Making Inroads Against Addiction Through Professional Education

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 as well. Substance use disorder, research, prevention, treatment and recovery support. I'm your host, William Moyers, and today we're on the road here at the Betty Ford Center in Rancho Mirage, California. Joined by Joseph Skrajewski, the Executive Director of Medical and Professional Education for the Hazelden Betty Ford Foundation. Welcome.

0:00:47 Joe Skrajewski
Thank you, William. Pleasure to be here.

0:00:49 William Moyers
What does it mean to be the Director of such an endeavor at our organization?

0:00:43 Joe Skrajewski
So being Executive Director of Medical and Professional Education means I have oversight over our four large-scale programs. Those are our Summer Institute for Medical Students, our Professionals In Residence, our Addiction Medicine Fellowship, and our online Course for Addiction and Recovery Education (CARE) through Aqua for Addiction.

0:01:10 William Moyers
How does somebody like you have such responsibility and such knowledge? How—tell me a little bit about your story.

0:01:16 Joe Skrajewski
Well William it's kind of a crazy story. I had no intention [Moyers laughs heartily] of going into nonprofit health care. That was never on my radar. I was born in Trenton, New Jersey. My parents had me at a relatively young age and I—I always wanted to do more. And so my Jersey dream was to get out of New Jersey.

0:01:34 William Moyers
Right.

0:01:35 Joe Skrajewski
And I remember thinking about how could I be successful in this world, what would I wanna do with my life. And so I actually went to school for finance and economics.

0:01:42 William Moyers
You wanted to make a lot of money!

0:01:43 Joe Skrajewski
I thought I would make a lot of money. Ended up at Hazelden Betty Ford where I help a lot of people. [Moyers chuckles] And so I started in the world of finance and economics and December of 2000 is where my story really starts. Because I was an undergraduate finishing up my senior year. And I went to interview with all the big firms in New York City. So the Goldman Sachs, the Morgan Stanley, the Merrill-Lynch, the Smith Barney, and it was an exciting time. And so those types of interviews where you go and you do your absolute best.

0:02:11 William Moyers
Of course.

0:02:13 Joe Skrajewski
Like you leave all your cards on the table, if you get the job, great, if you don't get the job, you've tried your absolute hardest.

0:02:18 William Moyers
And how old were you at—?

0:02:20 Joe Skrajewski
At that time I was 21 years old.

0:02:22 William Moyers
Young guy.

0:02:22 Joe Skrajewski
Hot shot 21-year-old, right out of undergrad. And so, I get the first call back from Goldman Sachs. Mr. Skrajewski thanks for coming in, we like your background, we like your energy, unfortunately right now with the uncertainty in the markets we simply can't extend an offer of [sic] you—best of luck to you in the future. Another call came from Merrill-Lynch. Another let down.

0:02:41 William Moyers
Hmm.

0:02:42 Joe Skrajewski
And then really the call came in that really was the call that should have changed my life. And so the call comes in from Morgan Stanley. Mr. Skrajewski, thanks for coming in, we like your background, we like your fire, we like your energy. We'd like to give you an opportunity.

0:02:58 William Moyers
Wow.

0:02:59 Joe Skrajewski
We'd like you to finish out your last semester of undergraduate, we'd like you to move to New York City, we'd like you to work for Morgan Stanley, World Trade Center, welcome to the firm.

0:03:07 William Moyers
World Trade Center. Mmm.

0:03:08 Joe Skrajewski
Now it's interesting because I don't know what you hear when you get a piece of news like that, but I know for me the first thought that crossed my mind—was party time. [Moyers chuckles] You mean to tell me all I need to do is finish out my last semester of undergrad, I'm gonna move to New York City, I'm gonna work at Morgan Stanley in the World Trade Center. It was like an absolute dream come true.

0:03:32 William Moyers
Yes.

0:03:33 Joe Skrajewski
And so what did I do I partied out that last semester of undergrad, I still got good grades.

0:03:37 William Moyers
Okay.

0:03:38 Joe Skrajewski
I didn't have any consequences. I couldn't be an alcoholic addict and why that was is when I was a little boy, four, five, six, seven years old I'd watch my grandfather drink. And when my grandfather drank he got violent and he was a different person. And so when I started drinking in my teenage years, I didn't change. I was havin' a good time, I was lively, I was fun, I—I couldn't be an alcoholic. So there was this built-in denial system from a very young age that people that drank changed and they changed in a negative way.

0:04:11 William Moyers
And that wasn't you.

0:04:12 Joe Skrajewski
And that wasn't me.

0:04:13 William Moyers
Yeah. Interesting.

0:04:14 Joe Skrajewski
And that couldn't be me, right? And so June of 2001 I start and I walk into the World Trade Center and it was like magic. It was me and a dozen other again hot shot 21-year-olds. And they brought in another guy he was giving us this rah-rah speech and we were so excited. He said you're gonna be millionaires! And you're gonna make all this money! And again that's what you wanted to hear as a 21-year-old.

0:04:32 William Moyers
Yeah. Right!

0:04:34 Joe Skrajewski
And—and it was so interesting because after they did the rah-rah speech, he said over the next ten to twelve weeks, you're gonna study for your licensing exam. And he picked up the study guide and he dropped it on the table and it made this big thud which meant that book was official right there, right?

0:04:54 William Moyers
Mmm.

0:04:54 Joe Skrajewski
And he said you can prospect clients on the sidelines, you can get 'em ready to invest with you. But until you pass your licensing exam, you can't do any of that.

0:05:01 William Moyers
Hmm.

0:05:02 Joe Skrajewski
And then I'll never forget this: I remember it clear as day like it was yesterday. He pointed on over to a wall calendar. And he said I'd like each of you to walk over to that wall calendar, flip it out three months, and circle the date you're gonna take your Series 7 licensing exam. And I still clear as day like it was yesterday remember walking over to that wall calendar, flipping out three months, and circling the date. September 11, 2001. And so the morning of 9/11 rather than go to my office like I did every day, I went to one of the Sylvan testing learning centers with the cameras on me and the partitions. And I sat down for my exam.

0:05:45 William Moyers
Wow. Wow.

0:05:46 Joe Skrajewski
And so there's actually a three-hour first part, there's an hour mandatory break in the middle, there's a three-hour second part. So I got there about 8 o'clock in the morning and after about three hours, I was ready for my break and I walked into this waiting room and I looked in front of myself. And I saw these two women and they were filled with emotion and they said sir, are you okay? And I looked back at them and I said, [sighs] Well, kinda stressed out right now I just took the first half of this exam. I still have the second half to go. And they said no, sir, no, sir, don't you work for Morgan Stanley? And I said yes. And they said well don't you work in the World Trade Center in Tower Two? And I said yes. They said well, sir, the towers have been hit by planes. And I don't know where you were William when that happened, but one thing I do know is that everyone everywhere felt something. It wasn't like you could pull out your phones and call your family and friends. Phones weren't working at that time. It wasn't like you could charge downtown and make sure that everything was okay, there was no getting back in. I knew what it felt like to be truly powerless over a situation.

0:07:03 William Moyers
Hmm. Mmm-hmm. [nods]

0:07:04 Joe Skrajewski
And I like many of us, I thrive off of control. There was no control in that moment. We didn't know what was gonna happen next. And so I walked out of that testing center, I went to the corner, there was a little Dunkin' Donuts there and there was a speaker in the corner that was talking about that morning's events. And as I was listening to that, one thing I was taught from a very young age by my father, who was a Police Officer, was you put one foot in front of the other and you continue to move forward. [Moyers nods] Thrive in the face of adversity. And so I walked back to that testing center after the break and I finished out my licensing exam. And at the end you actually hit a button and ten seconds later it pops up your score and I saw this passing score and I thought, wow! This should be a really proud moment for me now.

0:07:45 William Moyers
Uh-huh. Yeah.

0:07:46 Joe Skrajewski
But at that same time, thinking how could I be proud in a moment like this?

0:07:49 William Moyers
Yeah. [quietly]

0:07:50 Joe Skrajewski
Global tragedy unfolding. And so I went down south following that exam to where my parents still live near today near Trenton, New Jersey. And during that trip down south, I started doing things like evaluating my life.

0:08:01 William Moyers
At the age of 21!

0:08:03 Joe Skrajewski
Never a good time to evaluate one's life. [Moyers laughs] Wouldn't that be a good one, right?

0:08:05 William Moyers
Yeah.

0:08:07 Joe Skrajewski
And so I started asking myself do I like the relationship I have with my family? Do I like the friends I've surrounded myself with? Do I wanna live in New York City? Do I wanna work in high finance? And as I'm cycling through all those things that matter so much to everyone, the thought crossed my mind which is how I define the disease of addiction to our patients and our students. Because as I'm going through all those things that matter so much to each and every one of us—

0:08:32 William Moyers
Mmm-hmm.

0:08:32 Joe Skrajewski
Thought crossed my mind 'Hey Joseph maybe you drink too much. Maybe you use too much.'

0:08:39 William Moyers
Wow.

0:08:40 Joe Skrajewski
At the same time I remember thinking isn't this a good reason to drink and use more? And I don't know if you remember this but 9/11 took place on a Tuesday morning. And the stock markets closed down the rest of that week. They didn't re-open 'til the following Monday. And over those next five days, I drank and used more than I ever had in my entire life. Did that make me an alcoholic addict? Absolutely not. Had I crossed the imaginary line into addiction before? Probably long before.

0:09:09 William Moyers
Right.

0:09:10 Joe Skrajewski
But here I was and when the stock market re-opened that following Monday it was down like 700-800 points. Which at that time was like nine, ten percent.

0:09:16 William Moyers
A lot. Yeah, yeah.

0:09:18 Joe Skrajewski
And what had happened is all of those clients I had prospected on the sidelines could now invest with me. So I flooded 'em into the market and what happens when you have a global tragedy over time the market re-corrects. It starts comin' back up. And as the market came back up, people starting making money and money started coming in to me and I never knew what to do with money, William. You know I always thought you put on a nice suit and you shave up and you look the part. You don't let anyone else know how you're truly feeling inside. You put on this façade like everything is okay and you're in control and everything will work out for you. And it did for quite some time.

0:09:51 William Moyers
How long?

0:09:52 Joe Skrajewski
Money came in—I had never had any consequences to my drinking and using, so, I couldn't be an alcoholic addict.

0:09:57 William Moyers
Right.

0:09:58 Joe Skrajewski
And so from Morgan Stanley I went to Alliance Bernstein, a large investment research firm.

0:10:01 William Moyers
Mmm-hmm. Mmm-hmm.

0:10:02 Joe Skrajewski
I helped set up shop at another investment company in Stamford, Connecticut. But my drinking was getting worse. My using was getting worse. And I always tell people like the hardest job in the world is getting through the day in active addiction without a drink and without a drug. And so fortunately I had a good family and when the time presented itself for me to get well they were there. And they're—it's so funny because like alcoholics addicts are the last people to know they're alcoholic addict.

0:10:29 William Moyers
Yeah. [chuckles] Yeah. What'd your parents and family think?

0:10:32 Joe Skrajewski
Well I remember like ya know I crashed and burned, you know, and we—we know we dig a hole for ourselves in active addiction. I—I had definitely done that. I had spun out of control, I really couldn't maintain work anymore. And it was interesting because when I finally reached out for help, my mother ran over to a computer and she hit a few buttons and bam! treatment centers were researched all over the United States. And I remember thinking like how did she know?! [Moyers laughs heartily] You know it's—it's like alcoholics addicts are the last people to know they're alcoholic addict. Yet she got me into a place. And I went and I got clean and sober and I bought into a program of recovery and I did what people told me to do. And—and I was young, William, I mean--

0:11:09 William Moyers
Yes you were!

0:11:10 Joe Skrajewski
I was in my mid-twenties and it—and here was this key, here was the secret for me. I wasn't buying into the idea that I would be clean and sober for the rest of my life. That I couldn't have a drink or drug. That was far too big for me to believe in my twenties. What I was buying into it was if I didn't drink or use today, and my life got slightly better tomorrow, then why wouldn't I do it again? And if I didn't drink or use tomorrow and my life got slightly better the next day, why wouldn't I do it again? And slowly but surely the days became weeks and the weeks became months and the months became years. And it was frightening 'cause in that first year of recovery somebody said to me like what are you good at? Because I didn't wanna do finance and economics anymore. I just couldn't see myself doing business work for the next thirty, forty years. So I said I'm good at school. So they said why don't you go back to school? Get a Master's Degree. Get some licenses. So that's what I did. I went back to school for Psychology.

0:12:03 Joe Skrajewski
[continued] I went into Marriage and Family Therapy. And then I wanted to help people just like you and I. And I thought well nonprofit health care sounds like a great idea. Betty Ford Center, which then merged with the Hazelden Foundation, was right in my backyard. 'Cause I had come out to Southern California.

0:12:17 William Moyers
Ahh.

0:12:18 Joe Skrajewski
And we were on our way. So I started here as a clinician. I worked on our medical unit, I worked on our inpatient units.

0:12:25 William Moyers
What year was that?

0:12:26 Joe Skrajewski
So that was back in 2008, 2009. So it's been about a decade plus now that I've been here.

0:12:31 William Moyers
Mmm-hmm. Mmm-hmm.

0:12:33 Joe Skrajewski
And started here as a clinician and then I got a call from our Founding President and CEO here at Betty Ford—

0:12:37 William Moyers
John Schwarzlose?

0:12:38 Joe Skrajewski
John Schwarzlose. And so I ran across campus in the middle of the summer, hundred ten degrees I'm covered in sweat, I burst into his office, I'm a mildly excitable individual, William. [Moyers chuckles] And I said you know, John, I love being a counselor here! It's so amazing! And he said great, Joseph, why don't you have a seat?! And so I sat down and he started talking to me about medical and professional education. And what was so important to me, what mattered so much, is he said imagine changing the field of health care. Imagine working with the future of medicine. Medical students, residents and fellows. Whereby we could provide them with a learning experience on substance use disorders from our patients and our staff. Imagine how many people they could help over the next thirty, forty, fifty years they're in practice. And I said I think they could help a lot.

0:13:28 Joe Skrajewski
[continued]  And he said I'd like you to think about this a little bit, Joseph, come back and let me know of your decision. And I said I'll take it!! [Moyers laughs] He said I'd like you to think about this for a little bit. Come back and let me know of your decision. And I came back and I took that role. And it was the greatest opportunity. I mean I was really charged and I was really empowered to go and expand programming. We took our Summer Institute for Medical Students, which is a proud program developed by Dr. Jim West—

0:13:53 William Moyers
Sure. Yes.

0:13:52 Joe Skrajewski
--Who's a pioneer in our field. One of my favorite people. We would go to meetings together, he would come to closing luncheons together. I remember at his funeral you had a 98-year-old guy with 3,000 people at his funeral. I mean that's remarkable.

0:14:07 William Moyers
Yes.

0:14:07 Joe Skrajewski
98 you've outlived all your buddies, but here are 3,000 people that he had significantly impacted. And so Jim came up with the idea of SIMS and he would look me in the eye and Betty Ford would look me in the eye and they would talk about how important SIMS was to the future of addiction services and to the future of health care. And so I took that on as a—a real ultimate opportunity. That people like Jim and Betty cared so much about this program. And so we've expanded it a number of times. When we merged with Hazelden it was like magic for me.

0:14:36 William Moyers
Yes.

0:14:37 Joe Skrajewski
Because at that time, SIMS had become so successful here in California. That we had optimized our capacity.

0:14:44 William Moyers
Mmm-hmm.

0:14:44 Joe Skrajewski
We had no place we could put students anymore. So now we had another large-scale opportunity to expand. And so we set up SIMS in Center City, Minnesota. And now we could bring twice the amount of students each year. Quite frankly helping countless thousands more alcoholics and addicts—

0:14:58 William Moyers
Mmm-hmm. Mmm-hmm.

0:14:59 Joe Skrajewski
Over the course of their careers. We also had the Professionals in Residence program. Which has a forty-year plus track record as well on the Hazelden side.

0:15:07 William Moyers
Right.

0:15:08 Joe Skrajewski
And another thirty-plus-year track record here. And the way I look at Professionals in Residence is if individuals don't get education on substance use disorders while in school, which they don't—

0:15:20 William Moyers
Still.

0:15:19 Joe Skrajewski
The—which they don't still today. I mean we're doing two to ten hours an entire four-year medical school curriculum it's awful. Then if we're not getting that education in medical schools or in pharmacy schools or in nursing schools or in schools of public health, then I wanna make sure they get it while in residency, while in fellowship, while in active practice, and Professionals in Residence really succeeds in doing that. We're able to bring individuals to our sites. They're able to have weeklong immersion experiences. Whereby they're able to go through treatment just like they're a patient in treatment themself. [sic] They can look alcoholics addicts in the eyes and connect with them. And really my hope is when they go back home wherever they're going to their hospital system, and they're talking to people affected by a substance use disorder, I hope that raises their level of empathy. I hope it helps them with their humility. I hope it helps them understand that these are human beings with a disease that are struggling to get by. But at the same time are the most resilient people that I've ever met. And they have a bright future ahead of themselves.

0:16:22 William Moyers
Mmm.

0:16:23 Joe Skrajewski
And so SIMS and PIR quite frankly they're magical programs. They are outreach at its finest. They're education at its finest. And they're something that I'm incredibly proud of. And—and along the way we wanted to set up an Addiction Medicine Fellowship—

0:16:35 William Moyers
Right. Right.

0:16:35 Joe Skrajewski
An accredited one. Addiction medicine was beginning to get a—a little bit more respect in organized health care. So we set that up here at the Betty Ford Center. Whereby we have addiction medicine fellows that come through our sites for yearlong experiences now. And then over the course of the ten years I've been here as well people started saying well Joseph, you don't have unlimited funds, you can't just bring every medical student in the world to a Hazelden Betty Ford site. You know how about creating an online platform for you to actually flip the classroom and send it back to the schools. And so we created the Course on Addiction and Recovery Education.

0:17:09 William Moyers
Yes.

0:17:09 Joe Skrajewski
The CARE platform through Aqua for Addiction. And William when we created it, people hated it! [Moyers laughs] They were like why would we use this?! Our curriculums are perfect! Where is it gonna fit?! That's not important. But what happened over the last ten years? We had an opiate epidemic.

0:17:24 William Moyers
Yes.

0:17:24 Joe Skrajewski
And so sadly, enough people died during that opiate epidemic that people came full-circle. And they said hey is that Joseph Skrajewski guy that Tom McClellan guy that John Boop guy, the people that were instrumental in creating this thing, are they still around with that Course on Addiction Recovery Education? And we were. And so we went from a platform that nobody wanted to use 'cause they thought their curriculums were perfect to having quite frankly one of the most successful substance use disorder online platforms in history. It's now used by 40 plus medical schools, it's used by schools of pharmacy, it's used by NP schools, it's used by PA schools, it's really caught traction. And what's happened is people have started to realize that we need to talk about this topic.

0:18:07 William Moyers
Yeah.

0:18:08 Joe Skrajewski
Need to talk about substance use disorders and we need to help alcoholics addicts get the help they so badly need. And you know what, slowly but surely it's getting better. People like you who have dedicated their lives to this cause are finally getting to see some change. And it's taken 30, 40, 50 years. I mean our entire lives to see this. But I believe that we're doing some good things nowadays. I believe our advocacy efforts are at an all-time high led by our Institute for Recovery Advocacy. I believe our education and research arms are absolutely incredible. And then of course our bells and whistles, our treatment services, which is the you know the meat and potatoes of everything that we do. [Moyers chuckles] I've never seen anything more incredible than the treatment services we provide at Hazelden Betty Ford. And I believe in that.

0:18:51 William Moyers
You clearly do Joseph and for all the people who are part of that effort, you're the driver of it and it's your personal experience. The fact that you took adversity and turned it into opportunity, your knowledge and your fiery passion that have made it—you've reached thousands and thousands of people. So we thank you for your commitment to the cause, we thank you for coming on our program today to share that with other people, and, I thank you personally and professionally. For your presence in my life and in the lives of so many people who've been touched. Not just by addiction but touched by the reality of recovery. Thank you, Joseph Skrajewski.

0:19:20 Joe Skrajewski
Thank you so much, William.

0:19:31 William Moyers
I'm your host, William Moyers, this has been another edition of Let's Talk, a podcast on the issues that matter to us at Hazelden Betty Ford and matter to you as well. On behalf of our Executive Producer Lisa Stangl and the great production crew of Blue Moon Productions, we hope you'll join us again for another edition of Let's Talk.