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Substance Use Disorder
This is the best health podcast brought to you by wake forest Baptist health in partnership with MedCost. Good day everyone. Welcome back to the latest best health podcast episode from wake forest Baptist health.
Thanks for joining us today and listening, uh, to hear what we got to say with this latest episode of very good information. We actually have, um, for the first time we have three guests joining us today, uh, plus myself helping guide the conversation and we're going to be talking about a very important topic, um, with uh, substance abuse, uh, various substances and the abuse and treatment and resources available with our three special guests. Before we do that, I do want to, um, just once again give people the general coven 19 the Corona virus, um, website and hotline that wake forest Baptist health has set up, uh, as we do with each of the coven 19 related podcasts. Reminder, everyone can go to wake health.edu/corona virus, wake health.edu/perona virus or all kinds of resources that we have available for you from, um, clinic updates to FAQ.
Uh, all the podcasts that we've done listed there, uh, visitor restriction information, a wealth of information for you. Also, the hotline is still manned 24 seven, that's three, three, six, seven zero Cobin three three, six, seven zero coven. So I wanted to make sure people were aware of that at the beginning of this episode. I'm now onto my three really great guests that I have today. I'm very excited about getting the word out about, um, you know, substance abuse, um, issues, the, the, um, the medical, uh, background information on substance abuse and how it can affect people and, and ways of course to see treatment and available resources. So hopefully, um, someone listening out there today, um, can take advantage of this information, um, and pass it along to someone who they might think it can be helpful for. So, uh, we have, uh, first of all, uh, Dean Melton, who is the director of outpatient addiction programs here at wake forest Baptist health.
Welcome, sir. How are you? Well, thank you. Good. Thank you for joining us. A second. We have Dr. Heather Douglas, who's the medical director of the addiction clinic. Um, so welcome Dr. Douglas. How are you doing? Great, thank you. Thank you for having this podcast. Yeah, absolutely. I know y'all have been busy, so thank you for taking time to talk with us today. And last but not least, we have Dr. James Kimball, um, who is associate professor of psychiatry and behavioral medicine, uh, here with wake forest Baptist. So thanks dr Kimball. Uh, I'm glad you're joining us as well. Yeah, I'm, I'm honored to be here. Thank you. Absolutely. So to start things off before we dive into some question and answer time and some really great information that you have for us, and maybe just offer a quick introduction for yourselves, uh, just to help, uh, all the listeners familiarize, um, them themselves with you all and, and kind of your background a little bit. Um, so we can start off with, with gene, if you wouldn't mind going first, sir.
Yeah, yeah, the Melton. I am a licensed clinical addiction specialist. I've been involved in doing addictions work for almost 35 years now. I've been here at white force for the past 20 as the director of the eviction programs. And, uh, that includes an intensive outpatient treatment program we do here that meets four nights a week. And we also have a medication assisted therapy program that's typically, uh, uh, anti craving medications and also, uh, you've been orphan. Uh, most people know that as Suboxone. Uh, we do a clinic, uh, trading, uh, opioid use disorders. So that's what I do here and also have some opportunities to teach occasion.
Great. Great. Thank you. Dr. Douglas. Uh, do you want to go next?
So I'm the medical director of our addiction clinic here at Jonestown road. So our outpatient behavioral health is located seven 91 Jonestown road. And, uh, I work right next to Dean Nelson. Our offices are just two doors down from each other. Um, and I'm the psychiatrist here, so I manage the medication for our patients, um, whether they're in the intensive outpatient program or in a weekly, um, in a T what we call mat, medication assisted treatment program. Uh, there's some other things that I do as well with addiction and as far as research and neuromodulation, um, in teaching,
um, dr Kimball, how about you sir? Yeah. So I've been here at Lake bar since 2003 and I do a variety of things here. I, I primarily, uh, see patients in the inpatient hospital setting and when it comes to addiction, I see a lot of patients there, uh, where their, uh, alcohol or other substance use disorder has affected, uh, them in a variety of ways, including a worsening of their medical conditions.
Okay. Thank you all very much. Um, good information. Dean. I want to go first to you if you don't mind. I have a couple of questions. I'm going to start off kind of a trying to frame a picture here. Just talk about a little bit about what you do day to day in, in helping, um, the patients that you see. And you know, we can talk about, um, substance abuse and addiction for hours and hours and hours. And we're gonna, we're gonna try and condense it all down into, to a relatively short podcast. Know there's books and books and articles that have been written about this. Um, so I guess just to help frame the overall picture, um, maybe just give a brief overview of, of a little bit about what y'all do day to day, um, there at the clinic and how, um, people come to find you and get, uh, get assistance for substance abuse.
Sure, sure. At our location in John's town road, we're entirely an outpatient clinic and a lot of the individuals that contact us seeking care, they, they're either referred to us by their primary care physicians or they're referred to as a therapist in the community. Uh, our program has been going for quite a while now, so a lot of our referrals just come through word of mouth. A number of our patients also will come here after they may start going to 12 step meetings like alcoholics anonymous or narcotics anonymous. And so they'll, they'll contact this. And the way we do things in our clinic, we do a pretty heavy phone screen. We spend a lot of time talking individuals about what's going on, uh, about their level of substance use and what, where they are in terms of their level of motivation and what they're seeking.
Uh, and if they, if they really indicate that they're ready to do something, uh, about their substance use disorder and, and, and oftentimes their psychiatric issues. Uh, very often our patients also suffer from depression, uh, disorders, anxiety disorders, bipolar disorder. So, uh, we, we do dual diagnosis type of care here, uh, very often, but we'll, we'll make an appointment in a patient will come in and we'll do a pretty extensive, uh, evaluation, a psychosocial type evaluation, looking at all their, uh, uh, family history, their current medical history, their use history. So it's, can we go through all of that? And then if, if, if they qualify for the programs we run, we have two distinct programs and intensive outpatient program and people using all types of chemicals come into that program. And it's a fairly extensive, and individuals come in that programs, uh, four nights a week for at least five weeks. And while they're in there, we also ask them to enter into 12 step programs like alcohol tonight on the Sanitarium, those at least three times a week, we have Motsa HEDA for LGBT years into treatment that beyond relapse rates, we use a model of care here that very much incorporates a 12 step model. Gotcha. Yeah. And then all their other medications or medication assisted therapy program and Dr. Douglas and Dr. Campbell, we'll talk more extensively about Medicaid. They're trying to be in this healthy, it was the sobriety and benefit from treatment.
Gotcha. That's super helpful. I'm just kind of as a foundational overview of, of the, the way it operates, um, at the clinic. Um, you know, you mentioned Dr. Douglas and Kimball, they're going to talk about the, um, the med, the medication side of things. I wanted to ask you if someone was seeking treatment for a substance use disorder, um, other than medications, what types of, uh, services or offerings are there? What did they expect when they're, when they're going to treatments, um, and looking at things besides medication?
Sure. Based upon that evaluation, we're often looking at whether or not someone needs to detoxify, to be admitted to an inpatient setting for detox. And very often we've already clarified whether or not that's necessary just in our phone conversation. But when they come in and we're looking at, well, you know, the severity of their symptoms, the level of support that they have at home or in the community, and, uh, if they need a higher level of care than what we do here, we often refer them to an inpatient setting. And, you know, there are some outstanding treatment programs, not, not too far away from here. We often refer to a facility in Greensboro called fellowship hall for inpatient care. Elaborate very often with other facilities. A lot of individuals that go to inpatient care step down to an intensive outpatient level to continue their treatment.
And we also, um, as a part of our treatment programs, we, the model we use, we, we often look at, uh, we call it the whole person model where we're looking at mental and emotional and social and spiritual sobriety. Uh, so many individuals think that, um, if they simply quit using the chemical, then their problem has gone away or that is then what we often find is that when individuals stop using their chemicals, uh, they're often left with without the tool that I use to try to deal with things. And we also do some specialty programming here. We have some women's clinics and, um, that's one of the big things. Many of our women come in with different issues or more severe. A lot of women for years have gotten in treatment at a lot later stage in their addiction process. Uh, um, w we try to focus on their specialty needs.
So when we're doing this, we're looking beyond just medications. Uh, the medications simply help us initiate that process and sobriety and, and, uh, decrease cravings or the obsessive thought processes of wanting to use. And it also doesn't weight with, um, the physical withdrawal processes. Gotcha. We can deal with that. We can, they begin to work on those other areas, mental, emotional, social, and spiritual aspects. Gotcha. Well, I'm really glad you touched on that. Um, the whole person approach, uh, with, you know, the, it's, you know, the substance abuse and abusing these, these chemicals. Um, whichever, you know, might be the chemical of choice. Uh, obviously it has adverse effects on your, you know, uh, your physical body, um, you know, mental and emotional tolls as well. Um, so, you know, obviously one of the goals is to stop, you know, using the substance that is harming them.
Uh, but you go, y'all go behind that and kind of take a deep dive into some underlying issues that might be there to help. Um, you know, when they do stop using the substance, uh, it needs to be more sustainable, uh, and hopefully lasts long term, uh, than just, Hey, stop using, you know, drugs and alcohol. Okay. See you later. But you all take a deeper dive and find maybe some underlying issues that can help the person longterm. Right. Right. We do, we could addiction as a, as a disease process of the brain. And I like doing a lot of the discussion about the neurobiology of addiction and, and how those changes that occur in the brain are permanent changes.
Most people have heard that thought and what once an alcoholic always an alcoholic and how does that really make sense if a person stops drinking? And, um, and when we're looking at some of the, the changes at the level of the neurons in the brain and health, even though the brain may start functioning better and looking different when we're doing pet imaging, what happens is if they go back to using those, those, the brain almost instantly reverts back to be like it was when they were using in the past. Wow. So we, we, you know, we began that whole process of educating. One of the biggest fallacies that most people have is, and most people have had someone say this to them, if you just had enough power, and, and I almost jokingly talk about, you know, will power is the arch nemesis of recovery.
I always joke that, uh, alcoholics and addicts, they absolutely do not suffer from a lack of willpower. They actually have an overabundance of that because it'd be like trying to use willpower like a diabetic, trying to use willpower to make their pancreas start working again. Yeah. Interesting. So, you know, just the process of educating and helping people do some of this, uh, these minutes and then some of that denial processes, we can begin to talk about all those other things, the problems going on in your marriage, the problems, you know, coping with the emotional processes, uh, resentments, anger, fear, and those are all just part of the processes of being in a treatment program. And we just find that most people there, there's some data, ah, I can't point it out specifically, but in the treatment industry for years, it was that people who wake up one morning and they try to stop using, um, about a year later, only 1% of those people are still so for people, good treatment when they finish treatment, if they do not do anything beyond that, uh, only about 10% of those people, whatever your later. But for people who get good treatment and continue to engage in ongoing recovery, uh, like going to 12 step meetings, coming here to aftercare, they do that about three times a week during their first year of sobriety. At the end of the year, about half of those people are still subgroup. Tremendous statistical difference. Sure. It's a process. People struggle, but we understand that it's a process toward recovery. It's not just something that happens one day.
Yeah, that's a great information. Um, you, I want to bring Dr. Douglas in to the conversation now. Um, Dr. Douglas, you know, we've been listening to Dean, you know, kind of give us an overview and there's some, um, you know, processes by which you all go and, and, uh, take a holistic whole person approach. Um, obviously one of the tools in the toolbox for you all is medication and medication treatment. Um, and you know, one, one specific, um, you know, uh, issue that we've been, um, facing here in North Carolina and nationwide that we hear a lot about in the media of course is, um, the opioid use in, in, um, just the staggering statistics around opioids. You know, to just kinda dive into that specific issue for a minute, what are some of the medication treatments, um, that y'all are seeing, uh, that have been helping patients, uh, surrounding this, this disorder with YPO woods?
Absolutely. And you know, to kind of lead off onto this question as well, you know, in our clinic, um, the vast majority of our patients and our medication assisted treatment program or mat program, uh, do have opioid use disorder. But we do treat patients with all types. It's, it's, uh, important to not have a bias of what somebody is gonna look like. Are there anything you want to use disorder? You know, sometimes I think people assume that it's going to be somebody who's injecting with OB, with the opiates such as heroin. That's not what the vast majority of our patients are. A lot of patients come to opioid use disorder to try opioids for pain. So, um, you know, when somebody comes in doing that assessment also helps us to determine what they might and when treating opioid use disorder besides the three main medicines we use, which are methadone, naltrexone and you can morphine, um, you also have to think of medications that are going to treat the anxiety and the depression aspect.
I think when people are inactive cause they don't realize that there's typically a depression that happens after active use. And so we need to make sure to fully support patients during those times with, you know, other medications as well. So one of those three medicines that I mentioned, um, methadone, naltrexone and buprenorphine, they have very different mechanisms of action. Um, methadone for instance, is one that's probably most people have heard about. It's been around for a long time. These methadone clinics, those are daily dosing clinics. Typical, they're what we call a full agonist. In other words, they're going to fully act on an opioid receptor. You have careful with these medications that patients aren't all squeezing other illicit substances. At the same time cause that can cause we call respiratory suppression where patients can put themselves at risk of dying because they stopped breathing. That's the danger of that opioid receptor.
The, the next one that now treks on medicine, there's an oral option for naltrexone and there's a long acting injectable. I'm seeing more patients look for long acting injectable options. They feel that it kind of helps them to not think about their medications every day, once a month injection that now Trek show to the naltrexone is actually going to plop that opioid receptor. So it's a much different approach. So it blocks cravings and it also blocks that opioid receptor. So if somebody does use and opioids are not going to get the same high from it. And that's how it helps people maintain their sobriety. Interesting. Uh, and then the last one I'd mentioned buprenorphine, um, the brand names that you might hear off the times are Suboxone or Zubsolv. Those are either a tablet or a film. And for that buprenorphine, uh, those tablet and film, they come a lot of times in a comp, what we call it, combo product.
So in order to make sure that people don't miss, use the buprenorphine and inject it, they put the Naloxone with the buprenorphine so that if it is misused and injected, the patients will go through setting withdrawal. But if it's taken as prescribed, which is for it to dissolve under the tongue, then that Naloxone does not get absorbed into the system. So it does not cause withdrawals. And that one also, um, you know, besides the oral options for the, there's also a long acting injectable that came out. So it's a want them once a month injection of buprenorphine. Okay.
So, you know, how difficult or complicated is it if someone comes in and you know, um, they're seeking treatment for substance use disorders, how hard is it to start one of these medications? Is it a long ramp up time or you know, what are the constraints that you'll have to work through?
Right, right. That's a great question because I think sometimes patients assume that the medicine's not working for them or that they had a reaction to the medicine when in actuality it's that they might not have started it the way that they needed to. For instance, we'll start off at the top again with methadone. So with methadone being what we call a full agonist, if somebody does not need to go through what we call withdrawals from their substance abuse before getting started on it, and it's a daily dose up to a methadone clinic every day, the now Trek zone, because it's an antagonist, so it's the opposite of methadone, that naltrexone, you have to have fully washed out all of the opioids that are in your system. So when we discuss, uh, detoxing or withdrawing, you need a slow, they come off all the opioids that are in your system, patients that we can use to help with that detox.
And then the other one is the a, that last one I mentioned that buprenorphine, well, for buprenorphine, you do need to make sure that you're in what we call withdrawals. Um, there's a, there's a scale that we need is opioids, call it cows. So it's the opioid withdrawal scale. Um, once a patient is in withdrawals taking that you can Norky allows them to, uh, reduce the side effects of their withdrawals. It's what we call a partial agonist. And if somebody were to take the buprenorphine too early so they haven't really gone into their full withdrawals, um, they might feel sick suddenly like, Oh wow, I'm having a reaction. I'm in like full-blown withdrawals right now. That's because they taken it too early. If they were to wait just a few more hours to let those opioids fully come out of their system, then, um, then that buprenorphine is actually gonna lift them up to that partial agonist level. The beauty about the buprenorphine is it's not a daily dosing. So you can come in once a week, get a med check and you can get enough medication to last you for a full week or the long acting injectable in that case a full month.
Okay. Well, I guess that leads into my next question is, you know, are there certain, um, uh, I guess each situation in each medication management, uh, situation is different, but is there a length of time that someone needs to stay on these medications? Um, you know, is it, it's probably not quite, you know, the same dosage as my 10 day antibiotics. I'm on it. Y'all probably have a more complicated plan, uh, for persons over the long run, correct?
That's correct. So with these medications, there is not a set time limit. That's somebody who's going to stay with one, um, medication for a use disorder. And that's regardless of the use disorder. Um, they can stay on it as long as they need. Uh, one of the risks of patients coming off too early is that they haven't really met those therapy goals. So if they haven't addressed their, um, you know, their, their friends and family, their community environment where they have a safe, a way to socialize without re exposing themselves to substances, making sure that, so we talk about the people, places and things, they gotta change their lifestyle. And that's going to take time and it takes a different amount of time. They address those, those psychological needs and we can start talking about well, but as far as second timeline, it's very intimate.
Patients that have been on this medication or on time, if some patients have chronic and they're not necessarily looking at coming off of, um, for instance, buprenorphine cause we do use buprenorphine to also treat that pain as well as opioid use disorder. So they may, you know, need to be on it for the rest of their lives. But, you know, one other things I can definitely say about the medications, um, center is the medicine working well for them, um, on the oral medicines such as buprenorphine, you know, I'd mentioned it has to be absorbed. Uh, well it has to be absorbed sublingually, so under the tongue, uh, sometimes patients don't realize that and they might be swallowing the pill, you know, kind of chewing up the film and trying to swallow that in some way. And so if they're not taking it properly, that can cause them to not feel the full benefit. And then, you know, um, another thing that a psychiatrist will often recommend is not to smoke before using the sublingual. Cause smoking actually constricts those blood vessels get a lot more difficult. So, you know, little things like that, if somebody doesn't feel like they're getting the full benefit of the medication, then definitely they need to talk to their position.
Gotcha. So, you know, obviously when physicians or providers are talking with patients about medications, one thing they often if not all the time bring up are side effects or, or maybe some other risks, um, with taking medications. Um, you know, for the patient there, there has been a risk, a adverse, um, situation with, with um, the substance use disorder that they're facing. Whatever the substance is, it's having a negative effect on their body and their mind. Um, so you transition them to manage prescription medication. Um, and you guys go over those risks with, with the patients as well. Do you just want to highlight some of the, the more popular risks, if you will, that, that you often get into conversations about at your clinic?
Sure, sure. Well, so for, for instance, the ones that, um, methadone and buprenorphine, those two, sometimes patients will say that they might be too sedated, one of those medications in particular the methadone since it is a full Agnes. Um, and so for that one, it might just be that the dose needs to be adjusted. Um, buprenorphine I've had, you know, very rare instances of patients having like swelling in their feet. Um, and that's something that we might need to do dose adjustments, what the pupil norphine headaches occasionally happen and probably the most common side effects will be constant Haitian. Um, and that's because of the fact that that's work on those opioid receptors. So any constipation we can also manage either by lowering the dose or by getting medications for that. You know, some of the, the risks though I think that are most concerning that we warn our patients about is not to mix either the methadone or the buprenorphine with benzodiazepines and that benzodiazepines patients might know of either clonazepam or Xanax.
Um, Adavan that that entire class of medication, you wouldn't want to make some because both these, um, the methadone and the buprenorphine and the benzos work on that same, uh, what we call a new receptor. That's what gives you your respiratory drive. So when we're worried about overdose or worry that somebody is going to have medications acting on that new receptor and cause them to have respiratory suppression, which means their body's not going to desire to breathe and that's when they can, um, they can die. So we want them to absolutely watch what messages they're mixing with this, uh, with these agonists and methadone and buprenorphine. Another, uh, risk that a lot of times people don't think about is if they're on any one of these three medications and they're trying to override the protective factor of these medicines by taking a heroin or, um, any other type of opioid with it, they're gonna have to use a lot more of that opioid to overcome the benefit of these medications and white make them think that they're able to handle a higher dose of coping weight when in fact they're not once the methadone. And the buprenorphine or the naltrexone comes out of their system if they try to use that same level of opioid that with them at risk of an overdose. So that's one of those that, you know, a lot of people don't realize how they kind of set themselves up for overdose even after they finish the program.
Yeah, that's a great point. That's a great point. Um, you know, I, I just can, I wish we had, you know, another hour to talk about some of the success stories that y'all have, um, seen come through your clinic and maybe we'll have you all back on at a later date and we can talk more about, about that side of things. But I do want to bring dr Kimball into the conversation. You know, dr Kimball, thanks for being patient with us. Um, you know, I do want to transition to, um, uh, to talk a little bit about a substance that, um, might be in more homes than maybe some others with, uh, with alcohol. Um, you know, you can find that at the grocery store if you're of legal age and, um, you know, there's, or the ABC store and um, you know, that seems to be, uh, maybe more mainstream then some of the other, you know, quote unquote hard narcotics, um, that other people might be facing challenges with.
Um, but it still causes, uh, issues for, for several, several people. Um, and I'm sure y'all can attest to that. Um, you know, we're, we're at home now, we're social distancing or not driving that much anymore. You know, you people maybe seen a, uh, a funny meme on social media about, you know, drinking wine or, you know, day drinking, but it's, uh, it can definitely have adverse effects on your, on your mind and your body, um, if if used, uh, in an abusive way. So, you know, what's wrong with drinking a few drinks every day while I'm at home if I'm not going out that much anymore?
Well, the, uh, national Institute on alcohol abuse and alcoholism, it's basically said that the maximum number of drinks per day for a woman is wandering for day and two drinks per day for a man. And so basically that's seven drinks a week for a woman and 14 drinks for a man. And really anything more than that is really considered to be a harmful drinking. And so I think one of the things people don't realize is that, uh, alcohol definitely has effects both short and longterm on almost every single organ in your body. And at the risk of damage to health increases with the streak of alcohol consumed. And especially in this UPenn demic that we're experiencing and alcohol use and especially even in heavier use, weakens the immune system and thus can reduce our ability to cope with this infectious disease. Um, you know, and as, as you said earlier, alcohol alters your thoughts, your judgment, your thinking, uh, your decision making and your behavior is pregnant or becoming pregnant. It poses a risk to the unborn child. And alcohol certainly increases the risk of any interpersonal violence, um, that someone has. And it can increase the risk of falls. And if someone were to develop a carbon 19, they use can also increase the risk of self, someone developing complications, uh, from that disease process.
That's, that's very interesting. Dr. Campbell. Um, maybe in a backup, uh, one, one step just to help me understand when, when I am drinking alcohol and you know, what is, what is the alcohol doing to my body that has given me that feeling that alcohol does, what, what's happening inside my body, that alcohol is affecting that that way?
Well, I mean, alcohol, you know, alcohol is a, is a relaxant and, and it's certainly something that, you know, can, you know, has been used for millennia, uh, to help with a variety of situations and certainly can help with anxiety. Part of the problem is though, is that the, it's, it's a double edged sword. So the more people drink, the more they want to continue drinking. Everybody gets used to the amount that we do drink. And so as, as time goes on the, uh, amount that may have been beneficial to us at one time, uh, and it's not to be as effective in the longterm, and then we, you know, P pay people might need more and more alcohol to get the same effect that they did. They help them.
Gotcha. Gotcha. So, you know, speaking of Cove 19, you know, people may be seeing it on the news or on social media about, um, a few distilleries, uh, distilleries switching from making their traditional, um, alcohol to drink, to, um, to, um, disinfectant, alcohol like Hanson and sizer. Um, so that's been interesting to see. Uh, but going back to that, the actual just, uh, drinking alcohol, whether it be, you know, whatever it is, tequila AJ and vodka, uh, wine beer, does that in any way help if I'm drinking alcohol? Is, is, is that helping me, uh, to prevent or, or quelch this virus Cove in 19 at all?
You know, that's a good question. And there's absolutely no evidence that alcohol can either prevent coven 19 virus or treat the COBIT 19 virus. And just because disinfectants have topical alcohol in them, uh, the amount of alcohol in a vodka or gin, uh, is not as concentrated as that and your typical disinfected. And so as I said, there's actually no evidence that it can prevent and treat it. And as I mentioned earlier, can make a whole bunch of other things potentially worse for a person.
Yeah. And I guess this would probably be a good time to throw in the a disclaimer or a PSA that, um, people should not, uh, consume Hanson and Tizen are disinfected alcohol, uh, as well. If they fear that they might have come in contact with a Cove in 19, um, you know, they should not consume Hayne sanitizer or anything else like that. Right?
Yeah, absolutely. Please do not drink hand sanitizer. And along those same lines, there are other products, uh, that have alcohol in them. For example, ice approachable alcohol or rubbing alcohol. I have, I've seen patients in the hospital if they didn't have their vodka or gin consumed that and that tends to be really bad and can cause kidney damage and a whole bunch of other problems. For the, for the body
man. Well, well thank you for helping. Just to reiterate that point, um, you know, it's, it's people, we were at a stay at home order right now. Um, you know, we've been told to alter our lives and in noticeable ways, um, we have made me have to work from home or maybe some of us have been furloughed or laid off and we don't have our job right now. Um, and we're having, you know, some people are, are um, you know, more isolated than others. Um, you know, what are some options people can, can do if they need to seek medical advice, um, during this time, if, if maybe they think they have been abusing alcohol or, or they're tempted to, you know, what would you say to them as far as options available to them?
Well, you know, there's several options and you know, our clinic here on at seven 91, Jonestown road remains open. And even if someone is concerned about leaving their health, we are more than willing to, uh, to do a phone visit with someone or potentially do a video type of visit. And, you know, similar to a Skype or FaceTime with someone, uh, to really help with their needs. And if my colleague demon earlier, uh, you know, really helped us say, you know, in a day, do they need an intensive outpatient program? Do they need any, uh, medical detoxification, you know, can provide other resources as well to including treatment of any co-morbid food are excited for that the person may have.
Gotcha. That's, that's very helpful. Dr Kimball, you mentioned detox right there. This would be a good follow up. You know, what advice do you have for detox if, if maybe someone has, um, has faced a substance use disorder situation in their lives or they know someone that has, you know, some people are like, ah, I can, I got this on my own. I don't necessarily need to go see a doctor or go to the doctor's office. I can just quit cold Turkey and, and I can do this. Or, or, um, you know, maybe they, maybe they don't think that. Maybe they're like, yeah, I definitely need help to go through detox, you know. Can you talk to us a little bit about the detox process and, and why? Um, um, having medical providers involved in that is very important.
Sure. So when patients have an addiction, addiction, addiction is a medical disease. I addiction is not a disease, a willpower, uh, or as some psychosocial failing. And so because addiction is a medical disease, really it's the medical professionals who really can help with that person and help them to best be in treatment. And as my colleague Dean said earlier, you know, patients decided, yeah, I can do it on my own and I'll just, I'll just white knuckle it or whatever. Very few of those patients actually are successful. So you know, that we are here for people who, uh, if, if they're trying to get off their substance and the detox where we're here for people to talk about what potential options are available. Um, if someone has had a history of a delirium tremens or DTS, uh, it's, it's really unsafe for that person to try to detox at home. And that person would probably need to go to an inpatient facility, uh, to help. Uh, but in other cases we can provide, uh, options for that person in including, uh, the potential outpatient detoxification.
Gotcha. That's very helpful. Um, dr Kimball, I appreciate that and, and appreciate all of your y'alls, um, great information and guidance. You know, we're getting ready to wrap up this, this episode talking about, you know, um, substance use disorders and, um, you know, specifically, uh, options for treatment during this time of, of, uh, Corona virus where we're, you know, our lives have been, um, altered in, in major ways possibly, and there's increased anxiety and stressors in our lives and, um, possibly, uh, and, you know, we're having to deal with kids at home or elderly parents perhaps where we can't go see them, you know, that, that's, that's a law for some people. Um, you know, if, what, what resources, I guess I just want close with
this question and then we can start off with you and then, you know, um, dr Kimble and Douglas jump in please. Um, but w what resources would y'all offer, just as a closing comment for people? Um, if, if they, uh, would like some more information about treatment or they know someone, you know, a family member or a friend that, that they think could benefit from this information. What resources are out there in the community? Well, certainly we're continuing to provide all the services we previously provided or just cause my colleague, dr Kimball mentioned, we're doing things in a virtual way. You're doing phone visits. Most other, uh, facilities or programs within the, the regular Western cycle, Mary, to continue to provide their same services are just using those other methods to get that message out. Okay.
Off the bat, every services, uh, uh, they're still doing, uh, all of their services. And there's also the support groups that are going on, such as alcoholics anonymous, narcotics anonymous or drug addicts. They're all having virtual meetings. So one of the websites for all of the local, uh, 12 step meetings for AA anyway, there, their website is a wp.in wpi.net and individuals can go there and enter into the 12 step meeting. And that's been their response has been very helpful. It's been a tremendous response to people who are at home and just can't get out. Uh, Dr. Douglas or dr Kimball, any, any closing comments along those lines?
Well, I think, you know, you had mentioned the stress that people go through with being away from family members and loved ones right now. I mean in the sense of isolation and boredom, their experience in that home. I think the advice that I would recommend is really try to stay on a schedule. It can be very tempting to just sit in front of the TV and watch the news and just build that anxiety instead. Try to be productive. There's a lot of YouTube options. I've challenged patients to try to find a different workout video. Maybe they've never done Pilates before where, you know, what now is the perfect time to try polite people. I did. You know, there's just, there's fantastic, fantastic videos out there now and many of these subscriptions that you would have had to pay for before companies are offering them for free right now during the coven pandemic. And you know, the groups, the groups are great way that online groups are white. Great way to remain socialized. Um, call family and friends and try to get outside and get some fresh air. Just, you know, being in a box when he four, seven is not healthy. So just get outside, walk around a little bit. Stretch.
Yeah. And, and I guess I'd echo some of those comments. I think all of us have said, uh, at one time in our lives, I wish I had more time. Well guess what? Now we all have more time. And so I think, you know, what are some productive things that you could do with that time that you've been neglecting or putting off for that whole time? You know, and, and I, I guess the other piece of advice is be patient. We're going to get through this and we're going to come out stronger in the end.
Well, that is a great closing comment. Um, dr Kimball, I appreciate it. Um, my three guests today, Dean Melton, Dr. Heather Douglas, Dr. James Kimball, um, great information. I appreciate y'all taking time to talk with us today. On this best health podcast. And to all our listeners out there, appreciate you all listening. Um, feel free to share this with, with, um, you know, anyone that you might think could, could be a benefit, uh, and maybe on your social media as well. If you see the link out there on your, where you get your podcasts or on the wake forest Baptist health, social media. Um, thank you all so much for joining us today. I hope you all stay healthy and well.
yep. And, um, so all our, our podcast listeners out there, until we chat again, please be well,
thanks for listening to this episode of the best health podcast brought to you by wake forest Baptist health. For more wellness info, check out wake health.edu/best hell and follow us on social media, wake forest Baptist health care for life.
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