The Partnership to End Addiction

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, and by a grant from the State of Wisconsin's Dose of Reality: Real Talks, remind you that opioids are powerful drugs and One Pill Can Kill. I'm Mike McGowan.

Mike: At the Partnership to End Addiction, the focus is on preventing and addressing substance use disorders by providing families, communities, and professionals with practical knowledge they can trust to support young people at risk or struggling with addiction. As the Vice President Consumer Clinical Content Development at the partnership, my guest today, Pat Aussem is responsible for developing services and resources relevant to the families they serve.

Mike: Pat has a master's degree in counseling psychology and is licensed in New York as a licensed mental health counselor and in New Jersey as a licensed professional counselor with a master addiction counselor certification. Prior to joining the Partnership to End Addiction, she was engaged in clinical work at a psychiatric hospital and has also supervised an intervention program for perpetrators of interpersonal violence at the Jersey Battered Women's Services. Welcome Pat.

Pat: Thank you, Mike. It's so good to be here.

Mike: Well, I'm so glad you could join us. We'll get to the reason that I ask you to be a part of this first, but not that this couldn't take up the whole podcast, but tell us a little bit about the work for the Partnership to End Addiction.

Pat: Well thank you for that softball question.

Mike: Yeah, right.

Pat: So the Partnership to End Addiction is a national nonprofit, and we're here to serve families and to really help families who are on the front lines of substance use. So whether it's your, kid just got home from school and you found a vape in their backpack and they're telling you, marijuana is organic and natural. So how bad can it be? Or you have a daughter who has been using IV heroin and is pregnant and is not interested in treatment. What do you do? And so we have a variety of services. We have a helpline, we have a text-based support service called Help and Hope. We have a group of peer parent coaches who have walked in the shoes of people who have struggled with substance use with a loved one, who provide peer support.

Pat: We have online support group meetings, and everything is free and confidential to families, both in English and in Spanish.

Mike: Wow.

Pat: And then there are a couple other things I wanted to add though. We also have a group of researchers who are just excellent at looking at how do we develop effective treatment for adolescents.

Pat: 'Cause it's a population where peer support, peer influence can be really important. And so how do you get through to kids? Especially given the state of mental health for many adolescents. So they're working on that. We have another group of people who are out in the schools and training healthcare providers on substance use literacy.

Pat: Just understanding what are the risk factors, what do you do, when does it go from being experimentation to a bigger problem? And then where do you go from there? And then we also have a group that's working with moms who are pregnant and or nursing who are engaged in some kind of substance use.

Pat: So it's quite a range of services in that arena. And then of course, there's policy work. So how do opioid settlement dollars get spent? What's an effective way of using that money, which is billions of dollars that are being dispersed to the states? And then also looking at things like what kind of protection should we put in place to ensure that we keep adult use marijuana, cannabis adult use, and not attract kids. So it's a lot of very interesting work. I have yet to meet anyone at the partnership who isn't extremely passionate about this work and what we do.

Mike: Well, I think you have to be to do this because there's a lot of ups and downs in it, right?

Pat: True. There, there is. (laughs)

Mike: Well, let's start with one of the things that you said families, when somebody gets into trouble or a family gets in trouble, they turn to the people closest to them, their own family sometimes. And I hear this a lot. Well, the lady who cuts my hair says and so they're not always getting great information. I read an article that you wrote about what would be effective if a loved one, like a teenager is using or suspected using drugs.

Pat: Yeah. So often, right? I think when parents' first reaction can be punishment, lecturing, I'm gonna drug test you, you're gonna lose your phone for a couple of weeks, and I think it's really important to open up the conversation.

Pat: And the first question is why and why in a curious way, not why in a judgmental way. But really asking what is going on with you that this seems to be part of your life. So for some kids it's going to be, it's social connection. Initially it's a lot of fun. For other people it's, my anxiety is off the charts and this helps me.

Pat: Or I am not sleeping well at night or I am bored. And so really getting at the why can be incredibly helpful. I was working with a family where their son felt very isolated. He wasn't really connecting with kids at school. He was smoking marijuana after school at home in his bedroom, and his mother had caught him a couple of times and didn't know what to do.

Pat: And of course, you'll have the neighbor that says, send him to rehab. And it's like, this is not something that you wanna send somebody to rehab for. (laughs) So we started talking about what's going on? And she said, well, I think he's bored. He also doesn't have a lot of friends.

Pat: So then we started talking about what are his strengths, and one of his strengths is that he actually is a reasonably decent tennis player. So she found group tennis lessons for him to take at a community rec center in the afternoon so that now he has something to do and that helps with the boredom.

Pat: Has something to do that helps with social connection. And does it mean he is gonna stop smoking? We don't know, but the bottom line is that we've put something, an intervention in place that is incredibly helpful. So that would be the first step in my opinion, is to just get to the why, the bottom line, why.

Pat: And then from there it's really trying to find out how do we move them in a healthier direction? What can we substitute and notice, right? Sometimes when especially older young adults end up struggling and they're coming home and they're high, four or five days, but they come home two nights and they're not high.

Pat: You gotta notice, you can't say, oh, well it's about time you came home sober and said, flip it and say, it's really great to have you here and fully present. So, noticing the positives, understanding the why, really understanding what your limits and boundaries are and what consequences you're going to impose.

Pat: And by the way, it really helps to impose and to tell the person about the consequences ahead of time.

Mike: Yep.

Pat: Rather than after the fact so that when you start to do something, you can think about, oh gee, I'm gonna be grounded, or I'm gonna lose these certain privileges, or what have you.

Pat: If I do something in the substance use realm.

Mike: Well, those skills and those interventions, especially by parents take a lot of support and some work because your first reaction is to react emotionally and a lot of times out of fear. And we're not at our best when we do that.

Pat: True.

Pat: And that's where I think the partnership offers a tremendous amount of support.

Mike: Yeah.

Pat: We're gonna walk with you hand in hand on this journey, wherever it takes you. So whether it's, you're looking to prevent or delay substance use, or you are in the thick of it. Or your person is in recovery and you're trying to figure out how do I support them? And we also support parents who have lost loved ones to overdoses, by the way.

Pat: So we have a number of service offerings and support groups for those folks as well.

Mike: Well, let's talk about that for a second. And for those of you who listen, you already know that there are links to the Partnership to End Addiction at the end of this podcast. But in addition to your work with the partnership, you're on the Board of Community and Crisis, a local nonprofit in New Jersey focused on ending the opioid epidemic.

Mike: The numbers are down a bit, but we got so much work left to do.

Pat: Yes, we certainly do. So when you look at the numbers, they're down to around 80,000 people that we have lost to overdoses. I think about those families, 'cause I've worked with some of them personally who are just so struggling with the heartache.

Pat: In many cases, they didn't know what kind of treatment was available. They didn't know how to improve safety while they were waiting for treatment 'cause in many cases their wait lists or people don't have insurance or they have work responsibilities and they can't get there, or childcare responsibilities, or they don't have transportation or they don't have housing.

Pat: And so it makes it incredibly difficult to get the help you need, especially in those moments where you are really ready and able to go.

Mike: You were telling me before we started this that the partnership has started a new YouTube series and one of the videos that you have is for underserved populations because they have a very difficult time accessing help.

Pat: Yeah. Thanks for mentioning that. We recently did some research predominantly with black families, and they raised a whole host of barriers. They're not unique necessarily to black families, but certainly ones that they face. So certainly you would expect transportation issues, not having insurance or being underinsured, wait list, but also going to a facility and not seeing anybody that looks like you.

Pat: So you know or understands the culture. So one of the things as a country we need to do is really figure out how do we engage more people of color in this helping profession so that when people do need treatment they see faces who understand, speak the language and, and so forth to try to help.

Pat: But even more than that, I think when you look from a policy perspective, as you know, right now, there are significant cuts to Medicaid that will be happening. Medicaid serves a majority of their population who have substance use problems. So now all of a sudden the overdose numbers have been declining in part because people have had access to healthcare. Also because of Naloxone, which is the overdose reversal medication, and there have been steps to improve safety in terms of our drug supply and drug use.

Pat: And many of those things are going away.

Mike: You mentioned the black population. You could have also been speaking about the rural population in our country where the services without Medicaid funding. We've talked to people whose programs have gone under, they can't be funded anymore or I know a lot of therapists who aren't accepting certain insurances 'cause reimbursement is so low.

Mike: So talk about public policy for a minute. What does a responsible public policy look like when it comes to addiction and mental health.

Pat: Well, I think there are a few things. One is I think we've gotta start using prevention measures that work. That we know work. So the D.A.R.E. Program actually taught people that there are police officers that can be friendly (laughs) as opposed to really helping understand the prevention aspect of it.

Pat: And in terms of prevention itself, it means screening. So I know when I had kids. Go to the pediatrician and we'd count fingers and toes and how much do they weigh and how long are they? And then as they got older it was checking their hearing and whatnot. But really honing in on mental health for both the, not the only the kid, but their parents throughout the lifespan I think is going to be really important and not treating the brain and the mind as if it's not connected to the physical body.

Mike: (laughs) Right.

Pat: Really, focusing on that aspect. And to some extent it's being done in some schools and in some pediatrician offices, but it needs to be widespread across the country. So certainly the prevention angle is really important. And by the way, I would be remiss if I didn't say it's really important to delay substance use.

Pat: One of the messages that we try to drive home to parents and caregivers is delay, delay, delay. Because if kids start using when they're, say 15 years old, they have a one in four chance of actually developing a substance use disorder, as opposed to if they wait until they're much older. And by the way, the brain continues to develop, as you probably know, till you're in your mid twenties, which is why like rental car companies won't rent you a car unless you're 25.

Pat: And it's because of brain science and brain development. So anyway, that's the prevention realm. I think second part of it is making treatment accessible and affordable. So part of it really means taking another look at Medicaid and other avenues to help people access and afford treatment.

Pat: Access again in terms of getting there is important. So that may mean being more creative with telehealth, it may mean doing things like they do in Europe. So as an example, in Europe, methadone isn't in a specialized clinic that you have to go to every day. And we had a one of our peer parent coaches had a child that was struggling with opioid use.

Pat: And she lives in Utah and she was driving three hours one way every day to get this kid methadone. So in Europe it can be offered in your local pharmacy. So think about just that change in dynamic and even buprenorphine, which is another medication for opioid use disorder, can be very difficult to get in some places.

Pat: So we've gotta figure out a way to make the medications that are effective available. And to get quite frankly, healthcare providers to offer them. So I think those are a couple of things that, at least in the policy realm we need to work on. And just overall stigma, it's like this is a health issue.

Pat: Say what it is. And people can be treated, but they need effective treatment. Some of the treatment providers. That are out there are pretty shady, and they will keep people and kind of churn them and to get the insurance money and what have you.

Pat: And they play at the heartstrings of families who are desperate for help. So we really need to be a little bit more vigilant with bad actors.

Mike: Those are all great and we've been doing this long enough now that we have the data right, that when we don't do prevention. When we don't spend money on prevention, the costs go up.

Mike: And the deaths go up. You mentioned the opioid crisis. It's interesting 'cause that's part of the reason that I called you. When this started we started with Vicodin, right. And Oxycontin. Then the policy change and then we went to heroin 'cause it was cheaper. And then Fentanyl, which if you don't know Fentanyl by now, you have been in a closet.

Mike: And now we've added xylazine. Something called nitazines. First, what, nitazines?

Pat: So nitazines are another synthetic, manmade, lab made substance and it's even more powerful than Fentanyl. It ends up being like whack-a-mole. So I know there are some people that are very interested in scheduling Fentanyl to make it schedule one drug so that it is not to be used for any purposes.

Pat: If it's synthetically made, of course people should know there's Fentanyl that you can use in a medical setting. But this is Fentanyl that is coming in from other countries into the United States, and obviously largely responsible for the overdose deaths that we've seen.

Pat: And it's been mixed into, as you've probably talked about on your show, different counterfeit prescription medications. Like Xanax and Percocet and so forth. But you know now since there are a lot of focus, it's like we've got the spotlight on Fentanyl, and so now people are becoming more creative and part of that creativity is putting nitazines out there, which is, as I just mentioned, are more powerful than Fentanyl. And they're cutting the drug supply all the time. So you mentioned Xylazine, which is a sedative. There's Medetomidine is another one that is being used and it makes trying to help someone who's in a crisis with an overdose that much harder.

Pat: So really helping people that are in a position to provide medical support, really helping them understand what signs to look for. So beyond offering Naloxone, many of them are doing CPR or providing oxygen and doing things like that to really try and help save a life.

Mike: Well, because, unlike if it's heroin and you do a little naloxone, and I don't know if you've seen it.

Mike: I've seen it three times now. It's so bizarre. The person literally looks like they're about to die and two minutes later they're talking to you.

Pat: Right.

Mike: But with the new substances, the synthetic, it might take more than a squirt.

Pat: It might, and that's where things get tricky. Because you don't want to bring on precipitated withdrawal, which is extremely painful.

Pat: And in many cases somebody might then decide, the best thing that I can do to address this withdrawal is go out and use something else. Right. So there's that aspect to it. So really understanding what is needed and how much is important. It's tricky for a lay person. I am guessing it's probably tricky for some of the EMTs that are arriving as well.

Mike: Well, sure. And especially in an ever-changing environment where you literally come on something and you don't know what they took. We've had people on Pat, and I know you've worked with them and talked to them, whose sons or daughters thought they were taking a Percocet or thought they were taking a Xanax and when their blood chemistry was analyzed, it turned out to be like a hundred percent Fentanyl instead.

Pat: Right. Yeah. It's really difficult. I know the social media platforms have talked about putting guardrails in place to try to prevent that, but as long as you've got a cell phone...

Mike: Yeah.

Pat: Some people have described it as a dealer in your pocket, and I think that's one thing that it's important for parents to understand is that if you are equipping your child with a cell phone, smartphone, they have access to social media platforms typically, even though they'll say there's an age restriction.

Pat: Easy to get around it for the most part. There are people that are advertising constantly to attract people to their websites to buy substances, and then it shows up in the mail as some benign package or maybe at a friend's house and so forth. So it's important to be vigilant.

Mike: Well, speaking of age restrictions, I'm in Wisconsin and we are surrounded by states who have now legalized marijuana.

Mike: And there's even talk at the federal level of legalizing it 'cause they put their finger in the wind. Right?

Pat: Right.

Mike: But I work a lot with youth and I know that's your main focus. What does marijuana do to youth?

Pat: So it's really interesting. Marijuana is a substance that has changed so much over the decades. So in the 1990s, the ingredient in marijuana that gets you high, THC was 4% potency. Today it can be 99% potency. So think about that. I mean, it's just extraordinarily powerful. And many of the research studies that have been done to date have been done with much lower levels of potency than what kids are actually exposed to today.

Pat: That exposure, because their brains are still developing, can result in increased anxiety. It can increase depression and suicidal thinking. And also it can lead to psychosis. One of the things that I was asked to do not too long ago was a presentation for, on behalf of Rutgers, for the hospitals in New Jersey, which is where I'm from.

Pat: And one of the things the hospitals were experiencing was kids coming into the ER and they were having psychotic episodes, so hallucinating, paranoia, seeing things that weren't there, hearing things that weren't there, et cetera. And it turned out that it was because of their substance use.

Pat: One of the concerns is that if you have an episode with marijuana, a psychotic episode with marijuana, it can lead to schizophrenia, which is a very devastating mental illness that I wouldn't wish on anyone. And so one of the biggest risk factors for marijuana use is, is that. Another thing that we're seeing is cannabis hyperemesis syndrome.

Pat: Some people call it scromiting. Screaming and vomiting at the same time. So the marijuana that someone is using just overwhelms their cannabinoid system, which is we have cannabinoids throughout the body, and as a result, they have chronic vomiting. So what do people do? They see chronic vomiting and they think, okay, I must have food poisoning or something.

Pat: They go to the ER. In the ER they rule out gastrointestinal issues. And they... now hospitals are more likely to ask you about cannabis use. But the only thing that really cures that is to stop using. And then the other thing that I worry about with youth a great deal, is driving.

Pat: So kids seem to have gotten the message about drinking and driving.

Mike: Yeah.

Pat: But when it comes to cannabis use, you'll hear people say, oh, I'm a much safer driver than when I'm under the influence. So a couple of years ago there was a really terrific study done where they took 200 people, who were experienced drivers by the way, and also experienced cannabis users.

Pat: And they said to them, we're gonna put you through a simulation where you are stone cold sober. And then we're gonna have you smoke, and then we're gonna put you through the simulation again. And we want to know when do you think you are clear enough to drive? So the answer to the question for the people that you know, on average was after 90 minutes, I'm good to go.

Pat: I can drive just as well as I did. In the first test where I hadn't smoked anything, the real answer was four and a half hours.

Mike: Wow!

Pat: So one of the things we wanna drive home is that if you are an adult and you're smoking or eating cannabis products or whatever, you need to wait to drive. I think Colorado has established a benchmark of six hours or more. And start using ride services or public transportation or what have you.

Pat: And I think it's for kids. It's really driving home that message that we don't want you getting in a car with somebody who is under the influence of cannabis. Call home or text X to your parents and they'll make an excuse for why they have to come and get you so you don't have to out yourself to your friend and say, I'm calling my mother because you know, you've been smoking weed and she told me not to get in the car. (laughs)

Pat: You know, that kind of thing.

Mike: I think it's great. Again, it involves a lot of education and nobody says that everybody who does smokes marijuana is gonna have... But we're saying it's not without risks.

Pat: Correct.

Mike: Yeah.

Pat: I mean, and we're not opposed to what an adult population wants to do. People can make their decisions about how they wanna use any substance for that matter.

Pat: But when it comes to adolescents, we just know so much about the developing brain that we didn't know years ago and really understanding that this has the potential to change the trajectory of your kid's life...

Mike: Forever.

Pat: Forever. Yeah, yeah, absolutely. Forever. And even if, you know, (sighs) for some kids it may be that they get to college and instead of doing chemical engineering degree, they decide to do something lesser because they're getting high every day. You know, it's that kind of thing too. So it may not be as devastating as schizophrenia, but it certainly can change the course of your interests and what you're passionate about.

Pat: So, just something to consider.

Mike: I want to give you a couple of softballs as we end, since I started with one. People who say, oh, none of this stuff you guys do works. It's like bologna. You know look at what we did with tobacco, right? And especially with youth. And then now we gotta deal with what vape?

Mike: And when we started focusing on that, now we go to nicotine pouches. It's always something. So our policy has to be, Pat, more than drug of the month club.

Pat: Right. I think that's a great way to phrase it, because it does feel like it's the, as you mentioned earlier, it was the pain pills and the heroin, then the Fentanyl, then nitazines, and then it was vaping.

Pat: Is it vaping nicotine? Is it vaping flavors? Is it vaping marijuana? The nicotine pouches and so forth. There are so many formulations of every substance out there. So I think the real key message is to really understand and to help especially youth understand again, why are you attracted to this?

Pat: And by the way, interestingly enough, we're doing some work in Westchester County in New York, where they're really focused on kids' mental health.

Pat: And kids will now go to parties and say, I'm not drinking tonight because I know it makes my anxiety worse.

Mike: Yep.

Pat: Right. The Gen Z and younger are actually getting the idea and in fact, we've seen overall substance use declining. But I think it's really focused on what's the lifestyle you wanna lead and how can we help you be your best self and feel good about yourself and really put the interventions in place or really even creating the environment so that it's more focused on a healthy lifestyle as opposed to let's look at the drug of the month.

Mike: You sort of already answered my last question in a way or led into it, but we have a lot of practitioners who listen to this show. So how do you, because you and I have both been at this a long time and I get asked this question all the time, how do you maintain your optimism and keep yourself from getting burned out when you're working with some really difficult stuff every single day?

Pat: I look for the small wins. So when a family tells me that they had a phone call with their child who they haven't talked to in months, to me, that's a win. If somebody's sober for a weekend and they are sampling sobriety or they try to do sober January for two days that's a win.

Pat: Or dry January for two days, that's a win. So I look at that, but I also put time on my calendar every day for me. So I love exercise, so I'm out actually training for a half marathon, so I'm out running most days. (laughs) But I do that. I also have peers that I talk to who are, so kind of a peer support group, if you will, of other clinicians who we can kind of talk through things together.

Pat: But I am so hopeful about what we have the potential to do to together. I just think that we know the answers. We just need to be better and stronger together as a community to communicate those answers and to really turn the tide on addiction. The name Partnership to End Addiction.

Pat: Right. It, it's may sound like the moonshot. But the idea is we know it's preventable, which is the delay, delay, delay message. And we know it's treatable if you have the right treatment paired with the person. So that it's not a cookie cutter approach, but we pair with what's gonna be effective for that individual.

Mike: I love that you ended with your name. And I'll emphasize it. That's absolutely true. My entire family is littered with addiction and I didn't get the disease. And so we know you can, you can end addiction individually.

Mike: Pat, speaking of time, thanks for taking the time with us today and thanks for your work and dedication.

Mike: As I said before, there's links to the Partnership to End Addiction attached to podcast. For those of you listening and watching, you know how we're gonna end this. We hope you find hope, courage, support wherever you are. Thanks for listening. Be safe.