While addiction is recognized as America's No. 1 public health problem, very few medical schools require or even offer education on substance use disorders. Listen in as host William C. Moyers talks with three medical students who shadowed clinicians and patients during weeklong educational "residencies" at Hazelden Betty Ford treatment centers. The students share what they learned about the pervasive, complex and treatable disease of addiction—and how to best help future patients and their families. Read the podcast transcript below or listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:14 William Moyers Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues that matter to us and the issues that we know matter to you, too. Substance use prevention, research, treatment of addiction, education, recovery management, and advocacy. I'm your host, William Moyers, and when I went to treatment at Hazelden 30 years ago, most medical schools in this country taught about this much [gestures to indicate a tiny amount] when it comes to the issues that had caused me to go to treatment at Hazelden. 30 years later, most medical schools provide their students with about this much [gestures] when it comes to those issues. Fortunately at Hazelden Betty Ford, we have a program specifically designed to educate medical students on the issues that really matter: addiction, treatment, and recovery. Those medical students apply and are accepted based on their applications. They get to come free of charge thanks to the support of our philanthropic donors. And they come and they spend a week immersed in the treatment experience, either in Rancho Mirage, California or in Center City, Minnesota where we have two of our main facilities. 0:01:24 William Moyers [continued] This past summer, the summer of 2019 approximately a hundred and ninety students in medical schools from around the country and the world experienced the SIMS program and here today we have three of those students who have gone through the program. Katie Ferree, thank you for being here. 0:01:43 Katie Ferree Thanks for having me. 0:01:44 William Moyers You're welcome. Heather Oas. Thank you for being here, Heather. And Brooke Hendricks. Brooke, you are at the University of Minnesota. 0:01:53 Brooke Hendricks Yep. 0:01:54 William Moyers And I wanted to start with you by asking how was it that you found out about the SIMS program? 0:01:59 Brooke Hendricks So I found out about the SIMS program because like you mentioned, we really don't get much exposure at all to learning about substance use disorders in our first year. And based on an experience I had living and working in Syracuse, New York, prior to medical school and getting involved with a syringe exchange programs in a Suboxone clinic there, I had this big interest in Addiction Medicine. So, decided to seek out ways outside of our school curriculum that I could learn more about it. And that's how I found the Betty Ford SIMS program. 0:02:33 William Moyers Heather, you planned on practicing Emergency Medicine? 0:02:36 Heather Oas Yep. 0:02:37 William Moyers Why did you wanna come to the SIMS program? 0:02:40 Heather Oas So I worked in an Emergency department before I started medical school. And I saw a lot of patients who visited our department who were suffering with substance use disorders and I knew that as an emergency provider, I needed to be well-trained in Addiction Medicine in order to provide better care for those patients. So that was the biggest draw for me. 0:03:01 William Moyers And Katie, what was the interest that you—congratulations by the way you just graduated from medical school. 0:03:05 Katie Ferree I did. Thank you. 0:03:06 William Moyers What was it that compelled you to wanna come to the SIMS program? 0:03:10 Katie Ferree So, I have family history with addiction. I have my sister who is now 13 years into recovery. And living and thriving and just doing wonderful things. So, I experienced addiction firsthand when I was young and a teenager. And I saw what it did to my family. And I saw the strength that my family had coming out of that experience. So I wanted to go into addiction and connected with two other naturopathic doctors that had gone through the SIMS program themselves and encouraged me fully to apply to it. And it was just serendipitous when I found out about it and here we are. 0:03:44 William Moyers Let me follow up with a question to you. 0:03:44 Katie Ferree Sure. 0:03:45 William Moyers So you came in with some pretty intimate knowledge— 0:03:48 Katie Ferree Yeah. 0:03:49 William Moyers Based on the family experience and thank you by the way for sharing that. 0:03:52 Katie Ferree Absolutely. 0:03:54 William Moyers You came in with some expectations obviously. Were you surprised when you went through the program? 0:03:58 Katie Ferree I was. My sister is one in a million. She never went through treatment. She went through detox and withdrawal on our family couch and I slept next to her. So I didn't know what a treatment was. I didn't know the Twelve Steps. I didn't know anything of that nature. So, it was a wonderful experience in the SIMS program to understand from admittance to detox in MSU to being admitted to the different units on the Center City campus. And seeing the support and encouragement that everybody gives each other while they're in treatment. 0:04:32 William Moyers Heather, what was the biggest takeaway for you from the week that you spent? I think you were in Center city as well, correct? 0:04:37 Heather Oas I was, yes. 0:04:37 William Moyers Yes. 0:04:38 Heather Oas You know, I just found it really inspiring that I think the way that not just the medical profession but society in general the way that we approach and perceive addiction as a disease is changing and the way that we approach treatment towards addiction is changing as well. And so for me a really big takeaway was just being around other medical students and future providers, future colleagues. And just knowing that we're getting that education and that you know that gives me a lot of hope for the future. For patients who are struggling with this disease. 0:05:12 William Moyers Brooke, what kind of relationship did you develop on the unit? I mean you were there for a week— 0:05:17 Brooke Hendricks Mmm-hmm. 0:05:17 William Moyers But it was only a week. 0:05:20 Brooke Hendricks Right. I think one aspect of the SIMS program that really like promoted that relationship development was the opportunity to be part of a therapeutic small group. And to be in that same small group throughout the week. So I was in a day treatment small group which most of the SIMS students at Rancho Mirage that week were in an inpatient small group. So we had slightly different experiences which was really interesting. Because many of the other medical students were interacting with patients who maybe had just been there for a few days. Who were maybe still going through detox, still adjusting to being at the Betty Ford Center. And my group was more about planning on what's next. How do we maintain recovery? How do you find a meeting, find a sponsor? And that was really interesting to me because as I hope to work in the outpatient setting, I think that that is really where I'll meet patients. And so, it was just kind of a cool coincidence that I ended up in this outpatient treatment group. Who really like welcomed me and allowed me to share and to hear their stories and to really learn about their experiences at Betty Ford. 0:06:32 William Moyers Heather, you talked about—we talked earlier and you talked about the connection with the patients. But there were also lectures from clinicians. 0:06:39 Heather Oas Mmm-hmm. 0:06:40 William Moyers What were some of the takeaways you had from listening to some of the experts talk about these issues? 0:06:45 Heather Oas One big takeaway for me is just the change that is happening with treatment in terms of using medication assisted treatment. I think that's still a relatively novel approach to treatment. And, you know, it was really great to get that education because as you mentioned we really don't get a lot of that in medical school— 0:07:02 William Moyers Mmm-hmm. 0:07:03 Heather Oas And so, to hear from people who are firsthand using these types of medications to assist with treatment and approaching it as a way of having a long-term solution to a disease that is chronic, you know I think a lot of people think you just go to treatment for thirty days and then boom, you're cured. 0:07:19 William Moyers Mmm-hmm. 0:07:19 Heather Oas And that's really not the case. And so just knowing that there's providers out there that are, you know, approaching this in a long-term way was really informative and learning more about how I'll hopefully be able to do some of that in my practice as well was really important and I'm glad I got that experience. 0:07:36 William Moyers I wanna ask you all three the same question and Katie I'll start with you. I'm intrigued that you're pursuing neuropathic medicine— 0:07:45 Katie Ferree Naturopathic. Yes. 0:07:46 William Moyers Or naturopathic medicine. How do you—how are you going to apply what you've learned at SIMS and what—your interest in addiction as it relates to naturopathic? 0:07:53 Katie Ferree Sure. So I've always said there's a time and a place for all medicine. That holistic approach that Hazelden provides is exactly where I've always seen my practice or my future patients' treatment. We always need that medical stabilization unit. We need the detox. We need allopathic medicine to support in that way. We need allopathic medicine through recovery— 0:08:22 William Moyers Mmm. 0:08:22 Katie Ferree But through treatment and through recovery we also need to treat the whole person. Naturopathic doctors find the root cause. [Moyers nods] So if we can find a root cause and the possible connections of genetics in addiction, let's figure out how we can maybe treat a MTHFR mutation. Or a COMP-T mutation. And see if by treating that, we can decrease the chances of relapse in the future. 0:08:45 William Moyers Aah. 0:08:45 Katie Ferree In the same token, let's talk about nutrition and micronutrient deficiencies and support them in their treatment in recovery through a balanced diet. And giving them back that control of these are the foods that are going to nourish you. 0:09:01 William Moyers Mmm-hmm. 0:09:01 Katie Ferree These are the foods that are going to feed your body and feed your soul. So maybe your withdrawal is a little bit easier. 0:09:08 William Moyers Hmm. Mmm-hmm. 0:09:08 Katie Ferree Or your cravings are a little bit less. Things like that. 0:09:12 William Moyers Heather? Where do you plan to apply some of what you've learned? How are you going to do it? 0:09:20 Heather Oas So, you know, as a medical student, I'm hoping to take away a lot of just that attitude, that reduced stigmatization of substance use disorders. And spread that around with my classmates and future colleagues. And just, you know, I wanna reduce that attitude towards addiction that I've seen so much of. And you know I wanna apply that going forward so that, you know, these people aren't afraid to come forward and ask for help— 0:09:44 William Moyers Mmm-hmm. 0:09:44 Heather Oas Because help's there and there's people that are working to provide that assistance for those who need it. And you know just doing whatever I can to reduce that stigma I think is the big takeaway for me. 0:09:56 William Moyers And Brooke, we talked about community-based care and being down in the trenches of healthcare. Where do you see yourself as it relates to applying the experiences of the SIMS program? 0:10:07 Brooke Hendricks Sure. So, I right now would like to pursue an Internal Medicine residency followed by an Addiction Medicine fellowship. And like I mentioned, I would like to work in an outpatient medication assisted therapy type clinic. But I think on the path of Internal Medicine, one thing you have a lot of exposure to is working as a hospitalist. So the doctors who are taking care of patients who are admitted. And I think that that can be a really great place to apply what we've learned about substance use disorders. For example, you could have a patient admitted with withdrawal admitted, with infections caused by intravenous drug use for example. And rather than just treating that issue and sending them on their way, I think you have a unique opportunity to if not kind of like get into the root of maybe their substance use disorder, at least create a space where they could ask for help. And they could share maybe what's going on so that's where I see Addiction Medicine really fitting into Internal Medicine and working as a hospitalist. 0:11:13 William Moyers I know I'm selfish when I say this but I hope and I think I speak for my colleagues at Hazelden Betty Ford, we hope that you all will also be ambassadors for the fact that the medical community really needs to be part of the solution when it comes to addressing substance use disorders. And that medical schools do have an opportunity and an obligation to teach the very things that you all experienced through the SIMS program. Can we ask you to be our ambassadors? 0:11:40 Katie Ferree Absolutely. 0:11:41 Heather Oas Of course. 0:11:41 Brooke Hendricks Definitely. 0:11:42 William Moyers And as ambassadors and I'll go down the row starting here, what would be the key message that you would carry out there into the community? 0:11:49 Katie Ferree So the big thing is that if you are working in medicine, you have to know addiction. It's really that simple. Whether your patient is in recovery, you need to know what questions to ask them. Are they still going to AA, are they going to NA? Do they have cravings? Have they relapsed? How are they creating this sober living network around them? 0:12:12 William Moyers Mmm-hmm. 0:12:13 Katie Ferree If it's loved ones where maybe they've lost somebody to addiction or maybe they have loved ones that are going through recovery. Are they going to Al-Anon meetings? So just knowing what to say to my future patients— 0:12:24 William Moyers Mmm. 0:12:25 Katie Ferree Is something that I know that I'll hold true just going through the SIMS program. 0:12:30 William Moyers Mmm-hmm. 0:12:31 Katie Ferree But that's with me going into Addiction Medicine. My colleagues that are going into endocrinology or women's health, whatever it is. You're still going to come across people that are in some way affected by addiction. You need to know how to ask those questions. 0:12:44 William Moyers Mmm-hmm. [nodding] 0:12:45 Katie Ferree So, at the end of the day, every medical student needs to have additional training in addiction. Bottom line. 0:12:53 William Moyers I know you agree, right Heather? 0:12:55 Heather Oas Yeah. [chuckles] I was gonna say I have to echo everything that you mentioned. I mean, I think some people think that you know I don't wanna touch addiction, that's a messy area. The patient population is unique in its own ways and you really can't avoid it. Any specialty that you go into in medicine, you're going to be interacting either with someone who has an addiction problem or someone who has a loved one or friend, family member, who has addiction. It touches every person in some way. And so, just knowing how to be a support system either for the person who's directly suffering from addiction or who knows someone and by extension is therefore suffering from addiction in that way. Just being a good resource for them. 0:13:37 William Moyers And Brooke, your message? 0:13:39 Brooke Hendricks I think that one of the big things I took away from the SIMS program is that it just further demonstrated to me that substance use disorders don't discriminate. They don't choose different races, genders, socioeconomic statuses. So the more we can break down the stigma of what a substance use disorder looks like and who looks like—who the face of a substance use disorder is—I think the more likely we as providers are to maybe catch those early signs. Or to catch a person who's maybe coming to us as a cry for help hoping that we will ask those questions. And hoping that we will take the time out of that appointment to just open the door up for them to ask for help. 0:14:20 William Moyers Thanks to all three of you for your passion and your commitment to experience the SIMS program for your willingness to carry that message and for being here today to help promote the fact that medicine does have a role, not just in addressing a problem but a role also in promoting the solution. So thanks to all three of you for being here. 0:14:39 Katie Ferree Thank you. 0:14:40 William Moyers And I want to extend a special appreciation or a thanks to Kari Caldwell and Joseph Skrajewski who are integral to the SIMS program in Center City, Minnesota. And in Rancho Mirage, California. As well as the philanthropy team that helps to raise the funds that make it possible for the medical students to experience the program. On behalf of our Executive Producer, Lisa Stangl, I'm your host William Moyers. Thank you for joining us for Let's Talk, a series of podcasts on the issues that matter today and into the future. Thank you.