Maggie McKay (Host): Addiction can not only affect you, but the people around you. So today we're going to find out more about it. How to treat it with addiction medicine from specialist, Dr. Christopher Fernandez. Welcome to Wise and Well presented by Community Memorial Healthcare. I'm your host, Maggie McKay.

Thank you so much for joining us, Dr. Fernandez. 

Christopher Fernandez , DO: Thank you for having me. It's great to be here.

Host: Absolutely, so let's just start with what is addiction in simple terms and what are the most common addictions? 

Christopher Fernandez , DO: Addiction or the term we like to use, substance use disorder or substance misuse, helps with some of the stigma attached to addiction to reduce and become more of a medical complication than a personality disorder. Generally, a misuse turns into a use disorder or an addiction when there's a loss of control.

To put it simply, it becomes the main driver in your life. This could be something where you're not able to function at work. You're not able to function at home. The responsibilities that you have tend to fall by the wayside because procuring, using, and recovering from using whatever substance it may be, becomes the forefront of your mind and you're unable to focus or do anything else regardless of how much you may want to.

So not only do social aspects take that backseat, but also the physiologic takes a backseat to it. This can be described as the physical withdrawal that you feel, but also the cravings that can happen. And so when you're going through that withdrawal, you may not be able to focus on anything and have this obsession of getting that substance again in order to get out of the withdrawal and satisfy those cravings.

And so, in our simplest terms, that's what we like to refer to as our substance use disorders. And those can come in all different shapes and sizes. One that I like to always mention at the beginning, one that many of us may, be a little bit closer to than we think, is caffeine use. Take personal inventory.

How often do you say things like, I can't function until I get my coffee, or no one talk to me, or I get a headache if I don't have it. All of those things, again, can be signs that we are leaning towards substance misuse without of course, diving into a substance use disorder, because we're still able to function and fulfill those responsibilities throughout our lives. Other substance use disorders that we commonly see and we treat in clinic include alcohol, opioids, stimulants, sedatives like benzodiazepines, nicotine, cannabis, and we've even started to see some over the counter supplements, namely Kratom, that has started to cause substance use disorder in and of itself. 

Kratom is a plant, it can be found at cannabis stores, it can be found in gas stations, fun little drinks, capsules, many different formulations and ways that it can be taken. I've even seen it advertised as a workout supplement. The way that the plant is processed, it can affect the opioid receptors.

And so when you stop taking Kratom, you will feel a withdrawal that is similar to any other opioid, heroin, fentanyl. And we've noticed at least a trend in our clinic of more patients being seen for their Kratom use. 

Host: Oh my goodness. Well, how does addiction affect individuals and families? 

Christopher Fernandez , DO: Yes. So as we mentioned, for the individual, addiction takes over. That substance use will become the most prevalent thing in one's life and they'll start to fade away. As a society, we'll often look at people and say, oh, there's an addict. There's someone that has lost control of their life. But there's also an internal stigma that happens when patients are struggling with a substance use disorder that they feel that they've lost control of their life and also lost a sense of who they are.

For family members, this can be difficult to see. It can be seen as someone unable to follow through with commitments, someone who has lost any interest in their previous activities, and then also the frustrations of someone who has those cravings and withdrawal and that desperation to get their substance may lead to things like stealing or manipulation that were not normally a part of that person's life. And so from a family member, they've often described it as, I've lost my loved one to this disease. And during the recovery process, they've even said, my loved one has returned. It becomes both a very personal damaging, but also a familial damaging disease. 

Host: Are there certain factors that play a role in developing substance use disorders? 

Christopher Fernandez , DO: Yes. So there are certain factors that we mentioned, things like family history and genetics play a very heavy role. Comorbid conditions like mental health disorders can lead to someone using or being more susceptible to a substance use disorder. And then even early use exposure, when someone's introduced, how they're introduced, whether the peer pressure comes into play. 

And now we've even seen just the level of the drug. In the past with opioids and heroin, it wasn't as addicting, was not as potent. Now we have things like fentanyl that increase the rate of addiction due to just the potency of the drugs that are out there. 

Host: Can all types of addiction be treated with addiction medicine?  

Christopher Fernandez , DO: For the most part, I would like to say yes. Certain disorders, things like alcohol use, we have medications, same with stimulant and opioids. And for behavioral disorders, even things like gambling, pornography, sex addiction, there are medications that can be helpful. And oftentimes part of our full gamut of care, things like counseling, addressing any of those underlying mental health issues, can also be part of the treatment process that helps people to, again, regain that control that they want to have in their lives and move past the substance use disorder.

Host: You mentioned mental health. How do you address both mental health and addiction needs in your practice? 

Christopher Fernandez , DO: Mental health and a substance use disorder often go hand in hand, whether it be someone had tried a substance and it was the first time that they felt normal. Patients have described it as self medicating or not being able to deal with some of the depression, anxiety, and frustrations in the world and having a different substance to use,

helps those concerns go away. And so oftentimes we can address the physical symptoms like the withdrawal and the cravings to ensure that our patients are not suffering while they are trying to get over these substances, but also addressing the underlying mental health and reasons why they were starting to use those substances in the first place. 

Host: How do mental health issues influence addiction? 

Christopher Fernandez , DO: For some, again, it may be a self medicating process that they have struggled with so many different things until they tried using methamphetamine for the first time and having a stimulant in their system helped them focus and feel like they could participate in the normal world again. For others, they may have crippling anxiety and alcohol has helped them to be able to be social or function.

And so mental health plays a very strong role and having those undiagnosed or untreated underlying mental health issues often lead to greater risk of substance use. 

Host: What sets the Addiction Medicine Program at Community Memorial apart from other programs? What makes it special? 

Christopher Fernandez , DO: So for now, time is a big thing. I've been here since August, and so in the past six months, we've been able to be integrated in the community more each day. But some of the benefit is we still have that desire to grow and to help. And so we're able to make time. Some of the most difficult things for patients can be being seen at the emergency department or being released from the hospital or even from prison and having an appointment with their addiction medicine physician

a month or two months out. We know that, that timeline won't be very helpful for those patients. So one of the things that we can do is we have that chance to both fit them in to see them in sooner, but also the individualized care that we're able to sit down with patients, discuss their desires, discuss their goals, how we can help them reach those goals.

And so it's a much more personal touch and much greater availability to take the time with patients that, that they need in order to game plan and have better stepping stones for success in the future. 

Host: Dr. Fernandez, what are some local resources that are available for individuals who are struggling with addiction or their families? 

Christopher Fernandez , DO: We have some amazing resources here in the area. We have our substance use navigators at the hospital. I know that Ian was on the podcast a little while ago and I would recommend everyone take a listen to that because Ian is one of our greatest resources that we have. Him and then also Alexa, our substance use navigators that we have at the hospital.

And their partnership of the hospital through Conejo Health, and oftentimes when patients are in the hospital, they'll be able to visit them. They're able to call me, schedule them, get them in next day or two to make sure that they have this continuity of care. One of the resources that we have is on the website, mycmh.org. You can look up the substance use navigators that will get more information of how to get in touch with them. 

Host: And how can patients get in touch with you? 

Christopher Fernandez , DO: So again, luckily by that CMH website, searching Addiction Medicine, my name will pop up. And the good news is, the picture's only slightly photoshopped, so it is a pretty good picture of me if I do say so myself. And there's also calling the Memorial Health Centers. The 805-948-6353 number, and then previously on any of those substance use navigator links, they also have my number.

They know how to get on my schedule in order to make sure your patients have good follow up. 

Host: Well, thank you so much for sharing your time and your expertise today. It's been so helpful and informative. We really appreciate it. 

Christopher Fernandez , DO: Oh, well, thank you so much for having me.

Host: Of course. Again, that's Dr. Fernandez. And if you would like to find out more, as he said, please visit MyCMH.org. 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.

I'm Maggie McKay. Thank you for listening to Wise and Well presented by Community Memorial Healthcare.