Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And joining me today is Shala Hartmann. She's a licensed independent mental health practitioner and a licensed drug and alcohol counselor at Bryan Independence Center, and she's here to tell us about substance use evaluations. Shala, thank you so much for being with us.

First of all, I'd like you to tell us a little bit about yourself and the work that you're doing as it relates to substance use disorder.

Shala Hartmann, MA: Sure. My name is Shala Hartmann. I have been with Bryan Independence Center since December of '22 and I've been in the field of mental health and substance abuse for the last almost 12 years. Part of my role here at Bryan Independence Center is to do a lot of the substance evaluations that get people into the levels of care needed for whatever treatment that they need for drug and alcohol use.

Melanie Cole, MS: Well, thank you for telling us about that. Now, during COVID, lockdown, everything, a lot has changed in the world. Have you seen an increase in substance use disorder and even the intersection with mental health disorders and stress? As we've come out of this, have you seen that people are still really having issues with this and even eating disorders?

Shala Hartmann, MA: All of the above, yes, I've seen a huge increase. The problem with COVID is people were left, basically told they need to be home, they need to be alone. Don't socialize with other people. So, they told people to stay home, which made a lot of those closed door type problems worse. On top of it, especially relating to drug and alcohol use, alcohol specifically, the restaurants and other venues decided to start transporting it to people's houses for them. So, you could DoorDash alcohol to your house and didn't even have to leave to go get it. It made the accessibility for people with alcohol issues worse because they could just then have it brought to their house. They didn't even have to leave. And so, since then, it's now 2023, I still have people coming in very regularly talking about the need for an evaluation because their use got so bad over the last couple years. And, people that may not have had longstanding issues seem to have increased issues over this time. So, new and old I guess, substance issues with people, but an increase in both.

Melanie Cole, MS: Yeah. It makes so much sense. Now, tell us about some of the signs and symptoms of substance use disorders. As you just said, some people who necessarily weren't even in that category found themselves overusing drugs and alcohol during COVID and all of that. But signs and symptoms of true use disorder are different than someone who was a temporary or who then realized and cut it down or something along those lines. What are we looking for in someone that we love?

Shala Hartmann, MA: Some of the things that we're looking for as far as alcohol or drug use, I say this simultaneously because the criteria for diagnosis is honestly the same for both alcohol or drug use. Essentially what you're looking at is seeing all the different areas that it's impacting your life. So if it's starting to get in the way of thing like work, school, relationships, it might impact finances, all those kind of things. And the more that it impacts your life in negative ways is when it might signify to you that you may have an issue.

Bryan Health has some screening tools on our website that you can use to pre-screen yourself, which is a good guide to see ahead of time, you know, "Do I think I have an issue? You know, "Is it more of a problem now than it was?" Those screening tools are really helpful to give you some baseline information really on whether or not diagnosis is something that might be for you regarding drugs or alcohol. But when you come in and get evaluated with me, that's the areas I'm looking for, is really how is it impacting your life? Is it expanding? Not that it's just a problem for you, now your use is impacting others. And the severity of how bad that gets.

Melanie Cole, MS: So interesting this topic, and so important. So, tell us about the substance use evaluations. How does that work? What does it entail? Tell us a little bit about how it all works.

Shala Hartmann, MA: Sure. I do substance use evaluations here at Bryan Health’s Independence Center. People can schedule to get an evaluation done with me, or we have walk-in clinics on two days of the week. On Tuesdays and Thursdays between 8:00 and noon, I'm just openly scheduled available for anyone that walks in the door. So, if scheduling is difficult or if you just need to show up, as long as I've got availability, I will see you. And if I don't have availability, we'll either try to get you scheduled when I do have availability or just have you come back the following day that we have walk-in clinics.

We also have a nursing intervention program that nurses that are trained in substance use disorders are able to go into the Bryan-affiliated hospitals to evaluate people if they're admitted, whether it's for medical needs, for psych needs, if they're admitted in other hospital units to determine if drugs or alcohol are a problem. So, nurses will also go into Bryan East, Bryan West, Madonna, St. Elizabeth’s if a doctor refers an evaluation to be done in that setting.

Melanie Cole, MS: What does it entail? What is a substance use evaluation, Shala? How does it work? Because I know having known so many people with substance use disorder in my life, some of them are not going to sit for an evaluation very easily. It's hard to get them in. Tell us a little bit about what it's like for them.

Shala Hartmann, MA: I try to make it as comfortable as I'm possibly able to make it. What an evaluation is, essentially, I'm going to ask a million questions about a million things, and all of them are drug and alcohol-related questions because the whole point is to help me figure out is there a problem. And if there is a problem, what are we going to do about it, and come up with recommendations together. It's a collaborative process, so I talk to them very openly and I can only make recommendations based on the information that I have. So, the more I know, the better I'm able to help you. I also try to make people comfortable. And the fact that nothing they're going to tell me is going to get them in trouble, whether it's themselves or other people, because there's a lot of stigma associated with substance use, and people concerned about saying how it got to this point or all these things. So, I try to help them understand that substance information is protected very differently and we take that seriously. So, we need the information to help, but we use it to determine what to do to help them out.

So, we just talk as openly as we're able. I never make anyone tell me anything they don't want to. An evaluation is a voluntary process. I evaluate people for a lot of different reasons. I do have family members that really want their loved ones to come in. I do evaluations for people that have court involvement and the court wants to know what to do with recommendations or if there's an issue. So, the reason that brings them in is evaluated right when they come in the door in our initial paperwork. We see what brings them in, what they're looking to address as far as drugs or alcohol. And then, I dig in from there based on what they bring me.

Melanie Cole, MS: If somebody has a family member that they're concerned about, how do we encourage them to get a substance use evaluation? What should someone do? Who do they reach out to? Can a loved one reach out to you and say, "My family member needs this," or does it have to come from the person?

Shala Hartmann, MA: It needs to come from the person unless the person is an adolescent, so unless the person is a minor. A minor does require that a parent or guardian is present, not only to sign documentation, but also to authorize care. If they're an adult and in Nebraska, that's age 19 or older. If they are over 19, they are the ones that need to initiate that process for themselves. Family members can always call, they can always ask for information. If they need to know when walk-in dates are to bring family members here, they can. But with adults, it is a voluntary process the whole time. So, they are the ones that needs to be here and willing to talk as much as they're able for the evaluation.

Melanie Cole, MS: Depending on what you find out, Shala, what are some treatment options that you can recommend to people? What are you doing for them once you've determined that they have a substance use disorder?

Shala Hartmann, MA: There is several different levels of care that exist for drug and alcohol treatment. I'll start at the lowest levels and kind of work my way up. So, the absolute lowest level available is what we call education services. Education services are things like we have information available online. We have information available on our website. There are classes within the community that you can enroll in. I don’t know if you’re familiar with like a STOP class if you’ve ever been pulled over, but that class is similar to that, anywhere from four to 10-hour classes where people can be referred to these community providers that offer education-type classes that gives a lot more in-depth information about how use impacts them, impacts others. Sometimes how it's related to driving offenses, that's pretty common in education classes. And those happen in the community. Usually, those classes are a one-time thing and then they're done.

The next level up would be outpatient treatment. Outpatient treatment would be like what people would probably associate with like going to counseling. So, they'd meet with a provider once a week at minimum for however long they need. Typical outpatient treatment for drug and alcohol use is usually about six to 12 weeks, but it can vary, because oftentimes mental health diagnoses co-occur with substance use disorders. So, if outpatient therapy is needed for longer than that to address additional things, usually that can be done with the same provider, if they're licensed to do so. An outpatient treatment, again, can last as long as they need that to. Outpatient doesn't really have a specific end date, but it gives them a one-on-one person for them to talk through those issues, whether it's drugs, alcohol, mental health or relationships the therapist that they're working with or the counselor are able to address those things in a one-on-one setting.

There are outpatient groups available in the community. Treatment here at the independent center, we do have an outpatient group for individuals who came from our higher levels of care down to just continue to get group support from others that have been through our program and some of that experience. But there are outpatient groups that also exist in the community with other community providers.

The next step up from that is the intensive outpatient programming. Intensive outpatient is essentially three to five days a week of programming anywhere from usually about three hours at a time, plus an individual therapy session weekly. So, it tends to equate to about 10 hours of treatment a week. That intensity is also determined by an evaluation. You have to have an evaluation recommending that level of care if you're going to get into that. We at Bryan Independence Center do our IOP five days a week, so individuals get done a little sooner. They get done in about a month. Intensive outpatient just kind of varies on what the person's needs are. So, if they're working or if they are not, or whatever is happening, we can kind of evaluate which type of program might be best for them, and then refer to those programs.

 Melanie Cole, MS: That was a comprehensive list, which really tells us that there is help out there for people that are suffering from substance use disorders. As we wrap up here, I'd like you to reiterate about the online screeners at Bryan Health for alcohol and substance use and mental health, that pre-screener. So, kind of summarize everything that you've said and the importance of these evaluations.

Shala Hartmann, MA: I do need to note that there are additional higher levels of care that I didn't talk about that are necessary for people to know. We also at Bryan Independence Center offer what's called partial care programming, and that's a full day treatment program where people come all day. Monday through Friday anywhere from two to four weeks, depending upon their needs. And the level above that is short-term residential treatment. That's where individuals will come and stay here at the facility, usually anywhere from two weeks, but typically closer to 28 to 30 days that they'll stay in programming with us. So, residential treatment programs also exist here at Bryan, which we often refer to.

The online screeners are very easy to access through Bryan. They're pretty user-friendly to be able to walk through, click a couple things and it'll give you usually an indicator, because screeners are just that, they're just screening to see if there is a problem. But they're very user-friendly, very easy to access and that's a good way to kind of self-assess if you think maybe you should get an evaluation or not.

Melanie Cole, MS: To reiterate, there is help out there. That's what this is all about. And that people who loves someone like that, or who have or suspect that they are suffering from substance use disorder, that help is out there through Bryan Health, yes?

Shala Hartmann, MA: There is a lot of help available and we do everything we can to try to make that process as easy as possible, knowing that it's not easy to admit or to open up that use is an issue, but we are here to help. We want to provide the best care and services for people looking for it, and we're here for you when you decide you want that help.

Melanie Cole, MS: Thank you so much, Shala, for joining us. And the Independence Center offers two different ways to get an outpatient substance use evaluation. You can contact (402) 481-5268 to schedule a substance use evaluation, they're offered Monday through Friday. Or you can also come in to a walk-in evaluation on Tuesday and Thursday mornings from 8:00 AM to noon. I'd like to thank our Bryan Foundation partner, Union Bank & Trust. To listen to more podcasts from our experts, you can always visit bryanhealth.org/podcasts. And that wraps up this episode of Bryan Health Podcast. I'm Melanie Cole. Thanks so much for joining us today.