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Ep. 22 - LiveWell Talk On...Addiction Services (Matt Rocca, ACADC)

episode 22

Ep. 22 - LiveWell Talk On...Addiction Services

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Host: Dr. Dustin Arnoldchief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Matt Rocca, ACADC, program manager, St. Luke's Chemical Dependency

Dr. Arnold: This is LiveWell Talk On...Addiction Services. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. Substance abuse and addiction can be difficult to overcome. At St. Luke's we provide a wide range of services in our intensive outpatient treatment program. Joining me to talk more about addiction services at St. Luke's is Matt Rocca, program manager at St. Luke's Chemical Dependency. Thank you for coming by.

Matt Rocca: Thanks for inviting me, Dustin.

Dr. Arnold: You know Matt, you and I've had these conversations on this topic before, but let's start with some basics. You know, what, what is the most commonly abused substance that you see in, in, in your service line?

Matt Rocca: Sure. So certainly what we've seen, as long as I've been doing this work whether it's across the state or across the country, there's still nothing that compares to what alcohol and the negativity that substance has on our society and the individuals that we see in treatment. So alcohol is still far, far and ahead of away of all the other substances. So the data we do collect across the state of Iowa certainly does shed some light on some of the other substances, which would include for years we would see about 40 to 45% of people entering treatment, their primary substance was alcohol. Second to that very close though was marijuana. There was still hanging right around 40% we've seen a little bit of a shift in that in the last oh 10, 15 years or so where marijuana is sliding down a little bit. They're not getting into treatment as commonly as they used to for that substance and replacing it, though we've certainly been seeing the opioid use getting people into treatment. And to counter what the opioids are doing to people and how they're feeling, we're seeing an increase with methamphetamine also, amphetamine based substances, specifically methamphetamine getting patients into the treatment center, so alcohol is still out there, but some other substances are unfortunately trying to catch it.

Dr. Arnold: Would you say that methamphetamine is increasing then use still starting to climb?

Matt Rocca: Absolutely. The way we saw methamphetamine spike about 20 years ago across the country, across the Midwest, across Eastern Iowa. We saw a little spike then with again, the number of people using it resulting in getting into treatment. That's the only way we really know what's kind of what's going on. And then we're starting to see that again, just in the last five years across the state of Iowa, the data is starting to show, that methamphetamine use is increasing and we're connecting it with the opioid epidemic.

Dr. Arnold: That's, that's a distinct possibility. I read an article once about how that, the measures we were taking, the decrease methamphetamines in Iowa specifically was actually making the problem worse because we couldn't get Sudafed or the counter, the sheriffs are shutting down these meth labs that can make, and I'm going, this is hyperbole can make a pound a week. Well then the Mexican cartels can make a pound an hour. And so they, they really kind of muscled in when the local stuff dried up. So the best effort to fix a problem leads to another problem. And I, and I think that's that that's kind of the nature of chemical dependency and addiction services that often people try to fix one problem while making another problem worse. You know, you get the people try to get off alcohol and started using Valium, you know, and neither is the right way to do that

Matt Rocca: When using substances, if it's their coping mechanism of choice to deal with something that they're uncomfortable with, if you know they're mad, sad or angry, they don't understand how to deal with it. If they for some reason something changes and they can't use their substance of choice, absolutely. A lot of times what we're seeing they'll switch to another substance.

Dr. Arnold: Fill that gap.

Matt Rocca: They will, absolutely.

Dr. Arnold: Let's just take alcohol. Let's start with that one. If I'm having trouble with alcohol and I present to your service, what's that look like? What, what should I expect?

Matt Rocca: Sure. At St. Luke's chemical dependency, we are in our treatment programs and on an outpatient basis we do not do inpatient or residential substance abuse treatment. Nobody lives where we're at. In all the outpatient services that we offer, we are very group heavy. So we're going to put people into a group for treatment where they can be surrounded by 10 to 15 other people going through the same thing because we think that's the best way to get them connected with other people trying to make positive changes. So we don't do a lot of individual sessions and a lot of people really look for those and want them, which is good. We can get them connected with places that do offer that. But again, we just think, boy, if you're can be surrounded you know, some of our bread and butter programs two, three, four days a week with people that are going through the same stuff, that's going to be a good experience for them.

Dr. Arnold: You know, when I was a medical student, we, we were encouraged and we did attend a AA meeting just to, just to see what goes on. And so that, that's almost kind of the principles of AA is this sort of group mentality, you're not in this alone. And here's other people that have had the same problem and, and we can rely on each other and that's, that is powerful.

Matt Rocca: That fellowship piece in treatment is absolutely a big piece to success with recovery is finding those people to go through it with.

Dr. Arnold: Of the people that you work with, what's, what's the percentage that five years later they're recovered.

Matt Rocca: The term recovered, you know, is is a term that we're kind of cautious with using because we'll say it's lifelong, we'll say they'll be in recovery for the rest of their lives and that's a tough message to sell some individuals aren't aware of it. So our job with a lot of patients is really to try to offer some insight into that, that if you've experienced some success and haven't used for five years, we don't want you to minimize that. We want you to understand the importance of maintaining all the disciplines and changes that you made in your life to get to that five year mark, you're going to need to continue with those to get to six years or to get to five years and one day. You know, we're very one day at a time, but for an order for that to be maintained, we're going to say all those changes you made, you can't let up on them. You really got to keep those as a priority. Or some of this old stuff, old behaviors will start to sneak back up. So that recovery recovered concept we really tried to focus on a little more is it's lifelong. You're going to be dealing with this a long time from now, and that's okay. You know, it's an acceptance of the severity of it, which is something we try to help them all understand.

Dr. Arnold: Well, as the Bible says the flesh is weak, the spirit is strong.

Matt Rocca: There you go.

Dr. Arnold: You know, if you don't keep that strong spirit. People that have other concerns, particularly lets drift in to marijuana. You know, I, I know you and I have had these conversations before and we're going to keep that conversation going today. What, what is its addiction potential for marijuana?

Matt Rocca: Sure. Well, we would say it's no different really than any other substance, just because primarily it's a mood altering. Okay. And again, whether you're using it recreationally because you want to, because it's an easier a way for you to feel like you're having fun, the kind of fun you want to. Or again, you're using it as a coping mechanism of choice. Bottom line is it's still a mood altering substance that no different than any of these other substances. It's for, especially for marijuana, some of the others that's illegal. It's unhealthy. It's not only addictive, but it is that, that causing those problems in an individual's life when they think they're using it maybe to cope. And I need it for this reason, but they're forgetting about all the other problems that arise from it. So we just try to put it all together and help them understand. It's a mood altering substance. You know, it's one that's got a lot of unhealthy properties to it and ideally they come to that realization, wow, what I liked, what I got from it versus what I don't like I'm getting from it. Hopefully they see that kind of outweigh.

Dr. Arnold: Yeah, and I think it's, I think whether it's social media or pop culture minimizes the harmful potential of that. And it's much like I used to for personal reasons, family reasons, you know I hated the show Cheers because it's not glamorous to sit in a bar for all evening when your family is at home, you know? And I really thought that, that, that kind of, you know, that was a put up as entertaining and funny and you know, I saw that differently and you see, I mean it's happening all over again with marijuana. It's becoming, you know, vogue, recreational, and you see the cycle again. People are making a lot of money off a mood altering substance and the people that are making the money are the ones telling you that it's fine. Where have we heard that before? Purdue pharma in opioids, you know, they pushed opioids, oh they're not addictive, you know, so we've seen this before and it just, we fall right back into it that, well, it's must be safe cause it's legal in and in that way. And it is concerning. I do not think it's a benign substance.

Matt Rocca: Yeah. I think the greatest negative impact that we're starting to track in states like Colorado is starting to show us with their changes with their laws and what the minimization that we're starting to see the impact that it has on minors and young children because it is in their households and it is resulting in increased teen use of that substance resulting in vehicular accidents and emergency room visits. You know, young infants with exposure, young children with exposure to highly potent forms of marijuana resulting in whatever sort of a negative influence it has in their mind and body resulting in emergency room visits. Negative impact on academic performance and attendance. I think all those markers are starting to be seen in some of these other states where they've made some changes with their laws.

Dr. Arnold: You know, Libby had a, my oldest, you know, Libby had a book report and she, we were talking about the movie, the book, excuse me, Brave New World by Adolf Huxley. And in that dystopia the people took Soma, was the drug they took to kind of make them passive, you know, so that they just accepted the dystopian state and were always happy all the time. And you know, you kind of see a drift in towards that with marijuana. Oh, it's just, it's, it's benign. It's CBD oil with a little THC and you can take it and it, it, it just, it's like snake oil, you know, it cures everything and that minimization I think is really gonna hurt us in the long run. It really is. And that, and I'm not even gonna get into the medical aspect of the detriment, just the mood alteration in the dependency and setting that up is, it's alarming. It really is.

Matt Rocca: I would agree.

Dr. Arnold: I remember, I graduated high school in 87 and you know, there were probably one or two kids that smoked marijuana on a regular basis and nobody really wanted to hang out with them. You know, now it's the opposite. There's one or two kids that don't smoke marijuana and you know, they're the kind of the outcast and that's, that is disturbing because we will pay that price socially as time goes.

Matt Rocca: And ideally we will still try to even educate family members and the few miners that we work with, there's still actually more people in society that don't use substances than do. And sometimes we need to remind them of that, that they think, well everyone does it. And all my friends do. Well, you know actually no. You know, actually if, I think if you looked at some data that would show the percentage of people that are using it all versus having addiction, he put them all together. There's still more people that don't use substances than do and that's still an inspirational point we like to offer to them. They're out there. You just got to find them.

Dr. Arnold: That's a great point Matt, because I think sometimes in medicine particularly, you know, every patient I see that smokes has emphysema. So, you know, I just think everybody that smokes has emphysema, but it's only about 15%, but the ones that I'm seeing are the ones that have that. And in the same with me, if you're thinking well everybody must smoke marijuana cause all the people I see do cause your line of work. And that totally makes sense. Even with marijuana, it's group therapy.

Matt Rocca: Absolutely. Regardless of the substance we're going to say there's more similarities than differences regardless of the substance. So are there very unique things to each class of drugs where somebody might come in that we don't want to ignore? Yes. But when they start to distinguish themselves, sometimes it's our job to remind them you've got more similarities with the people sitting next to you than differences when it comes to the amount of change you need to make in your life. Significant challenging change to improve your life on your terms and not on our terms, but you know, by way you've conveyed to us, you want life to be different and better not using, changing that more similarities than differences is a big concept we send them.

Dr. Arnold: Now the, the service line is limited to chemical dependency. You don't do gambling and other addictions?

Matt Rocca: Correct. We don't do the process addictions.

Dr. Arnold: Is that what that's called? Process addiction. Okay. I did not know that.

Matt Rocca: The shopping, the spending money, gambling, food, sex you know, those sorts of addictions, pornography on the, on the internet. We've got referral sources certainly that we'll get those patients connected to if they need it.

Dr. Arnold: Yeah. I think much like television, the internet has been a great addition for mankind and also brought a lot of negative and that unfortunately. Well how did you get into this? What's your training? Take me through that.

Matt Rocca: You know, when I first got out of college and I went down to the University of Iowa to study sports psychology, a master's program that does not exist there any longer, but it was a good program but it was focused a lot more. There's only four of us that started that year and it turned out to be a lot more performance enhancement than counseling. So we were just kind of learning about that and we were really interested in the counseling aspect with athletes versus helping them make more free throws and make more putts playing golf. So after that I got into work down in Iowa City at a, at a group home for chronically mentally ill. So a lot of those individuals as we know also have substance abuse issues. And i found that kind of fascinating learning about it. I was there just about a year or so, and then one of my mentors there, a supervisor, encouraged me that I might be a good fit for some chemical dependency programs that have young males in their minor males cause they needed maybe an adult male role model that was very positive. And treatment centers, a lot of times they're really looking for males that are into the counseling field. There are few and far between. So I started doing that and I kinda cut my teeth. The agency that I worked with across town Area Substance Abuse Council, I did that for about 10 years, 12 years, and had a great experience and then had the opportunity over here and you know, once you to do something for 20-25 years, which is right about where I'm at. You kind of, you get a feel for it, you get confident with it and it's worked out well. You know, I just really feel like we know what's going on in the world of addiction in Eastern Iowa. You know, regardless of what we see sometimes on TV and what's going on in New York City or Los Angeles, what's going on with their drug trends. We like to think we know what's going on in Iowa. That's what we want to be experts on is what's going on in Eastern Iowa.

Dr. Arnold: Well and it's so concerning how meth and opioids have affected rural Iowa, small town. Some towns are just devastated, you know? That's really sad. Particularly just the heritage we have of those small towns.

Matt Rocca: Yeah, we're built on Iowa's rural. You're right. So to see that happen in a state that we've grown up in the way you and I have, yeah, it can be sad at times.

Dr. Arnold: That's really great information, Matt. I appreciate you coming by. I'll say this, your, your team is such a benefit to the, the doctors that work in the hospital because we don't understand these resources. We don't know. We know the person needs help and we, you give us great guidance and we're very, very, very thankful for your presence on the floor. Once again, that was Matt Rocca, program manager at St. Luke's Chemical Dependency. For more information, visit unitypoint.org. If you have a topic you'd like to suggest for our LiveWell Talk On... podcast, shoot us an email at stlukescr@unitypoint.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.