Joey Wahler (Host): Addiction to drugs or alcohol is a major challenge to overcome, but treatment is available. So, we're discussing addiction medicine. Our guest, Dr. Eduardo Javier, Medical Director of the Eisenhower Addiction Medicine Program. This is Living Well with Eisenhower Health. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Javier. Thanks for joining us.

Dr Eduardo Javier: Hi, Joey. Thank you so much for having me. It's a pleasure being here.

Host: Same here. So, first, what types of addiction does Eisenhower Health actually treat?

Dr Eduardo Javier: So, the types of addiction that we usually treat is called chemical dependency. There are two types of addiction, chemical dependency and behavioral addiction. So, our department treat chemical dependency and that means we're treating substance abuse, from, you know, heroin to fentanyl to nicotine to cannabis. The other addiction is behavioral addiction. That's more like gambling, sexual or shopping. That's usually dealt by psychiatry. So for chemical dependency, we have our department serving for that.

Host: And alcohol as well, yes?

Dr Eduardo Javier: That's right. Yes.

Host: So, when we say addiction medicine, In terms of this program, what exactly does that entail?

Dr Eduardo Javier: Addiction medicine is a branch of internal medicine that deals with patients with substance use that's from assessment to formulating a plan of care with them to medication management and case management. And also, catering them to their recovery and progress with their substance use, so from diagnosis to treatment of different substances of abuse.

Host: So, it basically will take a patient every step of the way during the course of the program needed for them, yes?

Dr Eduardo Javier: Correct. And also, monitoring them and following up with them, maintaining their progress and maintaining their recovery.

Host: So, is Eisenhower Health's Program just a day program? And in addition to medicine management, medication management, maybe tell us a little bit more about the other services that are involved in treatment.

Dr Eduardo Javier: Right now, it's just medication-assisted therapy. But our services, it's distributed throughout the establishment of Eisenhower. We see patients from the emergency room that are admitted to the hospital. We see patients as well in our clinic after discharge from the hospital. So, we don't have a behavioral treatment just of yet. We're trying to develop an outpatient program, which will be hopefully coming up in the next few months. But for now, we are seeing all the patients that are entering our establishment from the primary care to the emergency room and as well as, you know, those are admitted to the hospital that had substance use issues, and we're trying to navigate the treatment with them. And if they need to be referred to a rehab, for example, we have a number of rehabs that are available in the community and we help them navigate admissions to those facilities as well.

Host: Gotcha. And what you just mentioned, doctor, about being able to touch those that come into the facility via other routes, like the emergency room, like a primary care physician. Tell us please how important that is because obviously, in a nutshell, what that means is you're able to help a lot of people that don't initially come there for substance abuse treatment, right?

Dr Eduardo Javier: That's right. So, we wanted to capture, a lot of people as much as we can. So, the statistics is that 80% of people with substance use, their first contact with healthcare is in the emergency room. So, we wanted to have our services available there wherever they are. Sometimes they come in for a different reason and they would disclose that they are using some substances. So, we help them with that as well. And sometimes in the middle of the night, we want everybody to know that, you know, they can just come to the emergency room if they needed help with our substance. Be it 3:00 in the morning, our emergency room is ready and willing to help all of them.

Host: How about switching gears a little bit here? We know that people with addiction issues are often hesitant to get help for what may be a variety of different reasons, including very prominently oftentimes being ashamed, embarrassed. How do you and yours address that stigma, which is often a big hurdle to overcome just to get them in the door, right?

Dr Eduardo Javier: That's right. So, most of the patients, you know, generally doesn't even seek help just because of that stigma. Because they know they're going to be judged, they're going to be treated differently because of prior history or prior experience with healthcare encounters. So, what do we do is we educate our staff, our physicians and our medical staff and nursing staff regarding stigma and what is the effect of stigma in terms of caring for these patients and to examine our own internalized stigma as well so that we can deliver evidence-based medicine to our patient that needed it most.

Host: Often doctor, people in this situation are just looking for a little compassion, right? Someone to understand where they're coming from, what they've been through. And so, I would imagine that involves just sometimes simply put a human touch on the part of your staff, right?

Dr Eduardo Javier: Exactly. The most important thing too is educating everybody about what the disease of addiction is. If we understand what the disease of addiction is, then we know where the patient is coming from. Once we understand their symptoms and their story, then it's very easy for us to feel compassionate to each and everyone who comes to our care.

Host: And when you mention the word disease, it seems to me that in recent years, that's become much more recognized and accepted by the general public, hasn't it? Where for a long time, many people mistakenly thought that those with addiction issues, whether it was drugs, alcohol, gambling, sex, whatever, that it was by choice that it was someone just "overdoing things," taking things too far. But we've learned that that's not the case, right?

Dr Eduardo Javier: The disease of addiction is multifactorial and it qualifies as a chronic relapsing disease. Just like hypertension, diabetes, asthma, COPD, it is a chronic disease that has a neurological substrate, meaning to say there are certain parts of the brain that are affected by addiction, just like any other diseases.

So, the treatment and the way we perceive addiction should be just like we see and interpret patients with diabetes. You know, if they don't have their insulin, they're all going to die. Patients with CHF, if they don't have their diuretics, they're also going to suffer. So if we would hold treatment to patients with substance use, it's the same thing. The outcomes are the same. The relapse and the recurrences rates are the same as any other chronic disease.

Host: A few other things. We're talking about this addiction medicine program through Eisenhower Health. So, let me ask you a little bit more about the doling out of medication. On the one hand, tell us please a little bit about how you initially determine what drug or drugs someone may need. And then, what do you do in terms of the management of that so that they're not left on their own to take it, adjust it, et cetera, going forward.

Dr Eduardo Javier: So, yeah, it really depends on the substance of choice, right? So, let's say, for example, you know, the very timely problem that we have with the opioid epidemic. Most of the people now are using fentanyl. They're manufactured somewhere else and brought into the country, which is a very potent pain medication. It's a hundred times more potent than heroin, a thousand times more potent than morphine. So, for example, the patient is dependent on that. We take a really good history and get a good story on how the patient developed this addiction. And so, we offer them the evidence-based medication that are FDA approved, which are buprenorphine, methadone and naltrexone. So, we present these options to the patient, and we'll do a collaborative decision. If they decided to do buprenorphine, then we would start them on buprenorphine. We would induct them very carefully. If they decided to be on methadone, then we would start them on methadone.

In terms of dosing adjustments, we would, you know, observe them for a few days and determine what would be the most appropriate dose and then would discharge them on the dose that control their symptoms the least and the most effective dose that would control their symptoms. And we would make sure that they have a followup appointment with us at the outpatient clinic or with our primary or the methadone clinic or wherever provided that they may choose to go.

Host: Gotcha. Now, a couple of other things. How important are family's, friends', loved ones' involvement in the recovery process when someone is going through treatment? How do you foster that inclusion on their part?

Dr Eduardo Javier: Support from the family and the community is very important because addiction is a disease of isolation. The more isolated they become and the more heavier they use, the more isolated they feel. So, it's very important to have that support somebody to fall back on when things fall apart. And also. When they're having severe withdrawals and knowing that everything else is taken care of and they can just focus on themselves.

And the other thing too, the importance of family is that addiction is a disease of the family. Once a family member is affected by substance use, the rest of the family also suffers. So, it's very important that we include the family as well in treatment and healing, all members of the family that's involved with the care of the patient.

Host: Absolutely. But having said all that, what about the importance of offering confidentiality when that's called for?

Dr Eduardo Javier: So yeah, it's very important to observe that their health information is guarded and protected. We follow federal regulations in terms of protecting their information. Their health information are specially handled by our medical records. And we want to make sure that the patient knows that we will guard and protect their information the best way that we can.

And the reason why we're doing this is because, historically, most patients with substance use, they're discriminated against. They can lose their job, they can lose their license if that information is mishandled. So, we want to make sure that they're comfortable and confident that we will handle their information to the utmost respect and confidentiality.

Host: Absolutely. And so finally, in summary, doctor, if someone listening wants the type of help, needs the type of help we've been discussing, either for themselves or for a loved one addicted to one of the things we've gone over, what's the first step they should take to get involved with Eisenhower Health? How do they get started?

Dr Eduardo Javier: After they realize or after knowing that they have a problem or a family member has a problem, our clinic is always open. We accept walk-ins in our clinic. Our emergency room, as I have mentioned, I have trained some of the staff and most of the physicians there on how to handle patients that are coming in asking for help. They can call the hospital as well and be connected to the addiction medicine clinic. Our nurses are trained to handle their questions and calls. And if they need to talk to a physician, we have our attendings and our fellows to talk to and they can schedule an appointment. Most of our social workers as well would know how to navigate their questions and direct them in terms of directions as to where to go. And we would want them to know that, you know, there is help. it's available, and we know more about addiction now than we did 10 years ago. And so, we wanted to let them know that we are here, that we are ready for them whenever they need to seek that help.

Host: Indeed. And so folks, we trust you're now more familiar with the Eisenhower Health Addiction Medicine Program. And so once again, our thanks to Dr. Eduardo Javier. Doc, thanks so much again and continued success with the great work being done by you and your staff.

Dr Eduardo Javier: Yeah. Thank you so much. Thank you very much for this opportunity to let everybody know about our, services here at Eisenhower when it comes to substance use. I know this is a very sensitive topic that everybody is not comfortable talking. So, yeah, I feel privileged to be able to talk about our services. Thank you.

Host: Absolutely. Thank you. Same here. And you mentioned it's sensitive, and it is of course, but oftentimes literally life-saving as well. For more information, folks, please call 760-773-4300 or go to eisenhowerhealth.com. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to Living Well with Eisenhower Health.