Selected Podcast
Treating Substance Use Disorders
In this episode, we will hear from Dr. Maria Bajuyo, a board-certified family physician and addiction medicine specialist. She will discuss the value of counseling when treating substance use and addiction.
Featuring:
Maria Bajuyo, MD
Maria Bajuyo, MD, is board-certified in family medicine and addiction medicine. She is medical director of the Franciscan Health Substance Use Disorders Clinic in central Indiana. Dr. Bajuyo earned her medical degree from the Indiana University School of Medicine and completed her residency training at Franciscan Health. Transcription:
Scott Webb: Most of us are aware that we've had an opioid epidemic in this country over the past few years. And whether folks are addicted to drugs, alcohol, or smoking or vaping, a substance use disorders clinic might be the solution that's needed to break free from these addictions.
And joining me today to discuss the value of counseling and substance use disorders clinics in treating addictions is Dr. Maria Bajuyo. She's a board-certified family physician and addiction medicine specialist at Franciscan Health.
This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about substance use disorder, addiction, the substance use disorders clinic, and so on. So a lot to get to today. As we get rolling here, what is a substance use disorder?
Dr. Maria Bajuyo: So a substance use disorder is the updated terminology that has been used to identify disorders of addiction. Actually, the definition of addiction has also gone through many sort of changes over the years. But the American Society of Addiction Medicine now defines it as a treatable, chronic medical condition involving complex interactions between brain circuits, genetics, the environment and an individual's life experiences. Also, part of that definition, which is important I think to point out and they specify that, prevention efforts and treatment approaches for addiction are generally as successful for addiction as those for many other of our chronic diseases.
Scott Webb: Yeah, and that's good to have a nice baseline there as we get rolling here. So, what types of medications are used?
Dr. Maria Bajuyo: I'm treating conditions with medication such as opiate use disorder and alcohol use disorder. Those are the two main addictions that we have medications that are proven effective for. Other addictions can be treated primarily with behavioral approaches in our clinic. But as far as me personally, I'm treating mostly patients who are dependent on opiates or alcohol.
Scott Webb: Yeah. And how does the substance use disorders clinic work? You know, I've heard of those, but I'm interested if you could take us behind the scenes a little bit. How do they work?
Dr. Maria Bajuyo: Essentially, patients will get referred to us by their primary care doctor or an ER doctor or some point of contact with the medical system or sometimes they just call themselves realizing that they have a problem that they would like help controlling or getting under control. Our nurses will screen patients and make sure that they're appropriate for this level of care. Treatment for addiction spans all the way from inpatient admission to even maybe a longer stay like a residential stay somewhere for maybe a month all the way down to what we do, which is just outpatient level of care.
So we first kind of screen them to make sure that they don't maybe need more care than what we can offer. And then, if we decide that they're appropriate, they come in and see our nurse and see our therapists and we'll get them scheduled right away to see a physician, also to assess what their medical needs might be. So then, we use a combination of different medications. For alcohol use disorder, we primarily use a medication called naltrexone, which is appropriate once a patient has stopped drinking and it helps to prevent a return to drinking. It helps to control cravings and minimize the effect of drinking if they do return to drinking.
Other things for alcohol use disorder, we can use medications called acamprosate. Sometimes something like Topamax or occasionally we'll use something like Antabuse, although not really as often. For opiate use disorder, the two main medicines that we use would be Suboxone, which is an opiate. It's a mixed opiate. It has some agonist effects and some antagonist effects. That's the most common medicine that we use for opiate use disorder. We can also use naltrexone for that as well. But the patient has to be detoxed and off of opiates for seven to fourteen days generally speaking, and so it's a little harder to start a patient on naltrexone.
Scott Webb: Sure. And wondering, do you also see folks for addictions to smoking, vaping, that kind of thing?
Dr. Maria Bajuyo: Yeah. Usually not as their primary referral diagnosis, but the vast majority of our patients also smoke or vape. And so definitely, that's part of a comprehensive addiction care plan for those patients. I make sure to always address it and I include it on their diagnosis list. Many patients come in with the preconception that they can't tackle too many things at once and that they need to save that for later. And so definitely, we follow the patient's lead on that and just say that's understandable. If you decide that you're ready or when you decide that you're ready, we'd be happy to help you with that. Some patients come in and they're rip-the-Band-Aid-off kind of people and they're just like, "Let's tackle everything at once," and that's a great option too.
Scott Webb: Yeah. Sort of a one-stop shopping, right?
Dr. Maria Bajuyo: Absolutely.
Scott Webb: While I'm here, let's just cover all the addictions. As you've said, you know, that there's inpatient and outpatient and a variety of different ways that you approach this and treatment options available. So let's talk about counseling. How does counseling fit in with addiction treatment?
Dr. Maria Bajuyo: Counseling is a really important part of a multidimensional approach to good patient care. It has consistently shown that patient outcomes are better when they have access to therapy as well as medication. So just like with many other psychological conditions of anxiety or depression, that really both therapy and medication together show the best outcomes.
Here at St. Francis, we have several substance use disorder specially trained therapists and all of our patients have a therapy intake and are involved in some level of care with therapy here. We offer groups that meet weekly of varying different topics in each of these different groups. And then, there's also the option for individual therapy for patients who want both or they may just prefer one or the other.
Scott Webb: And this may be a bit of a loaded question, but what are the main reasons why people get addicted to substances, whether it's opioids or anything else, you know? Because we've heard over the last few years, it's just an opioid epidemic or crisis both here in the states and around the world. And then, we hear about fentanyl. And there's a lot here and I know it's a bit of a loaded question, but how does it happen? How do we get addicted to these things?
Dr. Maria Bajuyo: Sure. Yeah, opiates are a particularly interesting category when it comes to addiction because a lot of patients are exposed to opiates through valid medical prescriptions. So I mean, drugs of abuse really run the gamut. We're not prescribing cocaine. So a cocaine addiction really starts from someone sometimes choosing that exposure, other times being exposed maybe even in their home environment. But the exposure to opiates and alcohol comes oftentimes much more naturally or much more organically or innocently so to speak. But really, predisposition or risk factors for developing an addiction are both genetic as well as environmental. So alluding to some of those environmental factors there, talking about how are you exposed to opiates, how are you exposed to alcohol versus how you might be exposed to cocaine. But certainly, you know, your family's beliefs, how you were raised, attitudes toward drinking, attitudes towards drug exposure in peer groups that encourage drug use. All these things play a role into that initial exposure or that initial drug use. And certain then medical conditions or genetic predispositions, so people with attention deficit disorder are more likely to maybe try or experiment with substances, maybe as a feature of that condition, certainly not all. There's a connection there. As well as, we know that there's clearly genetic components to alcoholism and those traits do run in families.
So, you know, lots of environmental fact. As far as how you're exposed or how you're first exposed. But there's a strong genetic component also as far as who can drink and just drink socially or who ends up drinking and has a really hard time controlling and limiting that is strongly influenced by genetics.
Scott Webb: Yeah, definitely. And it does seem with opioids and the stories, unfortunately, the tragic stories that we've probably all heard through the media and social media and other places, just, you know, family, friends and whomever. As you say, it does seem like it often starts out as a valid medical prescription, pain medication for an injury or something like that. And then, it just spirals out of control. And then, when folks can no longer get opioids prescribed to them, they turn to the streets and then you start mixing in fentanyl and you see how the crisis happened, right?
Dr. Maria Bajuyo: Yeah, absolutely. When I went through training, there was a lot of emphasis on making sure we assess every patient's pain and making sure we treat every patient's pain. And we still do that and I still agree with that. But there was strong emphasis on that and there was a lot more liberality as far as prescribing 20 years ago.
Yeah, I do think that we have learned quite a bit about addiction. We've learned quite a bit about opiates in the last 20 or 30 years. That there have been court cases involving certain pharmaceutical companies about misleading marketing. And so, you know, there's definitely a lot of factors that play here and that's the environmental piece, that there was just a wide prescription of a lot of these pain pills. And it's interesting, since you're bringing it up, I do find that there can be an anger or resentment, or even a mistrust toward sort of the medical community among a certain subset of patients with opioid dependence, which is interesting then when they seek treatment from medication. But it does create sort of a rift or a disruption to doctor-patient trust, from the patients toward the physician even. And that's an interesting thing to navigate as I am building relationships with patients and we are learning to trust each other, that there's some of that in my direction as well.
Scott Webb: That is interesting. And of course, as we know and you well know, that trust is probably first on the list when it comes to that doctor-patient relationship. So that is an interesting sort of byproduct and we could probably have a whole other conversation about that. But also wondering, is there an age requirement? So when folks want to or need to participate in a substance use disorders program, is there an age requirement or an age range?
Dr. Maria Bajuyo: I would say that generally, they're treating adults. Our program would primarily focus on adults as far as medication is concerned. We have therapists here that treat patients of all ages. And therapy is certainly open to a patient at any age.
The medications that we use are primarily going to be for people 18 or older. There may be some rare cases where a younger patient may need buprenorphine therapy or something along those lines. In indie, we have the benefit of having Riley right on our doorstep. If it was a really complicated pediatric case, I'm sure that the adolescent program at Riley would be the best place to sort of manage the complicated younger patients in those cases. But buprenorphine has been around for a long time and certain formulations that can be used for pain. And so there's some data that would suggest it has some safety even in that population if it's necessary,
Scott Webb: Yeah, for sure. And this has been really educational conversation today, doctor. And as we wrap up here, I think that what scares folks off, this is just me talking here, but I think a lot of times what scares people off from really tackling and dealing with their addictions is the fear of withdrawal, right? Those withdrawal symptoms, whether it's smoking, alcohol, opioids, whatever it is. So as we conclude here, does addiction treatment help people with the withdrawal symptoms?
Dr. Maria Bajuyo: Yeah, definitely. Opiate withdrawal patients, particularly, just there's so much fear and anxiety and resistance to those symptoms, those specific set of symptoms. And they legitimately feel like they're going to die. They even know cognitively that they're not going to die from those symptoms, but they just have a sense, like a deep fear and like a sense that they will die. And so it is a very physical process of withdrawal, but there's a strong psychological component to it as well. And absolutely, when we treat patients with opiate use disorder with Suboxone therapy, for most patients, it almost immediately improves their withdrawal symptoms. And sometimes it alleviates them completely entirely. So buprenorphine is really a wonder drug when it comes to treating opiate use disorder and preventing patients from having that intense awful withdrawal.
When it comes to alcohol, withdrawal is a life-threatening situation, oftentimes when it comes to alcohol withdrawal. And so those patients, not all of them, but a lot of them need to be medically managed in a more inpatient type setting when they're experiencing alcohol withdrawal. And that's one of the things that our screening process does is try to weed out and tease out which patients are safe to come into the clinic and go home that night and which patients maybe need closer observation. But yeah, certainly there's a lot of inpatient medications that we can use to ease patients through the discomfort of alcohol withdrawal as well. So we don't do that here in the clinic, but they do it in the hospital here when patients have other medical problems or we can certainly collaborate with and work with other inpatient treatment centers in the area to get patients in on their time schedules and get them through that process of feeling better. And then, we see them when they're out of the woods and we can help manage the remaining symptoms that they might be still having.
Scott Webb: Well, this has been really helpful, really educational and I'm positive that listeners agree. So thanks so much for your time today, doctor, and you stay well.
Dr. Maria Bajuyo: Thank you as well.
Scott Webb: And for more information, visit franciscanhealth.org and search addiction and substance abuse. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: Most of us are aware that we've had an opioid epidemic in this country over the past few years. And whether folks are addicted to drugs, alcohol, or smoking or vaping, a substance use disorders clinic might be the solution that's needed to break free from these addictions.
And joining me today to discuss the value of counseling and substance use disorders clinics in treating addictions is Dr. Maria Bajuyo. She's a board-certified family physician and addiction medicine specialist at Franciscan Health.
This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about substance use disorder, addiction, the substance use disorders clinic, and so on. So a lot to get to today. As we get rolling here, what is a substance use disorder?
Dr. Maria Bajuyo: So a substance use disorder is the updated terminology that has been used to identify disorders of addiction. Actually, the definition of addiction has also gone through many sort of changes over the years. But the American Society of Addiction Medicine now defines it as a treatable, chronic medical condition involving complex interactions between brain circuits, genetics, the environment and an individual's life experiences. Also, part of that definition, which is important I think to point out and they specify that, prevention efforts and treatment approaches for addiction are generally as successful for addiction as those for many other of our chronic diseases.
Scott Webb: Yeah, and that's good to have a nice baseline there as we get rolling here. So, what types of medications are used?
Dr. Maria Bajuyo: I'm treating conditions with medication such as opiate use disorder and alcohol use disorder. Those are the two main addictions that we have medications that are proven effective for. Other addictions can be treated primarily with behavioral approaches in our clinic. But as far as me personally, I'm treating mostly patients who are dependent on opiates or alcohol.
Scott Webb: Yeah. And how does the substance use disorders clinic work? You know, I've heard of those, but I'm interested if you could take us behind the scenes a little bit. How do they work?
Dr. Maria Bajuyo: Essentially, patients will get referred to us by their primary care doctor or an ER doctor or some point of contact with the medical system or sometimes they just call themselves realizing that they have a problem that they would like help controlling or getting under control. Our nurses will screen patients and make sure that they're appropriate for this level of care. Treatment for addiction spans all the way from inpatient admission to even maybe a longer stay like a residential stay somewhere for maybe a month all the way down to what we do, which is just outpatient level of care.
So we first kind of screen them to make sure that they don't maybe need more care than what we can offer. And then, if we decide that they're appropriate, they come in and see our nurse and see our therapists and we'll get them scheduled right away to see a physician, also to assess what their medical needs might be. So then, we use a combination of different medications. For alcohol use disorder, we primarily use a medication called naltrexone, which is appropriate once a patient has stopped drinking and it helps to prevent a return to drinking. It helps to control cravings and minimize the effect of drinking if they do return to drinking.
Other things for alcohol use disorder, we can use medications called acamprosate. Sometimes something like Topamax or occasionally we'll use something like Antabuse, although not really as often. For opiate use disorder, the two main medicines that we use would be Suboxone, which is an opiate. It's a mixed opiate. It has some agonist effects and some antagonist effects. That's the most common medicine that we use for opiate use disorder. We can also use naltrexone for that as well. But the patient has to be detoxed and off of opiates for seven to fourteen days generally speaking, and so it's a little harder to start a patient on naltrexone.
Scott Webb: Sure. And wondering, do you also see folks for addictions to smoking, vaping, that kind of thing?
Dr. Maria Bajuyo: Yeah. Usually not as their primary referral diagnosis, but the vast majority of our patients also smoke or vape. And so definitely, that's part of a comprehensive addiction care plan for those patients. I make sure to always address it and I include it on their diagnosis list. Many patients come in with the preconception that they can't tackle too many things at once and that they need to save that for later. And so definitely, we follow the patient's lead on that and just say that's understandable. If you decide that you're ready or when you decide that you're ready, we'd be happy to help you with that. Some patients come in and they're rip-the-Band-Aid-off kind of people and they're just like, "Let's tackle everything at once," and that's a great option too.
Scott Webb: Yeah. Sort of a one-stop shopping, right?
Dr. Maria Bajuyo: Absolutely.
Scott Webb: While I'm here, let's just cover all the addictions. As you've said, you know, that there's inpatient and outpatient and a variety of different ways that you approach this and treatment options available. So let's talk about counseling. How does counseling fit in with addiction treatment?
Dr. Maria Bajuyo: Counseling is a really important part of a multidimensional approach to good patient care. It has consistently shown that patient outcomes are better when they have access to therapy as well as medication. So just like with many other psychological conditions of anxiety or depression, that really both therapy and medication together show the best outcomes.
Here at St. Francis, we have several substance use disorder specially trained therapists and all of our patients have a therapy intake and are involved in some level of care with therapy here. We offer groups that meet weekly of varying different topics in each of these different groups. And then, there's also the option for individual therapy for patients who want both or they may just prefer one or the other.
Scott Webb: And this may be a bit of a loaded question, but what are the main reasons why people get addicted to substances, whether it's opioids or anything else, you know? Because we've heard over the last few years, it's just an opioid epidemic or crisis both here in the states and around the world. And then, we hear about fentanyl. And there's a lot here and I know it's a bit of a loaded question, but how does it happen? How do we get addicted to these things?
Dr. Maria Bajuyo: Sure. Yeah, opiates are a particularly interesting category when it comes to addiction because a lot of patients are exposed to opiates through valid medical prescriptions. So I mean, drugs of abuse really run the gamut. We're not prescribing cocaine. So a cocaine addiction really starts from someone sometimes choosing that exposure, other times being exposed maybe even in their home environment. But the exposure to opiates and alcohol comes oftentimes much more naturally or much more organically or innocently so to speak. But really, predisposition or risk factors for developing an addiction are both genetic as well as environmental. So alluding to some of those environmental factors there, talking about how are you exposed to opiates, how are you exposed to alcohol versus how you might be exposed to cocaine. But certainly, you know, your family's beliefs, how you were raised, attitudes toward drinking, attitudes towards drug exposure in peer groups that encourage drug use. All these things play a role into that initial exposure or that initial drug use. And certain then medical conditions or genetic predispositions, so people with attention deficit disorder are more likely to maybe try or experiment with substances, maybe as a feature of that condition, certainly not all. There's a connection there. As well as, we know that there's clearly genetic components to alcoholism and those traits do run in families.
So, you know, lots of environmental fact. As far as how you're exposed or how you're first exposed. But there's a strong genetic component also as far as who can drink and just drink socially or who ends up drinking and has a really hard time controlling and limiting that is strongly influenced by genetics.
Scott Webb: Yeah, definitely. And it does seem with opioids and the stories, unfortunately, the tragic stories that we've probably all heard through the media and social media and other places, just, you know, family, friends and whomever. As you say, it does seem like it often starts out as a valid medical prescription, pain medication for an injury or something like that. And then, it just spirals out of control. And then, when folks can no longer get opioids prescribed to them, they turn to the streets and then you start mixing in fentanyl and you see how the crisis happened, right?
Dr. Maria Bajuyo: Yeah, absolutely. When I went through training, there was a lot of emphasis on making sure we assess every patient's pain and making sure we treat every patient's pain. And we still do that and I still agree with that. But there was strong emphasis on that and there was a lot more liberality as far as prescribing 20 years ago.
Yeah, I do think that we have learned quite a bit about addiction. We've learned quite a bit about opiates in the last 20 or 30 years. That there have been court cases involving certain pharmaceutical companies about misleading marketing. And so, you know, there's definitely a lot of factors that play here and that's the environmental piece, that there was just a wide prescription of a lot of these pain pills. And it's interesting, since you're bringing it up, I do find that there can be an anger or resentment, or even a mistrust toward sort of the medical community among a certain subset of patients with opioid dependence, which is interesting then when they seek treatment from medication. But it does create sort of a rift or a disruption to doctor-patient trust, from the patients toward the physician even. And that's an interesting thing to navigate as I am building relationships with patients and we are learning to trust each other, that there's some of that in my direction as well.
Scott Webb: That is interesting. And of course, as we know and you well know, that trust is probably first on the list when it comes to that doctor-patient relationship. So that is an interesting sort of byproduct and we could probably have a whole other conversation about that. But also wondering, is there an age requirement? So when folks want to or need to participate in a substance use disorders program, is there an age requirement or an age range?
Dr. Maria Bajuyo: I would say that generally, they're treating adults. Our program would primarily focus on adults as far as medication is concerned. We have therapists here that treat patients of all ages. And therapy is certainly open to a patient at any age.
The medications that we use are primarily going to be for people 18 or older. There may be some rare cases where a younger patient may need buprenorphine therapy or something along those lines. In indie, we have the benefit of having Riley right on our doorstep. If it was a really complicated pediatric case, I'm sure that the adolescent program at Riley would be the best place to sort of manage the complicated younger patients in those cases. But buprenorphine has been around for a long time and certain formulations that can be used for pain. And so there's some data that would suggest it has some safety even in that population if it's necessary,
Scott Webb: Yeah, for sure. And this has been really educational conversation today, doctor. And as we wrap up here, I think that what scares folks off, this is just me talking here, but I think a lot of times what scares people off from really tackling and dealing with their addictions is the fear of withdrawal, right? Those withdrawal symptoms, whether it's smoking, alcohol, opioids, whatever it is. So as we conclude here, does addiction treatment help people with the withdrawal symptoms?
Dr. Maria Bajuyo: Yeah, definitely. Opiate withdrawal patients, particularly, just there's so much fear and anxiety and resistance to those symptoms, those specific set of symptoms. And they legitimately feel like they're going to die. They even know cognitively that they're not going to die from those symptoms, but they just have a sense, like a deep fear and like a sense that they will die. And so it is a very physical process of withdrawal, but there's a strong psychological component to it as well. And absolutely, when we treat patients with opiate use disorder with Suboxone therapy, for most patients, it almost immediately improves their withdrawal symptoms. And sometimes it alleviates them completely entirely. So buprenorphine is really a wonder drug when it comes to treating opiate use disorder and preventing patients from having that intense awful withdrawal.
When it comes to alcohol, withdrawal is a life-threatening situation, oftentimes when it comes to alcohol withdrawal. And so those patients, not all of them, but a lot of them need to be medically managed in a more inpatient type setting when they're experiencing alcohol withdrawal. And that's one of the things that our screening process does is try to weed out and tease out which patients are safe to come into the clinic and go home that night and which patients maybe need closer observation. But yeah, certainly there's a lot of inpatient medications that we can use to ease patients through the discomfort of alcohol withdrawal as well. So we don't do that here in the clinic, but they do it in the hospital here when patients have other medical problems or we can certainly collaborate with and work with other inpatient treatment centers in the area to get patients in on their time schedules and get them through that process of feeling better. And then, we see them when they're out of the woods and we can help manage the remaining symptoms that they might be still having.
Scott Webb: Well, this has been really helpful, really educational and I'm positive that listeners agree. So thanks so much for your time today, doctor, and you stay well.
Dr. Maria Bajuyo: Thank you as well.
Scott Webb: And for more information, visit franciscanhealth.org and search addiction and substance abuse. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.