The Changing Face of Addiction Treatment

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[00:00:12] Mike: Welcome everyone to Avoiding the Addiction Affliction, a series brought to you by the Kenosha County Substance Abuse Coalition, I'm Mike McGowan. Today I'm pleased to have as our guest, Dr. Sela Kurter. Dr. Kurter is one of Milwaukee's leading experts in the field of addiction medicine. He's Executive Director of West Grove Clinic and carries a dual board certification in addiction medicine, as well as psychiatry and neurology. And has extensive experience working with clients with substance use issues.

[00:00:41] Dr. Kurter: Welcome Dr. Kurter.

[00:00:43] Thank you. Thank you for inviting me. It's a pleasure to be here.

[00:00:46] Mike: Well, I'm so glad you could join us. You know, we've had a lot of conversations here about not only the opiate epidemic, but usage in general.

[00:00:56] It always helps if you start us out just a little bit in general, telling us about your work and philosophy, working with clients with substance use issues.

[00:01:04] Dr. Kurter: Yeah, well, you know, I've been in addiction now for about 15 years. I'm board certified in addiction and psychiatry, and I'm an Executive Director of West Grove Clinic.

[00:01:13] We have clinics in Kenosha, Milwaukee, and Appleton. So then we're what we're seeing is just a dramatic increase in usage of opiates, specifically, synthetic opiates, such as Fentanyl and its analogs. We're also seeing increases in cocaine and methamphetamine use, and we're really seeing a, a changing face of addiction.

[00:01:37] You know, when, when you look at the lay public, you look at the media, they're always talking about pill addiction and prescription addiction. And really we're seeing less of that and much more heroin use, Fentanyl use, cocaine and methamphetamine. So it's a polysubstance epidemic that's occurring. And we're, we're concerned about it because a hundred thousand people died from opiates this last year, and we're not seeing that trend die down.

[00:02:05] Mike: No, we're not. And you know, it's interesting. We talked to a lot of recovering people on here too. Almost none of them say, oh yeah, this was my only drug it's, you know, the literal grocery cart full of drugs.

[00:02:20] Dr. Kurter: Exactly. And unfortunately what we're seeing in the clinics is some people don't even know they're taking it.

[00:02:26] So they initially thought they're getting a Percocet. It looked like a pill that, that was labeled as a Percocet or even a Xanax. And yes, it's. Unfortunate that they're taking it off the street, but they thought they were getting something else. And what it really is, it's laced with Fentanyl. And as we know, Fentanyls 20 times stronger than, than morphine.

[00:02:45] And so it's it and, and heroin. And so, you know, we're seeing overdose rates really escalate.

[00:02:52] Mike: Now when, when you're working with somebody with the opiates I, I assume you, your clinic is doing some medically assisted treatment with it. What are you using and how are you using it?

[00:03:01] Dr. Kurter: Yeah, that's a great question.

[00:03:02] So MAT, Medication Assisted Treatment is the term that's used for any FDA approved medication that's used for opiate addiction, okay. So the three that are out there right now is methadone, buprenorphine or commonly termed Suboxone and Naltrexone. It comes in a shot called Vivitrol. Okay. And these three drugs have been scientifically shown to be helpful with recovery.

[00:03:26] It reduces overdose rates and it saves lives. And statistically speaking it has been shown to be one of the most effective treatment options for people. And so what we do in the clinics is we combined MAT with traditional therapies, such as talk therapy, group therapies, intensive outpatient, and we also do dual diagnosis.

[00:03:48] So we treat underlying mental health problems, which we find to be a critical crux of the issue. And when we do it that way, we have very high success rates.

[00:03:58] Mike: Do you track those? Do you know what is it just anecdotal or.

[00:04:02] Dr. Kurter: Well, you know, right now, one of the big things is to do more studies and to track it.

[00:04:07] Right. But we have seen significant improvements when we combine all three modalities and we're right now in the phase of where we're starting to track it. Okay, but we're moving forward into more statistical analysis. Right. But in my experience, when you do all of these, when you do dual diagnosis and you do MAT, you have wonderful success rates.

[00:04:29] Now, Wakeman was a, a researcher and in 2020, he really looked at all of these things. He didn't combine mental health, but what he did do is he looked at MAT versus inpatient detox versus intensive outpatient versus traditional therapies versus no treatment at all. And he found that MAT had success rates about 60 to 70% of the time.

[00:04:50] And success was defined as reduction in mortality reduction in death. Okay. And you know, the commonly thing thing we think in the addiction community is you go to detox. Detox is gonna save your life, but they found that actually detox was successful in reducing mortality, 20% over a one year life, a one year span.

[00:05:09] Okay. So actually MAT was three times more successful in reducing mortality. Now that doesn't mean that you shouldn't go to detox. That doesn't mean you shouldn't do residential. Cause residential was also about 20 to 25% successful in reducing mortality, but it means know, know where the high yield treatment is.

[00:05:27] And it's MAT. So ideally when you have a person that needs help, they should go to detox. They should go to group therapy, but they also should consider MAT because statistically speaking their success rates are better.

[00:05:38] Mike: Well, that makes sense, right? Because if you, if you go back on the street and you relapse.

[00:05:44] If you're using MAT it's gonna have less of a fatal effect. And, and especially if you think you're taking a Percocet and all of a sudden you get Fentanyl, you know.

[00:05:53] Dr. Kurter: Exactly.

[00:05:54] Mike: You don't get a second chance to check back into detox.

[00:05:56] Dr. Kurter: And that's the key. You don't get a second chance. Right. And that's the key.

[00:05:59] So really the way we look at it is let's throw the kitchen sink at it. Okay. And you know, just anecdotally, I'm gonna tell you a little story here. You know I was looking at the statistics before I came on board here to talk to you. And we saw that Fentanyl in Southeastern Wisconsin really start to escalate around 2014, 2015.

[00:06:17] And then every year, since it's been exponential, there's been an 800% increase in synthetic opiates, Fentanyl in the last seven years. That's that's ridiculous. Okay. And so the funny thing is when I, in 2014, when I was treating patients, I started hearing stories from our patients saying, Hey, you know I just used yesterday and I was looking at their drug screen and there's no opiates in their system.

[00:06:37] Right. I'm like, what is going on here? Are they lying to me? Or is there something else going on? And. Low and behold, we realized it was Fentanyl because Fentanyl doesn't show up on a traditional drug screen. And so we started tracking Fentanyl. We started seeing every year more and more Fentanyl use. And part of the problem was initially I couldn't track for Fentanyl because the insurance companies didn't want me to test for Fentanyl.

[00:06:58] They, you know, they were worried about costs. And now if I don't test for Fentanyl, I'm missing a huge part of the story. So I think the important thing to the underlying message here is that addiction changes every year. The face of addiction is changing. And I think the message I wanna convey to your listeners right now is the face of addiction is changing in the next five years.

[00:07:20] What we're gonna see is more polysubstance use. So it's no longer gonna be just the opiate addiction. It's gonna be a methamphetamine addiction. It's gonna be a cocaine addiction. It's gonna be an opiate addiction mixed with everything. So people are gonna be using lots of stuff all at the same time and dramatically increase their risk of death.

[00:07:38] Mike: Well, and Fentanyl is in Coke now and meth. So, you're getting all of the drugs in one little pop.

[00:07:48] Dr. Kurter: Exactly. Exactly. And unfortunately, what we're seeing is more and more people don't know that they're getting Fentanyl, they're thinking they're taking something else and that can lead to devastating consequences.

[00:08:01] Mike: You know, I, I have to ask you this because I get this when I do trainings and stuff all the time. From therapists, from practitioners. And I get asked all the time and I bet you do too. "Well, isn't Suboxone, aren't the drugs you're talking about to use MAT. Can't people abuse those or become addicted to those as well?"

[00:08:21] I mean, I get that in every training I do. How do you answer that?

[00:08:24] Dr. Kurter: Yeah. So the way I look at it is this, you can abuse anything and ultimately when you are in the state of a dependence use or addiction, you're gonna look at anything to get your high. And so yes. Can people abuse Suboxone? Sure. Can they abuse prescription pills that they're given to by their doctor? Absolutely.

[00:08:44] Can they abuse Gabapentin? You know, now the new thing is Gabapentin and the risk of Gabapentin. Yes. But, and that's where a practitioner really needs to weigh the imbalance, the benefits versus the harm. Statistically speaking. However, just like I mentioned, Patients being on Suboxone or other forms of MAT statistically save lives.

[00:09:05] Now can a person abuse it? Absolutely. The way I look at it when I talk to family members, because I get that question asked by family members all the time. I, they say, you know, well now we're just replacing one drug for another and that's just continuing their addiction. The way I tell 'em an answer is I said, look unfortunately, your son, or daughter's already addicted.

[00:09:23] The brain has changed fundamentally so much so that they want this drug. They crave it and it, it, it closes off their judgment centers. And so they don't have proper judgment when they're craving. This drug saves lives. This helps them get back on track. I look at as a transitionary product. So you get them on Suboxone or whatever Methadone or Vivitrol, they transition on it.

[00:09:47] They get the treatment they need, they treat their mental health, their underlying mental health issues. If there is, by the way, 70 to 80% of patients who suffer from addiction, suffer from an underlying what we call access one disorder, that's depression, anxiety, bipolar, or severe trauma. We get that treated. We get that under control. They get into therapy, they get into groups, they get back to working again, they get their lives reconnected. And then if they desire to come off that treatment such as Suboxone, fine. But most studies say that the longer they stay on the better chances they have. So that's the way I answer.

[00:10:19] And, and whatever works to help them stay alive because that's what we're dealing with here. The other way I answer it is this. If I say, look, you're suffering from a life threatening cancer that has a 20% mortality rate in five years, by the way, that is the mortality rate for IV heroin users. And there are some cancers that are actually better statistics than that.

[00:10:38] And you say, look, I'm gonna be taking sophisticated poisons. And that's basically what chemotherapy is. To help save my life. You never get a question about that. You're like, okay, let's do it right. But when you say addiction, there's some, there's, there's a pushback. There's a little bit of a, like, I don't know.

[00:10:53] And that's the stigma that we deal with. But once you arm yourself with science and statistics and you say, look, these, this is what it is. And you put it all on the table. You let the patient make the right choices.

[00:11:05] Mike: You know, you just alluded to the partner question that I get to that as well, which is.

[00:11:11] How long do you stay on it? And can you wean people off of it? And I think that goes to the exact thing you just said, which is, well, we're treating a drug with a drug. So how long you stay on it is an individual decision between you and the client. I would assume.

[00:11:27] Dr. Kurter: Exactly. And then also the science, let the science lead.

[00:11:31] And the nice thing is, as MAT is becoming more and more popular throughout the world, we're getting more data that says, you know, this is how long people should stay on. And it's a very individualistic process. If you have a patient that's been using IV heroin for 10, 20 years, well then maybe they need to be on MAT for a longer period of time.

[00:11:52] They've been using one or two years, then maybe they can come off. I have successfully weaned people off Suboxone and many people have done well, have some of those people relapsed? Absolutely. And have they come back to Suboxone? Absolutely. Have some people stayed clean? Absolutely. I have a patient now he's been five or six years off Suboxone doing wonderful and staying clean. It's, it's all possible, but I think the key here is to really comprehensively treat the patient. If you're not treating the mental health, if you're not treating the trauma, you're not gonna make headways. Okay. And for that individual, treating that underlying anxiety. Made all the difference in the world and it allowed him to leave a very productive life.

[00:12:32] And I see that now in the addiction communities, because I give talks throughout the country, I see that some addiction treatment centers will just treat the addiction. They won't treat the mental health and they'll say, you know, get your depression and your anxiety and your trauma treated somewhere else.

[00:12:45] Well, when you do that, you're fractionating healthcare. You're fractionating the treatment and there's a high likelihood that patient won't get the care that they need. When you do that, you're actually undermining their addiction treatment. So I think comprehensive treatment is the key.

[00:13:00] Mike: Well, especially in some of the communities that you serve, you know, you're not just in the posh, affluent places with mobility, your downtowns right?

[00:13:10] Dr. Kurter: Exactly. And a lot of these people have transportation issues. They have resource problems. You know, many of them, some of them don't have phones, cell phones, where they can talk to a therapist online. So these are the patients that have the highest needs. And ideally you wanna have a one stop shop that can help them get the care that they need.

[00:13:32] Mike: Yeah. You know, I've, I've seen some studies recently. I know you're not a pain management clinic, but I I've seen some studies recently that are using things like Vivitrol for pain management instead of Oxy or Vicodin, less addictive. Right.

[00:13:48] Dr. Kurter: Yes, so I have to be careful with what I say, because currently right now, the DEA and the federal government only allows us to prescribe Suboxone or Vivitrol for a opiate addiction.

[00:14:00] However, science has shown that the active chemical ingredient of Suboxone, buprenorphine has been very helpful for people who suffer from chronic pain. Okay. And some pain centers are now using low dose buprenorphine. There's actually an FDA approved patch called Butrans, which is a low dose buprenorphine that's given to chronic pain suffers.

[00:14:21] And there's also some evidence that low dose Maltrexone can help with various pain conditions. Rheumatoid arthritis, lupus. I, I was thinking fibromyalgia. There's some evidence that it can be useful in those conditions too. That's not currently an FDA approved indication, but the science has shown that there's some use.

[00:14:40] So let the science lead that. Right. But currently there is restrictions for Opiate clinics, opiate use disorder or substance use disorder clinics in providing Suboxone for pain management. But if there are people who suffer from pain issues, looking into alternatives, such as a low dose buprenorphine, such as Butrans is a very reasonable option.

[00:15:01] Mike: Hmm. Well, maybe that's what you mean by changing face of addiction. Who knows how we'll be treating this stuff five years from now.

[00:15:06] Dr. Kurter: Right? Exactly. Exactly.

[00:15:08] Mike: You know the other part of the other question I get ask is there there's arguments, even in the professional community at which about harm reduction.

[00:15:15] How do you come at that topic?

[00:15:18] Dr. Kurter: Yeah, so, you know, the way I look at it is once you're armed with the science, you understand the benefits of harm reduction. So harm reduction is a very effective means of helping people get the help that they need. It saves lives. Right. So what is harm reduction? Harm reduction is using modalities that help people, even if they're still using.

[00:15:38] Okay. So for example, Let's say you know, giving Narcan out. That's a form of harm reduction. You're not saying you need to have total sobriety. You're giving Narcan so that they save their life. So if they overdose, you can give Narcan, it saves their life. Giving free needle exchanges, giving clean needles. That's a form of harm reduction. You're you're not saying, you know, maintain total sobriety. So if you're going to use at least use a clean needle, if you're an IV heroin user. Okay. So that's a form of harm reduction. You're reducing the morbidity and the mortality. You're reducing death. You're reducing complications associated with, with using, okay.

[00:16:11] The way I look at it is this way. If you use harm reduction only by itself, you're really not targeting the main issue. Okay. You should use it comprehensively with other forms of treatment. Okay. Use harm reduction as maybe a way to engage patients that are not willing to go down the sobriety route. Use harm reduction to reduce the transmission of HIV and other various forms of communicable diseases and hepatitis, great. Use harm reduction to save lives.

[00:16:40] Maybe you'll give that Narcan. And then that person will think, you know, I'm done with this. I wanna get help and you can get them into the treatment that they need. I use an analogy. So, let me ask you, Mike, and this is, this is great because it can hit home. Okay. Let's say you're in a severe car accident and you're bleeding profusely from your leg.

[00:16:57] You're bleeding profusely. What's the first few things you're gonna do.

[00:17:00] Mike: Besides go to the emergency room?

[00:17:02] Dr. Kurter: Right, besides go to the emergency. What are you gonna do right there? And then.

[00:17:04] Mike: [laugh] I dunno where you want me to go with this?

[00:17:05] Dr. Kurter: Think about it. Put a tourniquet on rightly right. You're gonna, you're gonna put a tourniquet.

[00:17:12] A tourniquet is a form of harm reduction. It's not really that you're gonna solve the problem, cuz you need to go to the ED. You need to get, get surgery. You need to get, see a doctor, but you're gonna put a tourniquet out because you're gonna reduce the bleeding. Right. But most people are not just gonna put the tourniquet and not get help.

[00:17:26] Right. They're gonna go get help. Right. So. That's a form of harm reduction. The same thing goes with addiction. You give the Narcan, but that's not the only thing you should do, right? You give the free needles. That's not the only thing you should do. And unfortunately, I'm seeing a lot of activists in the community going, I'm giving out free Narcan and that's, you know, great.

[00:17:44] And that's wonderful, but they also need to couple it with the data that says get them into treatment because once you couple the two, get them into mental health treatment, get them into the groups that they need to go. Once you do that, now you amplify the success rates, right. And you're getting them the help they need.

[00:18:01] So when you combine harm reduction with other forms of treatment, you really amplify the result. And so that's the way harm reduction should be looked at. It should not be a sole and in and of itself treatment.

[00:18:15] Mike: You know, doc, you, you you've mentioned mental health treatment a lot. And I, I wanted to get into that.

[00:18:20] You know, I've been doing this for a long time, long enough that they used to have floors of hospitals, one that was dedicated to addiction, and then you'd have the maternity ward and then you'd have mental health on another ward and they wouldn't even talk to each other. And then a while back, somebody said, you know, if you're drinking all the time, you're also clinically depressed, which [laugh] seems, seems like such common sense, but it, it seems it's a, a flare you're gonna have issues if you're using chemicals that need work. Right?

[00:18:51] Dr. Kurter: Absolutely. Absolutely. And, and also even in, in, in. In healthcare, there's a stigma. You know, I remember when I was in training and I would see people coming in for detox and this is not in the addiction zone. This was in the, the medical zone you know, at various hospitals and the physicians and the nurses were just very dismissive and oh yeah, they just need to sober up.

[00:19:11] And, and, you know, these, these people that were coming in were thinking of suicide, they were talking about how depressed they were. They were talking about how their lives were not going well and complete dismissal, you know? And, and, and the thing is, it's a great point to just engage them at that point.

[00:19:25] Like, Hey, how do you want your life to be better? Hey maybe if we look at it in various ways, we can help you. And the way we look at it, at least in our clinics is we look at it comprehensively. We say, okay, which is it? Is it the alcohol that's causing him to be depressed? Or is it depression that's causing him to drink?

[00:19:41] Right. And it can be both at the same time. Right. And so we try to treat it comprehensively and simultaneously if we can. All right. But the sooner you get to the heart of the matter, the better that patient's gonna do.

[00:19:54] Mike: Well, and you could spend your entire life trying to figure out chicken or egg, which came first. Right?

[00:19:58] Dr. Kurter: Exactly. And there's some providers out there. I mean, you know, I, I, I talk to 'em all the time. They're like, no, I'm gonna. For six months of sobriety or one year of sobriety before I can treat the depression. But at that time, their depression can get significantly worse. So you, you can't be rigid like that in addiction, you gotta be flexible.

[00:20:14] You gotta tailor the treatment for the patient. I've had patients that have lost, loved ones. I've had patients that have lost children and, you know, I, I had a poor lady that lost her child four year old child. And for four years she was suffering from horrible depression. And then she started taking up drinking.

[00:20:29] Well, Yeah. And so, you know, treat that underlying depression and you're gonna get great results.

[00:20:37] Mike: You know, you mentioned moms a minute ago and, and this has become a more relevant issue in the recent weeks. You've also I was reading your bio, worked with women who are pregnant.

[00:20:47] Dr. Kurter: Yes.

[00:20:48] Mike: You've also using substances.

[00:20:50] And I think that given our recent history. This is gonna become more common. So how, how do you go about treating somebody who's pregnant? Who's using opiates, especially.

[00:21:03] Dr. Kurter: Yeah, so that, that trajectory was an interesting, that history was interesting. I had just gotten out a residency and I had gotten my board certification in addiction and in Milwaukee there were very few doctors that were willing to treat pregnant women with Suboxone.

[00:21:18] Okay. And at that time there was very limited studies that showed that Suboxone was effective. But I had looked at the European studies because the Europeans were a little ahead of us at that time. And the Europeans were using Suboxone or the chemical of Suboxone in their pregnant women.

[00:21:33] They were having great results. Okay. At that time, the standard of care was methadone. And I was having pregnant women coming to me and saying, I'm not gonna take methadone. I took it before I already had my first child with it. I didn't like the results. I really wanna try Suboxone. I've been on Suboxone.

[00:21:47] It's been very helpful. I wanna have my pregnancy with Suboxone. Can we do it? And so I looked at that data and it showed that was very effective. And, you know, we switched to buprenorphine, which is the generic of, of Suboxone and. We treated them and they had great results. And consequently, since then there was a major study called the mother study and that pretty much showed that buprenorphine, the active chemical ingredient, Suboxone is equally as effective as methadone.

[00:22:14] There are some slight differences. Methadone has a little bit better retention rate. Meaning mothers stayed in treatment a little longer. There was less dropout. But on the flip side children that were born to mothers on Suboxone had less neonatal abstinence syndrome, which is withdrawal and their recovery time was a lot better than on methadone.

[00:22:33] So overall it said that it was very effective and that it's pretty safe and it helps saves lives. And mothers attended not to relapse while pregnant on, on buprenorphine.

[00:22:45] Mike: So, but even after birth though, to not, to, to hammer a point home, the infant and the mom are still going to need help you. Can't just...

[00:22:55] Dr. Kurter: Absolutely, absolutely.

[00:22:58] Right. And so, and they need to stay and mom needs to stay in treatment. So the worst thing you want is mom to relapse right after birth, because that affects bonding. That affects a lot of things. And we encourage breastfeeding at the time and mothers were breastfeeding and now data is showing breastfeeding is unbelievably important.

[00:23:15] So, you know we had really good results. And now consequently. The hospital systems have taken up their own programs. Now you know, Aurora started the Mark Program and this is a couple years after I started. And they're pretty much giving out buprenorphine to mothers who are opiate addicted and they're doing great.

[00:23:32] And mothers are having great success rates, the rates of neonatal abstinence syndrome that withdraw that the baby goes through is a lot lower. They're doing very, very good. And the end of the story is mom, stay alive, baby. Stay alive.

[00:23:46] Mike: That's great. You know we have to be careful sometimes I think with, in doing these, I've learned about words because people hear a word and then they interpret a different way.

[00:23:56] When you say treatment, what does it mean?

[00:24:01] Dr. Kurter: When I say treatment, I'm saying a comprehensive form of healthcare that involves medication assisted treatment, counseling, case management. That's what I mean by treatment. Okay. Therapy, it's comprehensive. Okay. And unfortunately at a lot of places, it's very fractionated, you know, you'll just get the therapy, you'll just get the MAT you just get this and you really need a comprehensive treatment.

[00:24:25] And, and the Mark Program is a wonderful example of that. They they're really comprehensive. They also include neonatal care of course with the obstetrician. So that's effective care. You really cannot skimper on the treatment. And yeah, unfortunately with a lot of the parents and patients that I see, some of them say, well, you know, I'm just gonna go to groups.

[00:24:44] Groups are great. Okay. And I'm not here to down anyone. Groups are great, but if you don't combine it with other forms of treatment, you are statistically short selling yourself from success.

[00:24:54] Mike: Well, and a lot of people hear treatment as, okay. I gotta go away for a period of time, but it can be a whole range of different...

[00:25:02] Dr. Kurter: Correct. I mean, there's residential, there's inpatient, there's intensive outpatient where basically you're still coming home. There's outpatient behavioral care you know, MAT you can see your physician provider in an office based clinic. So and, and for people who don't know methadone right now, which is still a very important segment of the addiction treatment options requires you to come every day. If you're in phase one in the first phase but Suboxone doesn't Suboxone is convenient office based depending on where you are and your needs and your severity, it can, can be weekly. It can be every couple weeks, it can be monthly.

[00:25:35] But eventually what happens is it's just very convenient. You can see your doctor in, in an office based environment.

[00:25:41] Mike: I'll let you tie a bow around this, cuz I know you're very busy and you've given me so much time, but what are the ingredients? So if you happen to make a cake of, of success, what, what do you wrap it up for us?

[00:25:52] What, what are the ingredients that you see that people can get off and turn their life around.

[00:25:58] Dr. Kurter: So first of all, you have to have, if you're, if you're the person afflicted, you have to have a desire to wanna get clean. You have to have a desire to wanna, wanna get treatment. Okay. And that's very important.

[00:26:08] You have to be ready. Okay. And I've had people, you know, come into clinic and their parents have forced them. And you know, sometimes there's help with that, but sometimes they, they drop out, but you have to be ready. Once you're ready then arm yourself with the awareness of what treatment options are out there.

[00:26:26] Okay. So effective treatment is first getting assessed. Getting your needs met, whether or not you need inpatient, whether or not you need detox, whether or not you need outpatient treatment, whether or not you can have access to MAT and mental health, but essentially you should have the option for MAT, medication assisted treatment.

[00:26:48] Meaning the option for Suboxone, Methadone, or Vivitrol. Mental health assessment to make sure that you don't have an underlying mental health problem. As I mentioned, 70 to 80% of patients who suffer from opiate addiction have an underlying mental health problem to get that treated, getting into therapy because even just recovery.

[00:27:06] Needs the processing of the therapy. Right. And staying in that treatment for a long period of time. What are we talking about? Long period of time, at least one to two to three years. So it's not a, I'm going to detox and I'm coming out and I'm done and I'm clean and I'm happy and everything. That's a fantasy, it's a long term recovery.

[00:27:27] Okay. And I connect to, to cancer. When you get cancer, you don't say all right, I'm just gonna do chemo for one month. And that's it. What do you do? You constantly are seeing the cancer doc. You're constantly getting, you know, you're getting some kind of recovery option. You're getting something, you're getting tested.

[00:27:43] You're going here. You're going there. It takes years. And even after that, you get tested to make sure it doesn't recur. Right. And that's the way to look at this. This is a chronic debilitating disease and you need, you need to treat it that way.

[00:27:56] Mike: That's outstanding. This has been terrific doc. Really appreciate you spending time with us today. So informative.

[00:28:02] Dr. Kurter: Thank you. I appreciate the opportunity and for the loved ones, that's caring for others that are suffering from this addiction. Don't give up. And from those that are suffering from this disorder, don't give up. Statistically speaking, if you keep trying more, more than likely you'll find success.

[00:28:17] Mike: No kidding.

[00:28:18] For those of you listening. I'll just echo that. Listen in next time. Stay safe, but don't give up.

[00:28:26] [END AUDIO]