Maggie McKay (Host): If you know someone who is struggling with substance abuse, you know how painful it can be. So today, we're going to learn about substance use disorder with Ian Anderson, Substance Use Navigator.

Welcome to Wise and Well presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Great to have you here today, Ian.

Ian Anderson: Thanks for having me. Glad to be here.

Host: So, tell us a little bit about your background, education, and how you got involved in helping people with substance use disorder.

Ian Anderson: So, I am originally from Salt Lake City, Utah. I moved out here to California about five years ago. And I am a certified alcohol and drug counselor through an organization called CCAP. They're the California Consortium of Addiction Professionals. So, I'm a community health worker, a medication for addiction treatment specialist, and a Certified Alcohol and Drug Counselor through that body. I worked in the private treatment industry in your typical rehab. There was a place called Cliffside Malibu that I worked as an individual counselor and group counselor for a couple years before partnering with Conejo Health and Community Memorial as the Substance Use Navigator.

Host: And what's your current role at Community Memorial Healthcare?

Ian Anderson: I'm currently the lead Substance Use Navigator at CMH, and we serve patients in the emergency room at CMH and at the Ojai Valley Hospital as well. So, we primarily see patients in the emergency department, but we also follow patients through the continuum of care to the medical floors, in the clinics, and in outreach efforts at a pop-up street medicine clinic.

Host: And what made you want to follow this specific path?

Ian Anderson: Well, I'm in recovery myself. So, that's kind of the most important factor for me, is this is a very personal issue for me. I'm very passionate about helping people heal from drug addiction. Over the years, I've had many friends and family members pass away and suffer from the effects of substance use. And so, I really want to make a difference, right? It's very personal to me.

Host: For those who are not familiar with it, what is substance use disorder? Because I've always heard substance abuse, but this is substance use disorder.

Ian Anderson: Well, I think substance use disorder has been around for a long time. It was classified in the DSM IV in 1994, the Diagnostic and Statistical Manual of Mental Disorders as a substance use disorder. Nowadays, we use terms like substance misuse as opposed to substance abuse. It's just a more progressive term. Less stigmatizing, I think, is the main point of that. But a substance use disorder is essentially a condition developed through problematic substance use that creates a pattern of substance use that ultimately leads to impaired functioning in multiple dimensions. So, namely, occupational functioning, people have issues at their job, they have relationship problems, they start to fail to meet demands of important responsibilities, or people start to spend less time doing things they love. And then, two really important factors of a substance use disorder and addiction are the development of withdrawal symptoms, when a person stops using substances, and experiencing craving, physical craving, mental obsession, uncontrollable urges to use the substance.

Host: What types of substances does the diagnosis refer to?

Ian Anderson: So, it refers to all substances ranging from nicotine, alcohol, cannabis, opioids, stimulants, hallucinogens, sedatives, among others. And the same symptoms can go for behavioral issues such as gambling or sex addiction. But certain substances, it's important to note, don't have the same classification because they don't have any known physiological withdrawal symptoms. But the most important piece is that this applies to all substances of abuse or psychoactive substances.

Host: And it's no secret that the prevalence of substance use disorder across the country has risen in the last several years. What trends are you seeing in Ventura County and what substances in particular are problematic?

Ian Anderson: So, speaking particularly to this program at CMH, we've had about a thousand encounters since the launch of the program in January of 2023. And the majority of them, about 54% involved alcohol. Many of those alcohol encounters also involved other drugs, but those were the primary substances in about half of those encounters. A quarter of them, about 24%, involved fentanyl, and about 15% involved methamphetamine. So, those are the three main substances we're seeing people struggle with.

Host: And what are the most common signs and symptoms of substance use disorder?

Ian Anderson: So, something to really look out for, I would say, are people failing to meet important responsibilities at home, at work, in their relationships. It's hard to spot somebody struggling with their mental health. Sometimes people are really good at masking this. But important markers, you might say, are those neglecting responsibilities, physiological symptoms, such as withdrawal, people getting sick and having to stay in bed for days, recovering from the effects of substance use, or people spending inordinate amounts of time procuring the substance, getting money to pay for the drug and spending time recovering from the effects of it.

Host: So, what are some of the more uncommon or more difficult signs to recognize? Because like you said, it's easy for people to mask what they're going through.

Ian Anderson: Yeah. I think the main ones would be people spending less time doing things they love. So, the time they spend getting the substance and using it starts to take over time they would normally spend in a creative outlet or with a hobby or spending time with friends, spending time with family. So, a lot of social isolation that might be harder to spot at first until you start to notice that somebody's not around often or they don't look like they used to, losing weight, those kinds of things.

Host: So in your role as substance use navigator at Community Memorial, how do you collaborate with physicians and staff to help support patients who may have substance use disorder? And what steps do you take to help those patients get the support they need?

Ian Anderson: The first thing we do is immediate consultation. When somebody comes into the emergency room, and it's discovered that they have an issue with some kind of a substance, the physician will order a consultation from me or one of my team members, and will go check in with a doctor and see what they've discovered so far. And when it's appropriate, we'll enter the room and perform a screening. So, we screen patients for substance use issues, the duration of their substance use, if they have any previous episodes of treatment for substance use or mental health disorders. And then, on the spot, we provide counseling through motivational interviewing. We help them come up with a relapse prevention plan using things like contingency management. And then, we spend a lot of time referring the patient to specialized treatment programs. And we make a determination as to what level of care they would be most appropriately served at. And then, we coordinate with the nurse, with the social worker, with the case manager, and the physician to make sure everybody's on the same page so that we can discharge them with a safer plan.

Host: That's a lot of people involved. It sounds like you've really got every possible need covered.

Ian Anderson: It's a really major interdisciplinary team.

Host: What's the most significant impact the substance use navigator program at Community Memorial has had so far?

Ian Anderson: I think the most important impact we've had is that more than a thousand patients have now left the hospital with more support than they went in with. So beyond any of the other results we can talk about, that's a thousand more patients who might have a more trusting relationship with healthcare providers in general. That's a thousand patients who have been given the opportunity to connect to addiction recovery services. In 2023, 93 hospital patients accepted treatment with buprenorphine, which is one of the most important medications we use to treat opioid use disorder.

Host: Ian, what other ways are Community Memorial and Conejo Health partnering to prevent unnecessary deaths due to substance use disorder?

Ian Anderson: Conejo Health distributed about 7,000 units of Narcan in 2023. Conejo Health and CMH have partnered to deploy a thousand harm reduction kits in all of the clinics in the Centers for Family Health. So, these harm reduction kits contain a life-saving drug called naloxone. They contain fentanyl test strips, and a couple other resources for patients to identify what their local treatment pathways are.

We've placed those in the clinics across the system. Conejo Health staff also facilitate a bi weekly support group for patients who have been inducted onto medication for addiction treatment in one of the clinics with the clinical champion of this program, an addiction medicine physician named Dr. Kerrigan.

Host: So once somebody has had a substance use problem or substance use disorder, do they say they're recovering for the rest of their lives? Because I've met a lot of people through the years who had a problem, say, with alcohol, and they say they're recovering, even though they haven't had a drink for 30 years.

Ian Anderson: This is an important question, and it's really a personal question. I myself identify as a recovered addict. The saying goes, "I've recovered from a seemingly hopeless state of mind and body." So today, Somebody who has spent multiple years in a new pattern of living, who no longer engages in those risky behaviors, somebody who is a changed person through their process of recovery, and whatever that included, whether that was a medication to support them, whether it was a spiritual solution for them, or a community based recovery program, there is no one path to recovery. But I think it's important to note that people who grow through recovery and are no longer addicted to drugs and alcohol, I would say they could safely say they've recovered from this condition.

Host: Ian, where can people learn more about the Substance Use Navigator Program at Community memorial?

Ian Anderson: So, they can first go to mycmh.org/sun to find out about Conejo Health and Community Memorial's partnership for the Substance Use Navigation Program. They can also see it on conejohealth.com or by visiting narcan.me. We're also on Instagram and Facebook. Community Memorial and Conejo Health Partner on their social media posts as well to cover this program.

Host: Well, thank you so much for sharing your expertise and, you know, giving us further information about this. I'm sure it's very hopeful and helpful to people who are struggling. So, it sounds like the work you're doing at Community Memorial is very meaningful.

Ian Anderson: Well, I appreciate it. And thanks for having me on. I'm looking forward to the next time.

Host: Awesome. We'd love to have you again. That's Ian Anderson. And if you'd like to learn more, again, please visit mycmh.org/sun. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is Wise and Well presented by Community Memorial Healthcare.