[Music] recovery from addiction is possible and frankly it's an ongoing process dr james fasante joins us in studio to unlock several keys of attaining and maintaining a life free from addiction they're the ones who raise the bar the ones dedicated to providing care in the most demanding of circumstances the ones that understand the healing benefits of kindness and compassion they're the people of sarah bush lincoln and they set the bar high sarah bush lincoln trusted compassionate care right here close to home for over 50 years horizon health has been keeping you and your family healthy and although some things have changed horizon health's commitment to meet the ever-changing needs of our community has remained the same horizon health 50 years strong carl is redefining health care around you innovating new solutions and offering all levels of care when and where you need it investing in technology and research to optimize healthcare carl with health alliance is always at the forefront to help you thrive [Music] thank you for joining us for this episode of being well i'm your host lacey spence and today our guest comes to us from carl up in champaign we've got a new guest dr james vicente welcome to the show thank you so much for having me of course so we like to always get to know our new guest to the show and since you're new from carl we would love to hear a little bit about your background and how you ended up there yeah well i'm a board certified internist and addiction medicine specialist i've been at carl now in champaign for about three years i moved to carl from new york city where i completed my specialty training in addiction medicine before that i was in boston doing internal medicine i've been really fortunate to work with carl on expanding our addiction treatment services across central and southern illinois outside practicing medicine seeing patients i also take a role in training doctors and medical students who are interested in addiction medicine that's another big thing we're doing at carl is expanding training opportunities for practicing providers across the state well wonderful we're glad that you uh landed in central illinois and are reaching our folks here so as you kind of mentioned we're talking about addiction recovery today and so first i'd kind of like to ask you have you noticed any um major differences coming from new york to more of a rural setting it's a great question to open up with well addiction it affects everyone in some way shape or form i bet a lot of the folks watching today know someone or have been personally affected by a substance use disorder which is the clinical diagnosis of an addiction coming from an urban center to a rural location one of the things i was struck with initially were how few access points there were carl has done a tremendous job in expanding addiction treatment services but for many people living in rural and remote communities across the state of illinois accessing treatment can still be difficult i'd say that's probably the biggest difference i've noticed in an urban setting there's so many resources sometimes street by street in large cities where in rural communities people are often traveling large distances to access care that they need that's so interesting to just think of them being so accessible so as we're talking about substance abuse what typically are folks that you're finding in this area battling well it's the same as people in new york or boston people are experiencing addiction in their own personal way but there are certain common elements to addiction first that someone's engaging in a behavior that's become compulsive and they can't stop the behavior despite the negative consequences in their life that's one of the hallmarks of addiction the good news is as an addiction we now consider as a chronic disease so we use the chronic disease model and that's important because addiction is highly amenable to evidence-based treatment and so when i think of addiction i think of people who are experiencing it and maybe actively using their substance of choice but then there are people who are in remission like we would describe a lot of other chronic diseases and so people are at different stages of that recovery journey who are living with addiction and so for us as providers we're kind of open and welcoming to anyone's recovery journey we know it's not a one-size-fits-all and for a lot of our patients we have to come up with a unique plan to help them achieve their goals as they set them so in that way we're very patient centered and we're letting patients dictate the care that they're interested in receiving and so we offer kind of a spectrum of treatment options for people experiencing addiction so before we go into that can you talk a little bit about how addiction was previously treated since it you said it's now a chronic treated as a chronic condition for a really long time we thought of addiction as a moral failing you know people are yeah engaging in substance use because they want to get high it's entirely their choice they can stop anytime they want to we now know that addiction is a much more complex experience it has to do with people's genetics people are genetically predisposed to experience addiction differently than others really every year we're gaining more and more knowledge about the genetics of addiction how it affects different people differently because of their genetics we also know a lot of it has to do with environment so the environment in which people grow up in or they they live in has a huge part to play in their addiction and then there are other factors as well that are really important when we're thinking about addiction all of these multi-factorial pieces of that addiction story help us understand it now as a disease it's not simply people are engaging in a behavior because they want to or they don't have the morality or fortitude to say no for a lot of folks they don't want to use and they're caught in a really vicious cycle of use and so what we've done by using the chronic disease model we've said hey let's take this experience this clinical disease and let's help clinicians take part in the treatment a lot of people engage in addiction treatment or addiction treatment providers addiction treatment happens in many ways many places many spaces and one place we're trying to increase access to addiction is in clinics now some addiction treatment takes place in churches or community centers and that's really important for a lot of people's recovery is their faith other people faith is not as big an element of their recovery but i always say you know we have to come at it from multiple angles and clinicians and sometimes medication can play a huge role in people's recovery well it also sounds like your community whether it is religious based or not just surrounding yourself with good influences as well absolutely community plays a enormous role in addiction treatment so as we are going through the treatment options do you mind diving a little bit deeper into what it looks like to again you said it's very patient catered but what it looks like to see them in a clinical setting absolutely so one of the first things we do when we want to treat a patient with a substance use disorder again going back to that clinical diagnosis of addiction is we understand what the patient wants to do with their substance use i think that's really important and that it's patient centered and so when a patient comes to see me for example the first thing i like them to do is set their goals for me healthcare is a ship and the patient's at the helm driving it as a clinician my role is simply to help them make informed decisions but not to make them for the patient so the patient comes to me or any clinician at carl addiction recovery center and we first understand what's motivating the patient and what they want to achieve and then we come up with a plan on how they can best achieve it now it's important to know that health care any treatment plan is a dynamic moving target for some patients and it has to adjust as their experiences change so sometimes patients meet me for the first time and they say i just want to moderate my substance use and i say okay let me help you achieve that goal and then maybe later in their recovery journey they said you know what moderation didn't work so great i want to stop totally and so we adjust the plan for a lot of peace patients medications play a big role in that and when we start talking about medicines to treat addiction we're talking about evidence-based therapies so as a clinician whether i'm treating high blood pressure or i'm treating opioid addiction i'm looking at the literature the empiric data those studies that have been conducted that says say this medication is effective it's safe for use and it's going to help this patient achieve that goal how they set it and so for a lot of patients i'll review what medical therapy options they have we may start one medication and then decide later on hey let's try something different so it's really important for every patient that they feel empowered to make informed decisions and sometimes those decisions include medication other times i may refer patients for counseling therapy those types of behavioral health interventions are really important for people trying to achieve recovery and that can look a lot of different ways too it may be one-on-one therapy to kind of evaluate or help people process life experiences that may be interrelated to their substance use like trauma or depression anxiety i i always say it's important to remember that for a lot of folks they're using that substance as a tool in their tool belt to manage really distressing behavioral health or mood symptoms that they experience yeah for example people who use alcohol oftentimes are using alcohol to manage anxiety and so when we remove that substance like alcohol we have to help that patient come up with healthier tools to manage something it doesn't remove your problem it doesn't and so in this way when we think about addiction treatment we're really working on a team with different people who can help that patient address their substance use disorder from different angles and i think it's great you mentioned that to take an a holistic approach instead of just one piece one piece it's all got to go together you had mentioned opioids that seems to be still covering news headlines how big of an issue is that in this area that's that's a great point it's hard to overstate the burden of opioid addiction and deaths related to opioid overdose here in the state of illinois especially it's been a problem that's been growing since the late 1990s however in the last few years it has increased dramatically we've actually seen a 33 percent increase in overdose deaths in a 12-month period in the state of illinois that's a dramatic tenfold increase from years prior wow recently a few weeks ago the cdc released a report that overdose deaths in the united states of america topped over 100 000 lives lost in the state of illinois you're two and a half more two and a half times more likely to die of an overdose than a car accident the leading cause of preventable mortality during pregnancy in the state of illinois is drug overdose and has been for several years in the state of illinois it affects people differently if you're african american in the state of illinois you're seven and a half times more likely to die of overdose than your white counterpart so it's affected many many people in the state of illinois it's affected different communities differently it is an enormous and growing problem it's one of the leading causes of preventable death in the state of illinois as well as the entire country as a whole and um i mean no pun intended this is it's just a really sobering number sobering to hear um and i'm sure the pandemic has only made this worse absolutely the pandemic has made a lot of things worse in terms of health i want to go back to your point earlier about community sure and community as an intervention to help people achieve recovery for a lot of people community is a fundamental piece of their recovery journey whether it's through their faith through their church or through a community center where they may attend group recovery meetings or their family who opens their arms to them as they're trying to achieve recovery or who they're in recovery and trying to maintain their recovery when the pandemics started almost immediately people were cut off from their communities and that sense of isolation that was really dangerous for people who use drugs they weren't seeking help they weren't reaching out when they needed to and now that we're going over that data from one two years ago we're really starting to understand the true magnitude of what happened when we isolated all these people who use substances during the pandemic um and so it's they're sobering numbers to look at now but it's also helping us look forward at what we need to do in terms of addressing the issue and expanding access to people who need it most and so let's dive into that a little bit first off just as a family member a concerned family member what signs should i be looking for in someone who i fear may be struggling with substance abuse it's a great question it's a question a lot of folks ask me what do i how do i know if my loved one is using substances oftentimes it's not clear at the beginning so the first thing i tell everyone is always to facilitate an open non-judgmental atmosphere where you can engage in these critically important conversations with loved ones why don't people seek care when they need it one of the biggest reasons is shame shame is really difficult for people to overcome when they want to access care they're ashamed of themselves for using or they're ashamed that they've relapsed to substance use and so as a loved one a family member one of the most important things is that you facilitate an environment where someone feels open to talk about their substance use and that's really really difficult there's a lot of emotions involved and it's it's tough to kind of create that space that's non-judgmental for someone to open up about their substance use but i feel that's the most important piece is to facilitate a discussion rather than trying to assume you know what's going on try to create a space where that person can talk about it in a non-judgmental way the other thing i tell all family members if they do suspect their loved ones using drugs or is it risk for overdose is to have overdose reversal drugs in the home like narcan narcan is the opioid reversal drug comes in many different formulations most commonly a nasal spray you can get it at any public health office in the state of illinois any doctor can prescribe it and here in the state of illinois we actually have a standing order this is a standing prescription for every man woman and child in the state of illinois to walk into any retail pharmacy at any time and actually fill a prescription for narcan even without a physician being involved if you were to walk into a pharmacy today and say i need narcan the opioid over overdose reversal drug that pharmacist needs to give you a prescription for a narcan and fill it your insurance should also cover it now if there's some kind of cost that's prohibitive for you receiving that narcan there are many places where you can be dispensed narcan in the state of illinois at carl we're working to expand this dispensing of narcan across our system it's already in our emergency departments and we're working at getting dispensing in all of our clinics i can tell you right now at the carl addiction recovery center we have narcan in every exam room and we hand it not only to patients but to loved ones who will be in a position to reverse that overdose and i bring this back to your question about how do i support someone i think maybe using drugs and the most important thing to remember is that dead people don't get a chance to recover right the risk of overdose is so tremendous in the state of illinois even for someone who's not ready to stop using sometimes the most important thing we can do is keep them from dying of an overdose and give them the chance to engage in treatment and achieve recovery in the future are there things you can look out for as far as changes to their behavior or their physical appearance that might help you if you're suspecting because like you said people family members might not notice it at first because they are good at hiding it but usually those effects kind of catch up on the back end yeah again it's tough as a specialist there are people who come in my office all the time who don't present as someone using substances drugs okay so i think it's important you know we can't really label people based on their looks or appearance as being someone who has problem use of a substance that being said when we go back to that diagnostic criteria of a substance use disorder how a doctor makes the diagnosis of an addiction it's essentially 11 criteria that a patient needs to meet and a few of those criteria get it that person's interpersonal relationships with other people are they strained are they continued continuing to use their substance despite these negative consequences either in terms of relationships with other people around them their work are they continuing to engage in their work or fulfill these socially productive roles whether it's caring for a child or a family member a lot of times people who are engaging in substances struggle to fulfill these roles but again other people who would benefit from changing their use of a substance don't present this way and so it's important that we don't think of a profile or an image of someone who's using substances it can affect many people in different ways and there may be people out there who are still fulfilling all these roles they take care of their kids they go to work every day but they really want to change their relationship with a substance and they would benefit from engaging in evidence-based addiction treatment and so while some folks aren't necessarily fulfilling all those duties and obligations there are other people who would benefit just as much from treatment who should certainly seek it well thank you for breaking that down and for helping us kind of break down some stereotypes definitely appreciate that so as you're talking about carl you had mentioned having the narcan available to patients what other steps is carl taking to address these issues yeah so at coral we are laser focused on expanding access to evidence-based treatment medications we know work how well do they work well for example with opioid use disorder the drugs that we use to treat opioid use disorder often are referred to as medication-assisted treatment here in the state of illinois a lot of the regulatory agencies now call it assisted recovery m-a-t or m-a-r what are these drugs that we're talking about well they include drugs like buprenorphine that's the active ingredient in a drug called suboxone that's the brand name drugs like vivitrol which is an injectable form of naltrexone or drugs like methadone these drugs work in different ways and for different patients they're a good treatment option and they work extremely well so one of the ways doctors evaluate how well a drug works or we call we use the term number needed to treat how many patients do i need to treat with this medication to have a desired outcome or to prevent a bad outcome for example statin drugs that lower cholesterol atorvastatin drugs like that you have to treat roughly 38 patients to prevent one non-fatal heart attack so think about that we put all these patients on cholesterol lowering drugs to prevent the thing we don't want which is a heart attack and we need to treat in the 30s of patients to prevent that bad outcome well when i talk about a drug like buprenorphine suboxone the number needed to treat is three that means if i prescribe this drug to three people i've prevented a bad outcome like overdose that is unbelievable in terms of efficacy or how well the drug works some studies say that if i start a patient on that drug buprenorphine i've reduced the odds of them dying by overdose by six-fold in six months that's a life-saving medication unfortunately many patients especially those in rural communities don't have access to these tools so at carl we have specialists like me and specialty treatment centers in champaign providing this care but more importantly we're improv we're empowering practicing providers primarily primary care providers in rural locations across our network to prescribe these medications and so i believe that's one of the most important things we're doing as a system empowering many different providers and when i say providers i don't just mean physicians i mean nurse practitioners physicians assistants all of these important health care providers are playing an active role in expanding access to these treatments we've also done things like expand access to these drugs in our emergency departments a lot of folks who are using substances are going to engage in emergency services and it's an opportunity lost if we don't offer them this care in our emergency departments so that's another really important thing we're doing as a system definitely it sounds very comprehensive definitely expanding that care so as we're probably about a minute left is there anything that i didn't ask about that you'd like to share about either what carl's doing what you're doing your approach to treatment before we go yeah so again this enormous problem that we have this overdose epidemic that's confronting our nation it's a huge problem and it needs a lot of people involved in the solution there will never be enough of me and by that i mean addiction treatment experts to address this problem it's incumbent upon all of us to be part of the solution we really have to work together as a community to find creative ways to help those who are seeking recovery to support those who are in recovery and so as a provider a lot of what i want to do is engage communities at carl we've created something called the carl substance use disorder leadership center this is a center that's funded by the state opioid response grant these are federal dollars earmarked to help communities confront the overdose epidemic this leadership center is involved in education like i mentioned but we also have a community outreach team and that community outreach team is going to different towns different communities and engaging in these critical conversations with all the players and stakeholders these are councils opioid councils ross councils these are recovery oriented systems of care all these different people who are involved in addiction treatment who are involved in the health and well-being of individuals in the state of illinois they are all fundamental important parts of the solution and i really appreciate the opportunity to talk about some of my care but i also have to make mention of all these other people working in the space oh definitely and for those who are looking for more information i gather they can go to carl's website absolutely we have a website for the carl addiction recovery center i encourage you to go there as a starting place and we look forward to anyone who's interested in engaging in treatment through our clinics or our network of clinics perfect well thank you for being here dr bassante we definitely appreciate it thank you so much for having me of course and we hope you'll join us for our next episode of being well carl is redefining healthcare around you innovating new solutions and offering all levels of care when and where you need it investing in technology and research to optimize healthcare carl with health alliance is always at the forefront to help you thrive for over 50 years horizon health has been keeping you and your family healthy and although some things have changed horizon health's commitment to meet the ever-changing needs of our community has remained the same horizon health 50 years strong they're the ones who raise the bar the ones dedicated to providing care in the most demanding of circumstances the ones that understand the healing benefits of kindness and compassion they're the people of sarah bush lincoln and they set the bar high sarah bush lincoln trusted compassionate care right here close to home [Music] you