up tothat normal baseline that you
established your whole lifebefore, so that you can go to
school, go to work, get yourkid, you know, take care of your
family.
Like it's about how do I feelnormal again?
And it comes nowhere, you're notgoing anywhere near that heck
(15:14):
yeah moment of that moment thatwe people call feeling high or
feeling.
That's not, it becomes veryquickly like, how do I get back
to normal?
And I think that that's reallylike when I think about like
what does this feel like and howdoes this happen?
I think it's very much like it'sa body deficiency and people
trying to take care ofthemselves, similar to how you
know we know about people whohave low thyroid levels, right?
(15:34):
Hypothyroidism, take a thyroidsupplement to so that they get
back to those normal levels.
People with type 1 diabetesdon't have enough insulin.
We give them insulin so thattheir body has that.
In this way, I really see opioiduse disorder in particular, but
also similarly with a lot ofdifferent use disorders, is that
people are trying to take careof themselves and fill that
deficiency.
(15:55):
And so that's where medicines inparticular, like methadone or
buprenorphine or suboxone, arelife-changing medicines because
they get you back to thatbaseline again.
So you can be your human self,do the things that you need to
do to be successful and to tryto navigate that world.
SPEAKER_04 (16:10):
So, Lauren, it's not volitional or it is.
I mean, people can choose to ornot.
SPEAKER_02 (16:15):
You know, do you know what I'm getting at?
I do.
I mean, I think nobody choosesto have a substance use
disorder, undoubtedly.
I mean, are there moments ofchoice in the beginning when
you're experimenting and andthinking of different things, or
honestly, in that moment whereyou're just trying to take care
of yourself in an extremelyoverwhelming and hard world?
I mean, there's so manydifferent reasons that people
initiate.
But when you develop a truesubstance use disorder, there is
(16:38):
no choice.
It is almost like primaldesperation of how to, of how to
take care of yourself.
So I think people are reallytrying to make the best
decisions with the with thestage in front of them.
But it's a desperate,non-decisional, extremely
brain-changed condition.
SPEAKER_04 (16:53):
So that was like the best description of addiction
I've ever heard in the last twominutes.
That was really helpful to me.
I've been practicing for 25years.
That was good.
I mean, that was very helpful.
You used a few words.
You use substance use disorder,and you've used the word of
addiction.
What's the right terms to use?
Is addiction the word we'resupposed to use?
In medicine, we use substanceuse disorder.
We use we got there's 35acronyms in these guys.
SPEAKER_03 (17:17):
Yeah, what other words?
I think well, what I do, andwhat I would recommend for a
family member is toopen-endedly, sort of
non-judgmentally, ask anindividual how they define their
own use.
Uh, so I will sometimes say, Isyour relationship with alcohol
healthy?
So you have an unhealthyrelationship with alcohol, and
that may be how they want todefine it for themselves, just
(17:40):
because I want to have an openconversation, non-threatening
conversation.
So, I mean, the technicalscientific term is substance use
disorder.
Uh, and that is the sort of, andit sounds technical.
S U D.
S U D.
It's very technical, but I thinka good way to communicate is to
let them lead with the languageand then match their language.
SPEAKER_04 (17:59):
So, what do you guys do for a living?
What does an addiction medicinespecialist physician do?
I've heard it said, Yeah, thereain't enough of you on planet
Earth to care for that.
The scope of the world.
SPEAKER_02 (18:10):
I'm really glad for you to hear that.
SPEAKER_03 (18:13):
Yeah, I I love my work, and it is part of what I
love about my work is that it'shighly diverse.
And not just the types of peopleI see, but the situation they're
in.
And there are many people who Isee who are experiencing severe
consequences from theirsubstance use disorder, from
alcohol, for example.
They're just not ready tochange.
And I go in and I talk to themand I express concern, and I am
(18:36):
concerned, and they're not readyto take the step.
So all I'm doing there isplanting seeds for the future.
Uh, and that could bedisheartening to some.
That's not disheartening to mebecause I've been around long
enough that I see that sometimesthose seeds grow.
All the way to the other end ofthe spectrum.
Last week I saw someone I'veknown for 19 years and is in
(18:58):
recovery and is doing great.
And 19 years ago, I could nothave predicted that this person
would have done so well.
And now he's helping, he's amanager at work.
He's helping his employees whohe identifies are drinking on
the job.
So he's now helping others.
All the way from someone notready to change to someone
helping others change,everything in between.
(19:19):
And so it's it is bothchallenging at times, but really
affirming at other times.
And so there's some days I walkout of work and I am so almost
giddy with having theopportunity to be involved in
patients who are doing thatwell.
And there's some days I workwalk out of work and I'm worried
uh for someone's health.
So it's the whole spectrum.
I don't know how you feel aboutit.
SPEAKER_02 (19:39):
I just I love I love talking about my work because I
think people come up to me andthey're like, how do you do
that?
And I always, it's like we weget the joy of seeing people
through hard times and seeingthe hope that there is on the
other side.
I mean, it's exhilarating.
And I think what is my job on aday-to-day basis?
It's it's so joyful because Ijust get to care and care hard
(20:00):
wherever somebody is in thatmoment, you know.
And I think it's a time, it's awe've created as a society an
experience for our communitymembers who have substance use
disorders, a really, really,really horrible space.
You know, they are our patientsthat we care for are used to, we
drive by people in our cars.
We, you know, walk over them onthe streets.
(20:22):
These are people who are so usedto being ignored by society and
they're so used to being treatedhorribly by healthcare providers
and being asked, like, oh,you're just drug seeking, oh,
you're looking for thesedifferent things.
I mean, the way patients areused to being treated is just
unbelievably hard.
And so the joy that I have in myjob to be able to be like, can I
just take care of you right now?
(20:43):
You're feeling miserable.
Can I offer you an idea ofsomething that might make it
better?
And maybe that's a cup of tea.
Maybe that's like it's startingwherever they need me to be to
help them get to that nextplace.
And it's exactly, you see somepeople who are like, you know,
you express care and you'reworried, and they're like, I'm
not gonna do anything.
And you're like, great, I'mgonna see you tomorrow in
clinic.
Let's like part of me is like,we need to work.
(21:04):
This is a relationship then.
And I need to show you that I amtrustworthy and that we can do
this together.
And then the other folks who arelike, I just have a
life-threatening situation thatI'm here in the hospital.
Like, this change needs tohappen now, and I need, I need
this next path to be different,and walking that with people for
them to see how how their worlddoesn't have to be in that
tunnel that we talked aboutbefore, that there's so many
(21:24):
other paths that you can do.
SPEAKER_03 (21:26):
Lauren, can I ask you a question?
I I think, and I think youhinted at this.
I feel that there is a uniqueform of, excuse me for saying
this, almost intimacy betweenmyself and my patients where
they can be honest with me in away about what's happening and
what they're feeling.
They sometimes can't tell theirspouses these things and they
sometimes can't tell their bestfriends these things or other
(21:47):
doctors these things, but theycan tell me.
And I think that is a reallypowerful experience for me.
SPEAKER_02 (21:52):
I think you're right.
I do think there's times, youknow, I walk into a room and I
usually sometimes if I just say,Hey, I'm an addiction doctor,
people are like, Oh, that's me.
You know, there's thisdefensive, like, do I have
addiction?
Sometimes that people have.
And so often I'll, you know,I'll be like, well, you know,
I'm the alcohol and addictiondoctor, and I support people and
how they feel, how how they'redoing in the hospital to make
sure that you're not feelingsick here in the hospital,
because that's hard.
(22:13):
And usually that's likesomething that we can use to
connect with people is like,nobody wants to feel sick in the
hospital.
You can help me with that?
Okay, let's let's start talkingabout that, even before we start
thinking about like what's thatnext step.
But I do think that the forpeople who are so used to being
who just have this idea thatthey're gonna be so stigmatized
by their healthcare providers,be for me to come in and say
that, they're like, you're gonnaget it.
You're gonna understand, you'regonna understand what I'm
(22:35):
needing to talk about right now.
And I think it's really it's ait's such a privilege.
SPEAKER_03 (22:38):
And I bet you make eye contact in a way that some
other doctors are a littlenervous about.
SPEAKER_02 (22:42):
Right.
Well, and I and I can be like, Ican be like, you're not grumpy
and irritable, you know, becauseyou're a miserable person.
You're because you're inwithdrawal and you feel sick.
We can do something about that.
I see you, you know, and we canlike what what works for you?
Let's do that.
And giving the rest of ourhospital team the permission,
like, you can take care of thisperson.
You can.
SPEAKER_04 (23:02):
So we are going to take a short break.
We are talking with addictionmedicine specialist Dr.
Lauren Graeber and Dr.
Charlie Resnikoff from thegarden spot of the country in
downtown Minneapolis on thecampus of Hennepin Healthcare,
where we are all privileged towork.
When we come back, we're goingto talk about innovations in
addiction medicine, what'sworking, what the future looks
(23:23):
like in this space.
So stick around.
We'll be right back.
SPEAKER_00 (23:30):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare as ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(23:52):
chiropractic care.
Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_04 (24:07):
And we're back talking with Dr.
Charlie Resnakoff and Dr.
Lauren Graber, two addictionmedicine specialists at Hennepin
Healthcare in downtownMinneapolis.
Dr.
Graber, I was gonna ask you,could you talk us through one of
your patient encounters?
What is it like to be one ofyour patients?
Or maybe what's it like to carefor one of your patients, is a
better way to put it.
SPEAKER_02 (24:25):
I was gonna say I can express my my side of the
story with that.
I think, you know, I wasthinking about a couple of
patients that I worked with thisweek.
I have one patient who came intolabor and delivery triage.
She's 26 weeks pregnant.
And but I'd heard about her.
I think I've I'd heard about herfor about eight weeks before
because her care team in thecommunity, not related to
hennepin, knew that this was aplace where we're really working
(24:48):
on, especially caring forpregnant and parenting people
with substance use disorders.
So I'd heard that there's thisperson, and you know, we're
trying to get into care.
And so I just say that becausethat's so common that people
really want to get care, want toget treatment, want to have
medication open options.
And just because of how hard itis, life, all of the different
pieces, like that takes time.
(25:10):
And so the fact that she walkedin this door, the OB team paged
me, and I said, You tell herwe're so glad you're here.
And so I got to meet her.
She just arrived in thehospital.
I think I probably got there anhour afterwards, and she was
really, really not feeling good,really not trusting of me, not
trusting, really nervous aboutwhat medications options they
(25:31):
were.
And then as I dug a little bitdeeper, really, really scared
about how her baby might betaken away from her.
And again, she's 26 weekspregnant, so she's halfway, over
halfway through the pregnancy,but like still pretty far from
delivery.
And just like that was the thingthat's on her mind.
And like, and I think a lot ofthe pregnant people I work with
really have that.
Like, I can't believe this hashappened to me.
(25:52):
I can't believe I'm doing thiswhile I'm pregnant.
Like, you know, all of thisself-blame, shame, and really
hard place.
And so that's the joy I have incoming in and being like, let me
tell you the fact that youshowed up here right now and
that you're open and interestedin taking medications and
talking with the team about someof the different treatment
options and community supports,like, you're showing how hard
(26:14):
you're working.
That is what's child protectiveservices, CPS.
That's what those folks want tosee.
They want to know that you aretrying, you are open to
medicines, and you are trying tofind a better path.
And that's a nice part of my jobis really this is, you know, I
work a lot with childprotection.
We talk a lot about how to keepfamilies together, how to
support families that arewanting to parent together and
(26:34):
really giving her that momentand that light.
SPEAKER_04 (26:36):
What a privilege that you're doing that work
here.
Like so I've been here forever,you know, and a day, and we
haven't been doing that work, tomy knowledge, it with at least
that intentionality, that wehave a specialist who is
treating new parents.
How did you get into that?
SPEAKER_02 (26:49):
Oh, I mean, isn't it just like life that you kind of
tumble and roll into differentthings?
SPEAKER_04 (26:53):
I totally, I'm doing a podcast.
Never saw that coming.
SPEAKER_02 (26:57):
I, in my prior life as a family physician, I did a
lot of mom-baby care and wellmom-baby group visits and
primary care, really thinkingabout like how do all of us be
the parents for our childrenthat they need us to be?
How do we go forward and reallychange all of us wanting to
change what's the life of thatnext generation gonna be?
And so I really that reallyresonated with me.
(27:18):
And for years, my patients weretalking about substance use and
I had no tools.
I didn't know what to do aboutit.
You know, I try to connectpeople in different places.
But honestly, it was when Imoved to Minnesota and I was
like, and I was like, okay,where's the team taking care of
pregnant people with substanceuse disorders?
It's really crickets.
Minnesota, we have so much workto do in this area.
And and I felt, you know, andand with some like fabulous
(27:39):
colleagues at the university andalso I was like just really
putting together like what likewhat would it mean like for me
to really take on then get thatexpertise in a different way?
It's been that evolution thatreally like brought me to
Hennepin and now is allowing meto develop and create this team
and work with those across thestate.
I lead one of the Project Echoseries on perinatal substance
use, really trying to educatehealthcare providers across the
(28:00):
state, like, how do we all dothis better?
So that no matter where ourpatients are ending up in
hospital, because I tell you, inthis city too, like my patients
are at every single hospital.
And so, how do I support andassure that they're gonna get
great care no matter where theyland, and at least care that
respects who they are and treatsthem with dignity and helps like
look towards that space of hope.
(28:21):
And so this patient that I sawthis last week, you know, she
was coming in a really darkplace and she's still, you know,
we're still working on gettingher on the it's not perfect.
It doesn't, it doesn't workright away in these first couple
of days, but starting her onmethadone, helping her
transition so that she's able tofinally feel better so that she
can get to a treatment programand have some more secure
housing, which is a part of herstory in terms of how she's
getting help.
SPEAKER_04 (28:42):
Do you work with our primary care teams?
Do you work with other otherteams as well?
Full disclosure, I remember zerofrom medical school on substance
use.
I don't even know if we had aclass on it.
Maybe we did.
SPEAKER_02 (28:52):
You know, I think it's a real deficit in medical
school education.
It's really like there's reallya day dedicated to substance use
and how to address and supportpeople.
And it's so nuanced, you know,because it's so much about
conversation and differentpieces and often embedded like
within our psychiatry trainingin different places.
But so I do think that's adeficit.
And that's part of what's beenreally exciting for us at
Hennepin is to really be able tocollaborate and work much more
(29:13):
broadly across the state andeducation efforts.
We do a lot of course with themedical school.
We have rotating residents andfellows in our on our team all
the time, really trying to likeget people to be comfortable to
have that conversation.
And I think that we're trying tomake inroads in how to do that.
There's so much more for us todo.
I mean, that's why when I when Italk about like, you know, how
do we take better care ofpregnant and parenting people?
(29:34):
Well, it's like, well, you know,we can't do much worse.
Why don't we try to pullourselves together to do even a
little bit better?
And how do we do that in a spacecollectively and using each
other's shared knowledge that wecan really build that different
vision?
SPEAKER_04 (29:47):
So, Charlie, I've known you for 20 years.
What are you doing now that isdifferent from what you were
doing 10, 15, 20 years ago?
SPEAKER_03 (29:55):
Well, I I think one of the good things that came
from COVID.
Is that we really examinedtelehealth, telemedicine, even
telephone visits with patients.
And by doing that, we loweredbarriers so that people who
couldn't get to the clinicphysically or who have mobility
issues or just forgot theirappointment can still have their
(30:18):
appointment by telemedicine.
And it is so much fun.
Every Wednesday afternoon, Ihave a telemedicine clinic.
It is so much fun to call orhave a video chat with people.
And so I think that is a hugeinnovation.
And it's it's actually oldtechnology.
It's the telephone.
Um, but it's used in a new way,and it improves their engagement
(30:39):
in the healthcare system and itimproves their outcomes.
And it's really meaningful, Ithink.
SPEAKER_02 (30:43):
So there's a lot of new innovations in terms of
medicines.
And I'm, but one in particular Iwanted to highlight is the
sublicade injection, some ofthese long-acting injections,
right?
What's that injection?
The med, there are a lot ofdifferent medicines that we use
for addiction medicine.
One of the primary ones isbuprenorphine or suboxone, which
usually is taken under thetongue.
Actually, it dissolves.
(31:04):
You don't even swallow it.
So that's strange already.
So educating patients aboutthat.
But in the last several years,there's these long-acting
injectable forms of it, um,where you actually give an
injection under the skin and itlasts for ready for it?
30 days.
30 days at therapeutic doses andit hangs out in your body for
much longer.
(31:25):
That in a world where substanceuse is often really chaotic,
there's so many different thingsgoing on.
Whether you're an early parent,whether you're a fresh
adolescent who's very impulsiveanyway, having a medication that
you don't have to remember totake all the time that's in your
body already is life-savinglydifferent.
It's life-saving too becauseremember, this medicine, if you
have bubinorphine in your bodyand you take any other type of
(31:48):
opioid, it bounces it off.
So it really reduces people'srisk of overdose.
So even in that impulsiveteenager who's like, okay, maybe
I'll try it again and see whatit feels like, it doesn't have
the same reward.
And it protects them fromoverdose.
I mean, that's an amazing giftthat you have for people who are
potentially in impulsive spaces.
So those long-acting injectableshave transformed my practice and
(32:08):
really, and now, especially withresearch coming out about how
safe it is for pregnant people,how safe it is for young kids,
like this is, and I say kids, Imean adolescents, this is a
really, really transformativeoption for meds.
I think the second thing that Ithink is a really innovative
space for innovation, I wouldsay, and I hope we can make this
happen, is that methadone, weknow, is an incredibly effective
(32:29):
medicine in the era of fentanyl.
And a lot of studies show evenmore effective than Suboxone and
buprenorphine, that people stayengaged in care longer and have
longer periods of abstinence.
And so my wish and innovation isthat we can get better access
for people to methadone, that itisn't just the few places, you
know, in the state of Minnesota,we've got we've got a handful of
methadone clinics here in theTwin Cities.
(32:50):
But I tell you, you driveoutward, it's impossible to get
people from all differentcommunities to access to
methadone.
So it would be my dream ininnovation.
And there's even a study thatwe're doing here at HCMC that's
allowing, like piloting this tohave clinic-based methadone
distribution and working withour pharmacy partners will mean
that more people around thisbigger state will be able to
(33:11):
have access.
SPEAKER_04 (33:12):
So I can I ask you to respond to this.
Our addiction medicine clinic isin a building that was built
during the, I was gonna say theEisenhower administration, but I
think it was more like theCalvin Coolidge administration.
It's old.
It's in a back alley.
Literally.
The patients have to walk in aback alley to get their
substance use disorders treated.
Where we have plans.
We have great plans, and we havewe have blueprints now.
(33:35):
We have a new space thatliterally used to house the CEO
of the hospital.
That is where the hospitaladministration used to be.
Faces the park.
It's gonna have windows, it'sgonna have glass, it's gonna
have a beautiful entrance thatis dignified.
What do you see as one of thephysicians who's gonna work
there as what we need to bedoing in a clinic?
(33:56):
And what has henna been doing tobetter serve the needs of our
patients in that clinicalsetting?
SPEAKER_02 (34:01):
I feel, I mean, it's a golden time to be working as
an addiction physician at thishospital right now, because I
think the priority that thehospital sees in being able to
treat people with dignity isreally coming through in these
new, in the new plans of where anew building will be.
The fact that it is going to beclose to, I mean, that really
the epicenter of where peopleare entering the hospital, that
this is a place that you arewelcome, you are respected, and
(34:22):
that we're gonna care for you.
It makes a huge difference.
You know, I think that where ourclinic has been and the tours
that we've given for peoplearound, like people come through
and and like scrunch their nose.
SPEAKER_04 (34:32):
It's like you have US Congress members looking at
the place and they scrunch theirnose.
SPEAKER_02 (34:37):
It's true.
I mean, and it's like, and butand and in many ways, I'm I'm so
grateful that they feel thatway.
Guess what?
Our patients do too.
And so, how do we create a spaceif we want people to feel
welcome, to feel cared for?
That physical space means somuch.
I mean, you were saying likeit's gonna have windows.
Our current place has nowindows.
So this is like that's a bigdeal to be able to do this and
to be able to do it in a waythat's so centralized and be
(34:59):
able to really help us accessand connect our patients to care
in the larger places.
It's very, very, very exciting.
SPEAKER_04 (35:06):
I can't wait to see a hammer flying and nails going
and paint going on the wall.
That's gonna happen soon.
This Hennepin Center forAddiction is gonna happen soon.
So, Charlie, what do you see forthe future?
What is your hope for the futureof addiction medicine?
SPEAKER_03 (35:23):
It's two answers.
Number one, we have excellenttools.
We are just not consistentlyapplying them throughout our
system.
So there's part of the future isjust using the tools we have in
a better way so that people haveaccess to them wherever they go,
so that people have reallyrefined access to the best
(35:44):
treatments and tools that wealready have in place.
So I think we would go reallyfar if we just did that.
If we just took our existingtreatments and used them better.
But there is a lot of researchinto new medications, new
treatments.
Um, there's a lot of excitementon the horizon.
And, you know, they're just sortof throwing everything at the
(36:06):
wall and seeing what works.
And dozens and dozens of newpharmaceuticals are being tested
for addiction.
And I think we're gonna havesome exciting breakthroughs in
the next five to 10 years.
Really game-changingbreakthroughs.
I'm I'm hopeful for that.
So that's kind of where I seethings going.
SPEAKER_04 (36:21):
I'm gonna ask you both the same question.
What do you wish every personlistening to this episode would
understand about addiction andrecovery?
SPEAKER_03 (36:29):
I think anyone struggling with chemical use,
substance use, you don't have todefine yourself as addiction.
Find a professional you can talkto honestly and explore your
options.
I guess I would say that.
And anyone who's a loved one ofsomeone struggling with
substance use, help them to theextent they're ready to be
helped in a non-judgmental wayto do the same.
(36:51):
Find a professional who can hearthem non-judgmentally and offer
them options.
And I think that that would bemy message.
What a great message.
SPEAKER_04 (36:59):
Okay, I'd like to get your thoughts on it, Dr.
Graeber, just like Dr.
Reznikov.
SPEAKER_02 (37:03):
I think if every person listening to this
podcast, I think consideredaddiction with compassion and
understanding of how it is amedical condition, so similar in
some ways to long-term cancer,hypertension, diabetes, and that
people are able to weave in andout of good times and bad times
and times where theirmedications and are working
(37:25):
really well, and times when itdoesn't, that this is a place
that ultimately it's anincredibly human space to be,
and to hold that flame forpeople is incredibly, incredibly
powerful.
SPEAKER_04 (37:35):
I think that's a great message to leave us with.
At Hennepin Healthcare here inMinneapolis, we have some of the
finest physicians, advancedpractice providers, addiction
counselors, nurses,administrators who are helping
us to achieve a future ofaddiction medicine.
This is where it is happeningclinically, scientifically, in
research, and the communities ofour state are gonna be all the
(37:57):
better for it.
I want to thank you both forbeing on the show today.
Glorin, thanks for being here.
Thanks so much for having me.
Charlie, thanks for being here.
Thank you.
And thank you to our live studioaudience.
You have sat through.
You have sat through our firstefforts at doing this, and so I
appreciate you coming out.
And listeners, I hope you'vepicked up something that you
(38:19):
found informative, and I hopeyou join us for our next
episode, which will drop in twoweeks' time.
And in the meantime, be healthyand be well.
SPEAKER_01 (38:29):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org.
Or call 612-873-talk.
There's also a link in the shownotes.
(38:50):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(39:12):
Until next time, be healthy andbe well.
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