(calm music) - And welcome back to Family Health Matters.

I'm Shelley Irwin.

With me today, Dr. Talal Khan, Medical Director of Outpatient and Recovery Services, chief of neuromodulation services at Pine Rest Christian Mental Health Service.

Elisha Ash, Certified Peer Recovery Coach at Network 180.

And Bob Smith, Director of Behavioral Health at Cherry Health.

Hi, Bob, good to you and to all of you for being here and sharing your expertise.

Bob, how do you spend your day at Cherry Health with this big title?

- I spend it trying to figure out how to provide healthcare to everyone and all kinds of healthcare.

- Yes, Elisha, your role at Network 180, please?

- I spend the day working directly with people who are co-occurring who have both mental health and substance use disorders.

- Dr. Khan, you're all over the map.

Well, what's your first strong cup of coffee?

Start the day.

- Yeah, that's actually true, but I'd rather not talk about myself.

I'd like to talk about addiction treatment as a team sport.

I think, you know, everyone's role is important.

My team has doctors, APPs, advanced practice professionals, nurses, social workers, recovery coaches, and, you know, and social workers.

It's, you know, and we go about our day saving lives, taking care of people.

- Hmm, yes, I know you're all busy.

We could have had this whole table full of those in the field.

Chemical dependency, let me start with you, Dr. Khan, define this and obviously there are other names to be used here with this conversation.

- Sure, so chemical dependency basically means using a chemical substance to alter a mood.

But we've actually gone away from these kind of labeling.

So chemical dependency, usually we used to call it abuse and dependence, but now we are talking about it more as a substance use disorder.

Addictions and substance use disorders are, you know, are the non-judgmental nomenclature for treatment and addiction, so that we are not judging people for the illness because of the disease model of addiction.

- Follow up on that, Ms. Ash.

- I like what Dr. Khan said just because, you know, being a peer recovery coach, I do have a history of active addiction as well.

You know, I'm a person in long-term recovery, so for me, that means I haven't used drugs or alcohol since January 20th of 2010, so over 13 years.

And back then there was a different model where, you know, we looked at when people would be assessed like myself, you're dependent, or, you know, you're a severe abuser, so on and so forth.

And it's less about being dependent on a chemical and more about really just a public health crisis that we're experiencing when it comes to addictive substances of any kind and behaviors as well.

- Yep, well, I add that in, Bob, what do you have to add to the definition and or interchangeable terms?

- Yeah, I think, when we talked about substance use disorders, really looking at it in the lens of a chronic relapsing disease, focusing in on that disease model, it's not about judgments.

It's not about whether or not someone needs to work harder to stop using or not.

That disease model's really about offering the treatment teams the ability to provide care in the way that the patients want that care to be provided and in a non-judgmental way.

- And one more terminology, substance use versus substance abuse.

- Yeah, so as mentioned before, we've really gotten away from that substance abuse, substance dependency, really looking at it as a continuum, substance use disorder.

- Shelley, could I add something to that?

I think that because of the stigma that we've experienced in this field for so long, the best way to talk about this is either someone struggling with the disease of addiction or someone struggling with substance use disorder.

So those are the two terminologies which make us undo that stigma a little bit, 'cause words matter.

- Yes.

The basics of all, who could be at risk for this, Elisha?

- Anybody.

You know, the people I work with at Network 180 for the majority, they're Medicaid recipients.

However, I've worked with folks who have come from homes that easily make well over six figures.

I've worked with folks who are like third generation, poverty level.

Anybody can suffer from addiction.

You know, addiction is the great equalizer.

It can touch any home and any person.

- And back to you, Dr. Khan, examples of addiction.

Elisha made reference to obviously, the common, the drug, but the addiction of sex, food, exercise and more.

- Yeah, absolutely.

So, like she said, everyone is vulnerable.

The disease of addiction does not care who it attacks.

It could be a factory worker, a doctor, or a student, you know, a CEO of a company.

But if you look at it scientifically, statistically speaking, you need to have the wrong genetics.

Basically, there's a family history, early exposure and repeated exposure of a substance or behavior, causes the illness of addiction to take control.

- Bob, add to that signs of addictive behavior.

- You know, changes in behavior, changes in moods, spending habits, right?

How are we just managing our own lives as an individual?

Those are kind of some of those clear warning signs that someone might be struggling.

A great opportunity for a loved one to ask that question, how are you doing?

Getting folks connected early on, early intervention to help support them and really minimize the impacts of that substance use.

- We should add to that, especially perhaps on the chemical dependent side.

- I'm thinking, you know, just from personal experience really changes in behavior.

I think my addiction started at 11, so, you know, during those early years, it's hard to gauge just because, you know, there's hormones or you're a teenager, so on and so forth.

But drastic changes in behavior are really the biggest red flag.

Acts of aggression out of nowhere could be a sign of, you know, early withdrawal or you know, somebody who is heavily under the influence.

Things like that are really the biggest kind of red flags to, you know, whether or not there's some sort of chemical or dependency issue going on.

- Add to that, Dr. Khan, and add to how a caregiver, loved one intervenes.

- Okay, so it's a two-step question.

So, everything that they talked about, any major change in personality, but the way we diagnose it, any substance use disorder or any addiction, (indistinct) addiction right now would fall under DSM criteria of, so we look for certain things, loss of control over the substance, meaning using it more than they want, using an increased amount, wanting to cut down, but being unable to, avoiding, and then loss of social obligations.

Inability to follow through with school obligations, taking care of kids, taking care of parents, all of those other things, which job gets affected.

Then tolerance and withdrawal are also key, where you need more to feel the same amount.

And then if you don't have the substance, you have withdrawal symptoms, physical symptoms, sometimes mental symptoms of experiencing withdrawal.

Also use in risky situations like knowing that you've drank a little bit more than you wanted to and still driving or driving while high on marijuana, those would be risky.

Or going to work and signing onto their gambling website.

So those are things that people would be red flags and those are diagnostic criteria, but a family member is not gonna do this.

Like, they're not gonna go through the criteria of diagnosis.

They're gonna notice a change.

My child is not behaving the way they were, or my spouse is not at my child's birthday party.

Something's missing, there's a drastic change, or their bank account is, you know, is being affected.

So having that conversation really early, identifying, is everything okay, can I help?

And what a family member can actually do is be that trusted person or be that support because there is shame in the person who's experiencing addiction.

They don't want to disappoint, so they don't reach out easily.

They don't reach out for help at the right time, which is the problem, which is why we really are treating, I'll give you the cancer analogy, right?

We are treating not when the cancer is in stage one, we are really dealing with it in stage four cancer or stage three cancer, right?

So by the time it surfaces, the disease of addiction is already at stage three or stage four, where we need to intervene.

And what the family member's gotta do is be that trusted person and be open, understand that this is not easy for their family member.

- Which is probably tough.

There could be so many emotions involved with that, yes.

Elisha, I'm gonna have you put your personal hat back on.

At what stage did you get your help?

- I was probably at stage three or four.

You know, I had been told in my early 30s that my liver had started showing signs of abnormalities.

- Since age 11, you- - I had started at 11, yeah.

I did have difficulty parenting my two children and my life was a mess, you know, I had had several evictions and, you know, there was incident that put me in a very serious situation with the law, driving under the influence, you know, in Michigan, three of those is a felony.

And in a two year timeframe, I got three DUIs.

So, you know, I definitely hit the majority of the DSM-5 criteria, and, you know, my life was in turmoil and my family had tried to intervene at different levels.

However, the level of use that I was at put me at a situation where I just kind of withdrew more.

So they didn't see me very much, and I was definitely at stage three or four.

- Bob, your follow-up thoughts and when would you want Elisha to make her first entrance into Cherry Health?

What would that have been?

- Yeah, I mean, I think my follow up thoughts here is just the importance of normalizing all of this, normalizing the discussion, taking the stigma out of it, taking all that judgment out of it.

This is a disease that no one chooses to have, no one wakes up in in the morning is like, "oh, goodie, I can't wait."

In fact, it's quite the opposite.

And so the folks that as mentioned that do make it to us, have a ton of needs.

And our job is to show up for them every day and be supportive and help out in any way that we can.

So, to me, I'm just always talking about the words that we use.

How do we pull that judgment down?

How do we make it a safe spot for people to show up?

How do people stay alive long enough to make it in to treatment?

That's one of the biggest tricks.

- Shelley, the thing is that only 10% of people who need help get help.

So there's about a 90% of people who would qualify for help, aren't even surfacing enough that we can help them.

Those are stats that we, for every one person that we are helping, you gotta know that there's nine who also could need that help, and they don't get it.

And there's multiple reasons for that.

You know, the socioeconomic reasons, the stigma is huge.

The disease itself, right?

Everything that drives our motivation to get help or judge this is the right or wrong that is overtaken by the disease itself.

So our motivation, our drive, our reward system, all the things that make us happy are taken over, hostage to the disease of addiction.

And we cannot make the, what other people, what a non-addicted person may feel as a normal straightforward choice.

The person who's struggling is unable to see it.

- And there are terms, I don't wanna get too off the track, but a high functioning alcoholic that, I mean that could live their life, tell me more.

- That's a good way to fool yourself.

Like I said, it is just a crutch that someone is using to progress further in the disease.

The disease severity only increases.

The truth is, you know, the addicted individual is struggling, suffering and dying and they can hide it for as long as, I mean we can talk about, you know, cancer doesn't happen to me, it happens to other people, right?

That's how we think.

Oh, I can smoke all day or I can drink all day, but that doesn't happen to, my liver's not gonna burn.

It's the other people, so we cannot think like that.

We are all equally vulnerable.

And you know, the earlier you use, the more extensive your use is, putting it under a shade of I'm functioning, it's not affecting my work.

It's only making, allowing it to become bigger.

- It's a game of numbers, right?

Like, I mean, that might be true for a moment and it's easy to say that in that moment, but none of us get to tell the future.

- In recovery, we call it the game of yet, you know, I remember when I first got in trouble going into a recovery meeting and just hearing, okay, well that hasn't happened to you yet.

However, the longer this disease progresses, it will happen.

- So, one of the things that used to happen back in the day when stigma was used, people used to wait till someone hit rock bottom before they could get help, but if you think about it, rock bottom is gonna be a harder climb up.

Why not make, wherever you're at today, as you have not lost your family, you have not lost your good job, you have not lost your driving ability, you've not lost your liver function, don't wait till you do all of that.

Because to get out of that hole is much harder than where you're at today.

So if you are a functioning alcoholic, please stop now before you become a non-functioning.

- Sounds like most of the discussion needs to be at that point, prior to.

And yet one is asking for help.

Where does treatment fall, start with you, Dr. Khan.

- So starts with finding a trusted person, a friend, a family member to help you guide 'cause there are chances that you will give up really easy if you are asking the question that, do I need help?

You're already there, that's half the battle.

Recognizing that you need that.

But then getting professional help, getting with all, everything online now it's very easy to access, but finding your partner in your primary care doctor because their professional help is out there.

But unless you ask for it, you're not gonna get it.

So finding a therapist, finding a physician, an addiction psychiatry, an addiction psychiatry team that could take care of it.

Somebody would fall in the full continuum of care.

And the earlier you ask for it, the less the treatment will be.

So you could get help in an outpatient setting, but if you are too deep and you're withdrawing and there is a medical problem, then you need a medical detox.

If you're unable to function in life with your disease, then you need residential, which could be short term or long term.

And then that continuum of care, you know, it's not like a, oh, I go to hospital for two days and I come out and now I'm healed because this is a chronic relapsing condition.

Like most chronic illnesses, it requires ongoing treatment.

So you could start off in detox, but then you could need some residential state, you could need some intensive outpatient therapy, which is group therapy.

You could need relapse prevention.

Group therapy is very helpful in addiction 'cause you don't want to feel like you're alone.

12 step facilitation is there.

There's recovery coaches who help out and then there is individual therapy with one-on-one talk therapy.

But very important is also family therapy.

Like this is a disease that doesn't affect an individual, affects the family, it affects the neighborhood, it affects society as a whole.

So, like I said in the beginning, this is a team sport.

We all have got to do it together.

- Elisha, how does Network 180 help?

- Network 180 serves kind of as the hub for some of those, or the majority of those services.

You know, if somebody is saying, you know, I've hit a place where I think I need help and maybe I need withdrawal management to, you know, help me detox from the substance and then start making my next steps, you would go to Network 180, have an assessment done, and then the next steps would be made from there.

But that's really where it starts, you know, going in and saying, hey, I need help with whatever the case may be and being assessed and we take it from there.

- I trust you'll agree, Bob, the good work at Cherry Health.

- Yeah, and I think I wanna speak a little bit to the comment about primary care being involved in this.

You know, I start off by saying my job is about healthcare, right?

I'm a social worker.

I've been working in mental health and substance use services for a long time, but I do really feel like those needs are healthcare.

And so what we have done as an organization is really looked at our primary care space and how to increase and improve our screening for substance use disorders, early intervention, making sure that we've got behavioral health staff able to step in in those moments and have a conversation to really start that thought process happening.

And then helping folks get into treatment as quickly as possible.

I think one of the things those of us in the field know is that we want to catch people when they're ready.

And so if I get a phone call saying I'm ready, the answer is, I want you here now, not next week.

Because next week could be too late for a number of reasons.

- And I'll just throw the ultimate worst case scenario, drug overdoses is real, I'll start with you Ms. Ash.

- They're very real, and I mean, the drug business has gotten much more savvy over the years.

There are pills out there that look like something you'd get from a pharmacist and you just don't know what it is.

There are different variations of, you know, fentanyl infused drugs that make it into Kent County.

It feels like almost every week.

And if you don't know, you don't know, you know, for the most part, the drug business isn't about keeping you healthy.

It's about making money and your misery really doesn't matter.

So I mean, as we are seeing more and more of that happen, and from my professional perspective, seeing younger and younger people succumb to drug overdose, I think that's maybe one of the biggest red flags.

If you see yourself kind of in a situation where you're using with folks who have had multiple overdoses and survived, time's ticking, and, you know, that may be the moment to just at least consider giving Network 180 a call and saying, hey, can I at least get help with withdrawal management and detox and see at least what that's like to have a clear head, it could save your life.

- Dr Khan.

- Yes.

Before the pandemic, we were already dealing with the opioid epidemic.

And at that time, and this is a shocking stat, we were losing one young American every 19 minutes, that number is now 16 minutes.

Every 16 minutes, we now lose a young individual.

- Nationally?

- Nationally.

To overdoses, opiate overdoses.

So I'll say this, find any help that you can get.

You could go to Network 180, you could get Cherry Health, you could go to Pine Rest.

We have, back when I started about 14 years ago, I was one addiction boarded psychiatrist at Pine Rest.

And now we have eight double addiction boarded psychiatrists working there, we have a full continuum of care for the disease of addiction.

And we will be there holding your hand right throughout this journey.

- Obviously I wanna save a little time for perhaps prevention, but are you also treating, perhaps a mental illness or another disorder that is correlated, Bob, with the chemical dependencies?

- Absolutely.

Also way underdiagnosed on either end of the spectrum, right?

So as treatment providers, you know, making sure that we are diagnosing appropriately for the full continuum of needs.

I wanna speak real quickly on the overdose too, because I think this is near and dear to my heart.

As an organization, we've installed two Narcan vending machines to ensure 24/7 access to the communities.

One's in Montcalm in our Greenville location, the other one's at Heart of the City, right downtown, 24/7 access on the south side entrance of our building.

Our friends at the Grand Rapids Red Project, we should all be calling them out as a wonderful supportive resource for our community, not only for Narcan, but also for supplies to ensure prevention of transmitted diseases and ensuring that people's healthcare, that people stay healthy despite the fact that they might be struggling with a substance use disorder.

So those are just really important things here for our community to know.

And then I forgot the actual question.

(laughs) - Just the question about- - Dual diagnosis.

- The dual diagnosis.

- Yes, way underdiagnosed, you know, that's something that for the field is extremely important to understand.

I think especially that commonality between trauma and substance use disorders, whether or not the trauma came first or the substance use, you know, resulted in some more traumatic events for people's lives, it becomes tricky.

People's care is really tricky and so making sure that you access high quality services to just get the whole person care is really important.

- Elisha, can we prevent this?

- It is preventable, you know, I think early education, early intervention are the biggest keys to taking care of, you know, making sure things don't progress too far and just kind of to follow up on the co-occurring aspect, noticing if there is a mental health concern and really intervening there earlier.

You know, like I said, a lot of the people I work with are co-occurring, you know, they have a mental health concern as well as one or more substance use diagnoses.

I'm a co-occurring person, you know, had some of these things been noticed earlier, the substances I think I chose to use may not have looked as attractive.

So really just being aware and removing the stigma of mental health and substance use and just saying, hey, this is a whole person that needs help, is the best way to get at it in the beginning.

- And you're really touching on the idea that like, that substance use as a coping skill, right?

Now, is that the safest coping skill that someone might be able to use?

Maybe not, but it might be the best one for them in that moment.

So do I judge that?

Not mine to judge, right?

Now, could I help someone develop healthier, safer coping skills?

Absolutely.

And so for me, the game is how do I offer something better in place of that substance for the folks that I serve?

- I need three resources for obviously our action items.

How do we find out more about your services, Bob?

- Cherryhealth.com.

- [Shelley] It's as easy as that, isn't it?

- Easy as that.

- (indistinct) for Bob not Robert.

Thank you for your comments.

What do you leave us with, Elisha?

- Network180.org or the access center is open 365 days a year, seven days a week, every single day.

Even through a pandemic, 790 Fuller, you can go in and ask for help.

- You can spend a whole other half hour on the pandemic.

Dr. Kahn, your summary for the next minute or so, please?

- Well, I wanted to put in the, make a pitch for pinerest.org/addiction as well.

You asked can this be prevented?

There's things that can be done.

Most importantly is making it accessible, making treatment affordable, you know, making legislative changes where someone is not struggling because they're dealing with this addiction and they're not punished for it.

Making it accessible, educating early, like the children who are 10, 12 don't go into using drugs, which we know are really damaging for that young brain, like I said before, early exposure and repeated exposure.

So we gotta protect our kids, we gotta make sure that their families are there for each other, and when the need arises, we should all rally right next to the person who's struggling rather than pointing fingers at them.

- Yes, life is good for you.

Thank you for sharing your story.

- Thank you.

- That's for sure.

- Glad to be here to share it.

- Your kids are young adults now and- - They are, 20 and 24.

- Doing their thing and obviously sharing your story.

Well as always, thank you for sharing the story, Bob, and Elisha and of course Dr. Khan, representing three instrumental organizations in our own backyard, so stay the course, but let's get you back to work, people need you.

- Thank you for having us.

- Thank you.

- As always, thank you for watching this edition of Family Health Matters.

Hoping you enjoy your day, find us online, wgvunews.org.

Spread the word with the voices from these three experts.

As always, thanks for watching and certainly have a good day.

This specific chemical dependency, our topic, I'm Shelley Irwin, thank you.

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