Annc: This Studio Sacramento episode is supported by UC Davis Health where doctors, nurses, and researchers share a passion for advancing health.

Learn more about their latest medical innovations at health.ucdavis.edu.

♪♪ Scott: Addiction is a treatable chronic disease.

It is not a moral failing.

So says CA Bridge, a new approach to treating substance abuse pioneered at the University of California Davis.

This program, linking patients brought into the ER with support and compassionate services is helping people reclaim their lives.

Dr. Aimee Moulin and counselor Tommie Trevino join us today to discuss this program and its impact in changing the lives of those struggling with addiction.

Before we begin, I'm going to share something that was sent to me as I was working on the show.

I repeated this about 25 times.

blood alcohol, near death, as I was told.

I have a list of resources to help you right now.'

Scott: Tommie, Dr. Moulin, tell me, tell us, why is the story of how the writer of this letter got help in the ER, more of the exception than the rule?

And Dr. Moulin, why don't we start with you?

Aimee: Thank you so much.

Um, so, you know, the writer said, "I was embarrassed that it was 25 times."

And I would turn that around and say, I'm embarrassed that it's 25 times because it's really my job to make a difference so that... that pattern isn't repeated.

Because we have, as you mentioned at the start, addiction is a treatable medical illness.

It's not a moral failing.

And so, it is my job to treat that medical illness, to mitigate the repercussions that happen with that medical illness.

So, the fact that it took me, as an emergency provider, and my colleagues 25 times to recognize that we could do better, I'm embarrassed.

Um, and so really our goal here is to kind of to make that story everywhere, universal, so that it doesn't take 25 times.

And so that everybody has the opportunity to get into treatment, to change their lives and that we can end that cycle.

Scott: Tommie, from your perspective, how does this happen and why does it happen?

Tommie: You know, I'm a recovering, uh... uh, drug addict, alcoholic myself, and I know the embarrassment and... and being ashamed of it and not reaching out for help and putting up walls of, um, anger, keep people away.

And, uh, being blessed enough to be able to work at UC Davis and offer people opportunities to get their life back like... like I managed to get my life back.

Until the day came when I wanted to change my life and made up my mind, there was nothing that was going to stop me from doing it.

And it was the hardest thing that I ever did in my life.

I went through emotional changes.

I found out a lot about myself.

It's been, uh, close to 20 years now that-— I...

I thought it was less than that, but close to 20 years now.

And I'm still working on myself, you know.

Um, along with it... it's-— comes self-medication, right?

We self-medicate for a reason, drugs and alcohol.

And at the time, I didn't know what that was cause I started the age of 21, and I am now 63 years old.

So, I've been learning and trying to figure out why, the question that you asked me, because I struggled with depression.

I struggled with anxiety, and I struggled with anger issues.

And that can be the way I was raised, it could be my parents, you know?

And... and so I'm learning all those now.

So, numbing myself was the easy way out.

It didn't have to deal with it.

So now being sober, I have to face those challenges and... and it's hard and it's not easy.

So, being an example to other human beings that are struggling with the same disease that I am and being blessed to be working in the emergency room.

When I was trying to beat my disease, I didn't have the help.

I didn't know.

I didn't know.

I was too ashamed to even ask.

I didn't know there was rehabs, I didn't know that there was places to go ask for help.

I didn't know I can go to my doctor.

I didn't know these things.

Instead, luckily, I went to the library and read about it and planned my... and planned my journey, and... and it was hard.

So having an opportunity to work in the emergency room, I know what people are going through the addiction.

I know the feelings and emotions they're going through.

And there was no "Oh, I cannot do it" in my vocabulary.

I'm a good example of that, hey, you can... you can control this disease.

You're never going to beat it, but you can get it under control like you would any other disease.

Sugar diabetes, right?

You have to keep that under control.

The same thing with addiction and alcoholism, you have to keep it under control.

And offering... people that come to the emergency room, I understand.

I just don't walk in there and say hi to them or stand over.

I ask if I could sit down, talk to them and... and build a relationship.

You'll get that warm feeling.

And just lay it all on the table and say, "Hey, it's okay to be an addict.

It's okay to have this disease.

It doesn't make us any different than anybody else.

We're just struggling with the disease.

We have to keep it under control.

Let me help you."

I now have resources; I'm well connected to the community.

And it all depends on insurance, money, and... and a lot of other, um, barriers that go along with it.

So, I have to find out what the patient, um, is struggling with and meet them where they're at.

And um-— Scott: Meet them... meet them where they're at.

Tommie: Meet them where-— Scott: And that's a... that's a really interesting way to state that, Tommie.

And I...

I'm curious, I want to go.

Dr. Moulin for a moment and ask Dr. Moulin, explain to us, and... and I hate to put you in a tough position like this, but how is it that the addicted are typically treated when they go into the ER?

Across-— not just within our region, but across the country?

Aimee: Yeah.

So, we have a long history of providing highly stigmatized care to vulnerable people who are suffering from addiction.

Long history.

And so, I think it takes a lot of active work to overcome that.

Um, unfortunately, because of that history, people expect to be treated poorly by our healthcare system.

And that's really a tragedy.

Um, our motto is to meet people where they are, but don't leave them there.

And so, you have to go and reach the person to where they are and to do what you can to move them towards recovery.

Um, and so that's kind of, that's our motto.

And I think the other part that is wonderful about doing this in the emergency department is we're always open.

We're easy to access.

So that you don't have to go through all of these hoops and have all of these pieces in place before you can meet someone like Tommie.

You can just walk in our doors.

Scott: When-— I want to go back to a point that you just made about there's been a... a long time sti-— stigmatization of people who present with this sort of condition.

In the motto for... for CA Bridge, it talks about the issue that this is a disease, not a moral failing.

What is behind the long-held view that we as a society, and I guess it shows up in the ER, that addiction is purely a moral failing and not a disease condition?

Aimee: I think that we have a long history of stigmatizing diseases.

Um, if you look at this goes back to, at one point, cancer was stigmatized.

Aids was stigmatized.

Seizures were stigmatized at one point.

And so, it's just kind of this evolution, as we understand that there's a biological process that we can intervene on, that we can adjust that we can treat.

And so, changing the way that we think about people.

Um, the other thing that has really helped me and that I think helps my colleagues is I changed the way I think when someone is experiencing withdrawal, particularly opioid withdrawal, they feel, um, anxious.

They feel agitated.

They have-— it's... it's basically, it's... it's like that day when you have been outside and it's hot and you're hungry and you can't eat, and you just are depleted of dopamine.

You're not your best self.

And so, when I see someone in that state, I have to recognize that is a symptom of a disease that I can treat.

Scott: Hmm.

So, tell-— Aimee: And so, I think part of-— I was just going to say, part of it is changing this from, "Hey, this is someone who is doomed."

And we often see this in the media when we talk about addiction, the focus is on overdose and all of the kind of destruction that occurs from addiction rather than a story of recovery.

And so, changing the mindset, and Tommie really taught me this, he will see someone in recovery.

And so now when I see someone who is struggling with addiction, I don't see someone who is doomed, but I see someone who can recover and should recover.

And actually, recovery rates, particularly for opioid use disorder are better than a lot of cancers.

Scott: Could-— you use the word doom, but could you substitute that with "written off?"

Aimee: Exactly.

Scott: I'm curious, Tommie, you... you shared with us a little bit about your experiences as well, but, um, how did you first come into this work?

How did this get started for you?

Tommie: This started when I went to the library and started reading up about addiction.

And I wanted to find out what I had to do to get well, to... to... to get this disease under control.

That's what started it.

And then once I got into it, it was like, I wanted to share it with every addict in the world.

I just wanted to share my experience and how I was able to get my disease under control.

And... just, my journey just brought me here to this day.

I mean, I just keep...

I just keep-— I...

I...

I'll go out to the streets.

I go...

I go to homeless camps.

I go down to drug dealers' houses.

I mean, everybody knows me in Sacramento.

It seems like they do.

I go everywhere and I shared this message with everyone.

Scott: And Dr. Moulin, how did you and Tommie get connected up?

Aimee: We, um, I don't even know how many years, six years ago, Tommie?

Maybe it was more than that.

Um, had a small piece of funding to kind of think about how we treat people, um, in the hospital with mental illness and substance use disorders.

And so, we decided to try and bring in a counselor into the emergency department and just see if we could make a difference.

Um, we really made it up as we went along.

Um, I remember the first day Tommie came in and to the emergency department and said, "What... what do I do?"

And I kind of looked at him and said, "I...

I don't really know either."

We... we just kind of, um, just tried to make a difference.

And we basically see the patient as our pilots.

And so, we would just try to do the best that we could for each person.

And Tommie can talk more about this, but we learned as we went along and we would see where they hit barriers and do what we can-— could to overcome those barriers, to kind of clear that path.

But, um, we definitely just, the patient was our pilot and we just followed along.

Scott: So, Tommie, when someone comes into the ER and they're presenting in being in crisis of an addiction event, related event.

Walk us through the process of how you get connected up to that individual and interact with them, and then ultimately get them to the services and support that they need in order to be able to take-— attack their problem head on.

Tommie: You know, I don't really know, um, what I do or how I do it, to be honest with you.

I... I-— Scott: You just do it, right?

Tommie: I just...

I just know that I have a opportunity to help somebody and I'm going to take advantage of it.

That's all I know.

And so, when I walk in that room, I never know what I'm going to say.

It's usually, "Hi, my name is Tommie.

I'm a counselor.

I'm here to help you if you want help.

Is it okay if I sit down?"

And 99% of time it's, "yes."

I'll pull up a chair, sit down.

Uh, I don't like standing over anyone.

I like sitting down and taking my time and just, "Hey, are you from Sacramento?

Where are you from?"

I don't even talk about the drug or alcohol or whatever it is.

I don't even bring that up.

I go straight into, "Where's your family?

Are you married?"

I go into just building that relationship up.

Sooner or later, the patient usually brings up, "Well, I know why you're here.

Because of meth or because my meth use, my heroin use, my alcoholism."

And I say, "Yeah, you're right."

And I ask them, "Do you... do you need some help with this?

I can help you.

I'm well connected in the community, and I can help you."

And from there, it just, the rest is history.

If they want help, I help them.

If they don't want to stop.

That's okay.

It's okay.

That's where harm reduction comes in.

If you don't want to stop drinking, that's fine.

But instead of drinking five bottles of wine today, let's cut it back to three.

Let's try three.

"Okay, Tommie, I'll make a deal."

Not a deal.

We'll call it what you want to call it, but just cut it back.

Just cut it back a little bit.

And I know that that's the start.

That's a start.

Heroin, if you're using heroin, it's okay.

You don't want to stop right now?

That's okay.

Let's talk about where you can get clean needles.

Let's talk about your drug dealer.

Let's talk about not getting different drug dealers and getting your... your... your heroin mixed with fentanyl or some other stuff they're putting in, uh, in drugs nowadays.

Fentanyl is the big problem now.

They're... they're putting fentanyl in everything now.

So, just getting to know and build that relationship up and knowing that I'm here for them whenever they want.

If they're... if they're ready today, fine.

If they're not, I'm here.

I'm here next month.

I'm here in six months and I'm here hopefully in a year.

I'm ready for them anytime.

Scott: Tommie, I want to ask you, as a non-physician, you know, you come into the room, every time is different.

You don't know where it's going to go, but you're there to help.

How are you received by the physicians that you end up working alongside with and... and the other staff?

These are all, you know, um, highly trained, licensed people, and you're walking into their ER and bringing your own skillset and your own experiences and training to bear.

How... how were you received in the beginning?

Tommie: From the beginning, it was uncomfortable for everyone, including, especially myself.

Uh, the ER is a busy place.

There's people moving around.

There's nurses, there's techs, there's doctors, it's... it's busy, a lot of movement.

You have to, like, stand out of the way and it... and it-— and I feel like social workers, discharge planners, I feel like-— I felt like I was in their way from the-— getting in their way in the beginning.

But I would just...

I would just wait.

If I seen somebody that was under the influence, I'd recognize it and I started helping them out.

With time we all adjusted.

Everybody, um, accepted me now.

Um, I help not only our patients, but I help staff families now.

Scott: Really?

They come to you with questions as well for their own issues?

Tommie: All the time.

Janitors, um, security guards.

You name it.

Any... anybody now knows who I am and what I do in the hospital, and they come to me.

It's all confidential, but I help-— I would help anybody at any time.

Um-— Scott: Right.

Doc-— Tommie: I have doctor's-— excuse me.

Scott: No, please finish.

Go ahead.

Tommie: Um, now, and I used to think that there was a big stigma and nobody wanted to help addicts.

I really used to think that from the beginning.

But now I have doctors that come up to me, nurses, techs, "Tom, we didn't know what to do before you got here.

We didn't know.

We're trained on fixing a broken arm or, or whatever, and getting people in and out of here.

If that's it.

We didn't know how to approach somebody that was struggling with addiction.

We would just make sure they got the fluids or whatever it was, medication for withdrawal and they were discharged.

And that was it."

But now we take the time, and we'll help those patients get on different kinds of medications, suboxone, naltrexone, and so on.

And now we don't see that patient coming back every week, every month, every two weeks.

Now that patient might come back every six months, eight months, or maybe not at all.

Now, because now they know where they need to go if they want to get help.

Scott: I want to get, uh, Dr. Moulin in here and ask you Dr. Moulin, you are both participant and observer of all that Tommie just described.

What do you think are the greatest learnings that your colleagues have been able to take away from observing Tommie in this program in action and its impact on patients?

Aimee: Yeah, I mean, hopefully what you can start to see is that Tommie is remarkable.

That he, um, really has a wonderful, amazing, unique skillset to connect with people.

So that conversation that he has with people and that connection that he makes with people happens, just imagine this, in our busy, chaotic, loud emergency department.

That he is able to do that in the emergency department is really, um, remarkable.

And we are so blessed to have him.

And I think at this point, all of my colleagues recognize how blessed we are to have him in our emergency departments and that sea change of how he has modeled for the physician staff, everyone in the emergency departments, everyone in the hospital, and I think our community.

That he has modeled, how we should approach, um, people who are struggling with addiction and how we should interact with them in a way that is therapeutic and increases the likelihood that they're going to make it into recovery.

He has modeled that for us.

And-— Scott: It... it seems as if you're really describing a real difference between handing someone a pamphlet on addressing their addiction and really ensuring a warm handoff for the patient as they do exit the ER.

But somewhere, somehow that there is a place that they're connected to, to go for more.

Aimee: We do not end when someone exits the emergency department.

And I think that's the other remarkable thing about our program is that we follow up.

Um, Tommie and his team will follow up with patients to make sure that they successfully landed in treatment, that they were able to access the resources, pick up their prescription, um, that we don't consider our job or our relationship with that person done.

We... we make sure that they actually successfully land in clinic.

Um, and people are in contact with Tommie, you know, months later.

Um, and the other thing that people know is if they relapse and that is a normal part of recovery, that it's a chronic illness and relapse is normal, they can reach out to Tommie.

They can come back into the emergency department, and we do what we can to get them back.

So, we don't consider our relationship ended when that person leaves.

Scott: And I really love that word, relationship.

Tommie, w-— at-— when... when people leave, having the conversations with you and they keep in touch, much like the writer of the letter that we opened the show with a bit earlier.

Can you tell us about the type of difference that's been made in the lives of the patient-— Tommie: Well, I'’ll give you a good-— Scott: Patients that you all have touched?

Tommie: I'll give you a good example.

We had a patient that was here three years ago, um, wanting to transition from methadone over to suboxone, and he was fighting an opioid addiction.

And we're friends now and he's doing really well.

His wife just had a baby this morning here in the hospital.

I mean, and... and he was here for three days, and... and we had breakfast for the last three days here and it was just great.

That's the relationships that I build with people.

They know that I am here for them.

Sometimes I will even go to their home.

If they're struggling, they have a family member, if they're too embarrassed to come to the hospital or can't make it, I will go to their home or meet them wherever they want.

And... and provide a plan, come up with a plan.

I really believe that you have to have a plan.

You just don't say, "Today, I'm going to get clean."

You plan out your... your... your journey.

It could-— you could start it next month, if you like.

Whatever... whatever you're comfortable with.

Scott: Dr. Moulin, this-— that... that is a really wonderful capsule to hear of that not only impact of the individual but the continuing impact outside of the ER.

How is this type of program being looked at by other ERs, both locally and beyond, that are attempting to do more?

And is that happening?

Aimee: Yes.

So, I think one of the exciting things is people say, you know, "ERs, won't do this.

ERs are not interested.

They'll never do it."

And that has just not been the case in that we have seen, um, people in emergency departments want to help and we just need to give them the tools to do the right thing.

Um, sometimes I would hear people say like, "Oh, you can't do that."

And I say, "Okay, what is it that you are doing now that is working so well?"

And if we start there and we recognize our current system has failed, then you look around and say, "Okay, now it's time for me to do something different."

Though-— Go ahead.

Scott: Well, actually in... in taking that in our final moments, can you share with us, if we, or a loved one is struggling with addiction, where should we go and what should we do in trying to intervene and help them?

Aimee: I think the hardest part is having a family member who is-— you watching struggle and that you want to help.

Um, and I know that Tommie has worked with family members to try and help their loved one.

Um, and I always think, you know, what I'’ve learned from Tommie is to approach that person with love and to see, take that model of, you know, meet the person where they are, but don't leave them there.

And so that everything you can do to understand where they are at that moment with love and try to move them towards recovery and treatment and support that journey, I think is key.

And to recognize that it's a chronic illness.

And so that, that journey, um, is one that is sort of, it's something that you're always gonna... you're always gonna to work on.

But that people do recover, um, and that recovery is real and beautiful and wonderful people can get there.

Scott: And I think we're going to leave it there.

Thank you both very much, and much success in your work to come.

Tommie: Thank you, Scott.

Aimee: Thank you, Scott.

Scott: And that's our show.

Thanks to our guests and thanks to you for watching Studio Sacramento.

I'm Scott Syphax.

See you next time right here on KVIE.

♪♪ Scott Syphax: All episodes of Studio Sacramento, along with other KVIE programs, are available to watch online at kvie.org/video.

Annc: This Studio Sacramento episode is supported by UC Davis Health where doctors, nurses, and researchers share a passion for advancing health.

Learn more about their latest medical innovations at health.ucdavis.edu.