Ep33 Addiction Treatment Help People Get Better for Longer

Ep33 Addiction Treatment Help People Get Better for Longer

[00:00:00] Boom, boom, boom, boom, boom.

Chris Langley: Hi, welcome to Addiction Recovery Place Podcast. The podcast championing addiction treatment professionals around the world.

I'm your host, Chris Langley, and I'm very pleased to introduce today's guest, Ryan Carruthers. Ryan is the Chief Clinical Officer at Centrepointe in Lincoln, Nebraska. Welcome to Addiction Recovery Place podcast, Ryan. It's great to have you with us.

Ryan Carruthers, PhD: Yeah. Thanks. .

Excited to be here.

Chris Langley: I very much appreciate your time and obviously you're very busy. So we're just going to dive straight into the first question. So can you tell us about how you became the Vice President and Chief Clinical Officer at Centrepointe?

Ryan Carruthers, PhD: Yeah. I have, been working in the field for, about 19 years at this point, and I kind of took a backwards journey. A lot of folks start off working for agencies and then eventually worked your way out [00:01:00] into private practice. I started out in private practice, did that for about a decade, and then that got to be a lot of hustle and bustle, and it was a grind. I moved on from private practice and started trying to find my way around to an agency that was a good fit for the philosophy that I believe in, which includes harm reduction, as a centerpiece that philosophy, and stumbled into Centerpointe about seven and a half years ago.

It's just been a really good, fit, and that's my story. In terms of professional role, what really brought me into the field, I tell the people that I work with [00:02:00] in our programs that everyone comes into the addiction field with a story, and those stories, tend to take one or two different varieties that I myself had a problem. The other typical story is someone I really cared about had a problem and for me, it was both, that I myself had a problem. I found myself in a treatment center, in Nebraska, And, someone that I really cared about also had a problem. The combination of those really sparked this desire to, help people, who were suffering with addiction and mental health issues.

And, so that's what, brought me into the field.

Chris Langley: Wow, that's an amazing story. Thank you very much for sharing that with us, Ryan. I've had a really good look at the services that you provide, and you provide a very wide variety of services, which are very much needed within the community of [00:03:00] Lincoln. So can you tell us about some of the services that you provide at Centrepointe, please?

Yeah, our goal overall is to be the whole health organization of choice locally. In order to do that, you have to provide a full continuum of care. What you don't want is someone having to go over here, fill out a brand new paperwork and then go over to the next place to get their mental health services. All of our services are really designed with this philosophy of whole person, whole health. They really fall into kind of three buckets or general types of services. I'll start at the highest level of care. We have 5 different residential programs, over a hundred beds of, residential care that we provide. Those services are for folks with addictive [00:04:00] disorders. We have some also two, co-occurring programs. You have to have severe and persistent mental health disorder, along with an addictive disorder. So our residential services is one of the services we provide.

Then, we have the more traditional, outpatient based behavioral health services. Everything from, we do same day assessments, so you can walk in, get assessed, same day. One of the biggest problems that people have in accessing service is they get motivated one day, whether that's because of some external coercion, a nudge from a judge, like some of the people we work with to call it, or whether it's just internal, and they're like, "look, I need to do something about this." Then, they [00:05:00] have to get put on a wait list or come on, Wednesdays at 7 a.m. and line up for 3 hours to maybe get a slot just to get evaluated to be able to be determined to be eligible for whatever service. We've done away with all that, by just having same day access. You can come in and just get access to an assessment, to outpatient therapy, to even medication management services, same day.

That the biggest thing with our outpatient services. In particular, we do outpatient counseling for drug and alcohol issues, therapy for mental health issues. We do have, medication management with psychiatric providers. We've also done another thing, we started a couple months after pandemic, we got a grant to become [00:06:00] what's called a Certified Community Behavioral Health Clinic, CCBHC, which is really just the idea of a one stop shop for behavioral health issues. We utilize that grant money to start our own primary care. Folks can come in and not just get their mental health needs and their substance use needs addressed, but also get their physical health needs addressed. We have a partnership at our outpatient facility as well with the onsite pharmacy. Again, just that idea that, you come in and all the, services are right there.

We also do services out in the community, through our outpatient office. Locally, we call it community support. It's typically just, case management. Folks that follow people often for many years trying to make sure they get all the services that they need, and develop the [00:07:00] functional skills that they need to be successful in an outpatient, in an at home environment. Then in addition to those outpatient services, we also have what we call our community response services. These are where a lot of our really unique services come in. We, have a Assertive Community tTretment team, and ACT team, which provides wraparound services seven days a week, to the highest need people that are able to live in the community.

right? And so These are

folks that have been in state, hospital institutions, sometimes for decades of their lives, and then as they transition out, they need extensive support. Often we're taking them their mental health medications [00:08:00] on a day by day basis, doing daily deliveries to them. There's that program. Then we're also, with the expansion of 988 throughout the United States, where folks can call that instead of 911 if they're having a mental health

emergency. We are the city of Lincoln's 988 response team, and so we have a 24-7 crisis line of our own that we operate and have for about four decades. Then we also have 24-7 mobile crisis response. Now 988 can activate us. Our local dispatch through the police department can also activate us.

If they know it's a mental health call, and their officers, are just like, "look, we know what's going on here, and it's not really a law enforcement issue. [00:09:00] They'll go out for safety purposes, and then we go out to really try to address the needs of the person. Then I'm trying to think what I'm forgetting. I'm sure there's a couple things. One real unique partnership we also have with our local police department is, when folks are arrested in the state of Nebraska for alcohol or drug related crimes, where they are not going to be put into jail. Driving under the influence or public intoxication then they will be put into what state Nebraska calls Civil Protective Custody. and so the state actually, or the law enforcement officials actually take custody of them, but they bring them to, what we use the term, "sobering center." This sobering center, where the old [00:10:00] model before we took it over, a little over two years ago, was they were put basically into a jail cell until they are sober.

Our sobering center takes a little bit of a different approach, and tries to make sure that people get treated with dignity and respect and with humanity, even if they're under the influence. As long as they're not violent, they can be in the sobering center until they're deemed to be safe enough to be released on their own or recognizance kind of thing. Overall, our agency really tries to take the approach that if there's a need that's identified by the community, for anything that kind of fits under the scope of our mission, which quite simply is just to help the people we serve get better sooner for longer. If the community Identifies a [00:11:00] need, we just step up and say, "okay, what can we do? How can we be of service?" and it's one of the things I love most about working for the organization, honestly.

Goodness me. That sounds like you have every single basis covered within the community by the sounds of it, and the fact that you're working with the police, law enforcement as well. That's the first time of doing a podcast I've actually spoken to an organization that is working so closely with the, with the police.

Kind of reminds me of my old background in the UK. So it's lovely to hear that these services are available. I just want to ask you something, Ryan, how are you actually funded? You mentioned that you've had grants in the past. So how has your organization funded?

Ryan Carruthers, PhD: I think the kind of catch all term now is braided funding, which just means we've got it coming from every which direction. Overall, the vast majority of our funding, comes from Medicaid.

Nebraska is a Medicaid expansion [00:12:00] state, which has greatly increased the of people to get behavioral health services, needed behavioral health services in the state of Nebraska, over the last four years. That's the majority of it. probably about 70 percent of our funding comes directly from billable services to Medicaid. The rest of it, comes from various grants that we receive. We're always applying for grants, as small as $750 sometimes. Our CCBHC grant is a million dollars a year. We get grants that kind of range all over the, size, and then, we receive private support as well from, being a non-profit organization. We have several funders that generously [00:13:00] give to support the work that we do.

Chris Langley: That's great to hear. That really is. I'm just going to move on because I want to talk about harm reduction, Ryan. I'm just very impressed with seeing that your service promotes this model, which is quite unique in the Midwest, from what I can tell. Can you explain to us how this has been received by the community and why harm reduction is sometimes being shunned by other professionals or services?

Ryan Carruthers, PhD: Yeah. What a big question there. In general, on a person by person basis, harm reduction is generally very well received, as long as it doesn't get political attention. People realize when you really start explaining what harm reduction is, and the benefits, not to the people receiving the services, but the broader benefits to [00:14:00] society. It just makes sense to people. It really is when you start getting, politics involved in it, that some of it gets real controversial. Just this last year we, experienced exactly that where there was a movement that was really bipartisan, to make some progress towards some common sense legislation.

We just weren't able to get it across the finish line ultimately because politics got involved.

When it comes to the stigma around harm reduction services, honestly, I think some of the worst offenders, are professionals in the field unfortunately. There's [00:15:00] folks that really, often not always, but often because of their own, recovery journeys, that they believe that abstinence from everything is the only solution, often neglecting their own attempts at trying to control their use and minimize the harms associated with it, and absolutely neglecting the, autonomy which is one of our, in the, realm of ethics is one of the core ethical principles, respecting people to make choices for themselves. Unfortunately, like I said, I think addiction professionals are often our own worst enemies when it comes to promoting common sense harm reduction practices.

Chris Langley: Most definitely. [00:16:00] What would you say the main benefits of harm reduction when compared to an abstinence kind of model?

Ryan Carruthers, PhD: Yeah, I think it really opens up the door. When I teach about harm reduction, what I often end up talking about with other professionals or with, even the people in our programs, is the development of relationships. One of the programs I didn't talk about, we have a street outreach team, works directly with, people experiencing homelessness.

This is a group that notoriously, because of their lived experience, they, are a little averse to receiving help from professionals, especially professionals like myself. I'm, wearing a button down every day, and [00:17:00] they're not necessarily keen on us coming in and telling them how to make decisions and live their life. Our street outreach team, goes out every and works works with people that are unsheltered. The core of what they do is develop relationships with people. That is so vital because it opens the door. That if they say they're ready in three months, six months, a decade, whatever, with those relationships that already exist, we can speed up the process of getting them help. The other thing that I think is, a benefit of harm reduction is exactly

what the name implies, reducing the harms

associated with, with substance use. And there are [00:18:00] some real harms that are associated with it, and sometimes people act like because we're nonjudgmental of people who use drugs as harm reductionists that we are somehow promoting the use of drugs or neglecting the acknowledgement of the harms that drug use causes.

And no, not at all. It's harmful and programs like, simple things like Naloxone, just getting people Narcan, one of the things our outpatient facility did, last month through some opioid settlement money that came into the local community, installed the state of Nebraska's first harm reduction vending machine which is incredible. Unfortunately, becase of the state Nebraska laws, the [00:19:00] main, thing that we can have in it in terms of harm reduction supplies is Narcan. We can't have syringes. We can't have even drug test strips. Those are not allowable in the state of Nebraska right now. Those are the kinds of, battles that we try to fight. The Harm reduction, at the end of the day, it saves lives. The idea of sterile syringe programs, the state of Nebraska doesn't have one, and it's no coincidence that we're one of only four states where our HIV rate in the state of Nebraska is increasing. There's only four states in America, and we're one of them. The fact that we don't have a sterile syringe program is it's

negligent.

Chris Langley: That says [00:20:00] there's literally no needle exchange or syringe programs at all in Nebraska.

Ryan Carruthers, PhD:

There's none. They are explicitly, illegal.

Chris Langley: Wow. So are there any other harm reduction initiatives available in Nebraska? Obviously, you're doing an amazing service where you're at, but is there anything else going on within Nebraska with harm reduction?

Ryan Carruthers, PhD: A lot of it is right now focused on how we can best utilize the, opiate settlement money, and, doing things like the Narcan vending machine. It's focused on that area because of how restrictive our laws are right now when it comes to supporting people who use drugs. We have started, we haven't incorporated, but for the [00:21:00] last two and a half years, we've had a coalition of v I would say, a broad coalition of folks that are interested in the goals of harm reduction that we've established a monthly meeting that we call the Nebraska Harm Reduction Coalition. We haven't organized in any kind of a way.

To maintain and expand that that group for two and a half years and to expand the number of voices that are at that table, itself is a victory. One of the other things that I've been, intimately, involved in is training on harm reduction topics. Going out to every professional seminar and [00:22:00] gathering of counselors and addiction professionals that they'll let me in to talk about, what harm reduction is to try to destigmatize, to also make it very practical and implementable. One of the things, I said we have five residential programs, and so I hear from places that run residential programs and they're like, "that's great but you can't use drugs while you're here." I'm like, "yeah, but a harm reduction practice in a residential program would be something like making sure that people have access to medication for addiction treatment, right?" MAT meds it's really not harm reduction. It's gold standard evidence based practice, but it certainly is a [00:23:00] step in the right direction.

So talking about allowing MAT meds, people are in residential programs, and, talking about quite easily, a relapse should not lead to an automatic eviction from a residential program. Most of our residential programs locally are still at that point where, if you relapse, you're automatically gone. Trying to combat some of those really dark age practices that just are not good for people seeking change their lives.

Chris Langley: When we first met Ryan, and you've just mentioned it earlier that, that a harm reduction bill was passed by Congress, but then was vetoed. Is that correct?

Ryan Carruthers, PhD: We have a unique system in Nebraska that we have a unicameral legislature. So We only have one, [00:24:00] body of,the legislature. They handle everything. They call it a nonpartisan body, but saying something's nonpartisan in politics in 2024 is not a real thing. Yeah, there was a bill LB307. I actually helped to, draft it with one of our state senators, and testified on behalf of it, and it was going to allow local townships and cities to approve. through their local health departments, or through local behavioral health,

so it could be either or both would be able to run a syringe service [00:25:00] program. The way that it works, they have to take three votes on a bill because it's a unicameral. There's testimony and all that goes along with every vote, and it passed on bipartisan nature with over two thirds of people voting in support of it, very few no votes at all. Some people were abstaining from voting on it, but no real pushback to it. That's what it takes to pass a bill in the state of Nebraska is three votes. Then the governor has to sign the bill. Our governor, I think he was, mislead by some people around him, is what ended up happening, but politics got involved and he vetoed the bill. The [00:26:00] legislature though has the ability to override a veto, with a two thirds majority which they had on every previous vote for this exact bill. But again, politics got involved, and they failed two votes short of the governor's override. So we are left without syringe service programs, and like I said, that was what sparked this Nebraska Harm Reduction Coalition collaborated to start meeting and getting together was the crafting of that bill and the advocacy for it and all that. We took it in stride and said, we're going to have to go back to the drawing board. We're looking for a, state senator to take up, [00:27:00] another version of the bill, and hopefully. we'll have another crack at it. The first go round, we tried to, and sometimes I think this is a mistake, that we make in the Midwest with, harm reduction stuff, we tried to have it pass through without any publicity. We didn't put any. press releases out. We didn't tell people what we were doing because our hope was just that it was going to be non-controversial and just go through and not get any attention. Then what happened is the first attention it got in the media was when the governor said no. We're not going to pass it, and here's why. That week I did four or five different interviews on local media stations, and [00:28:00] even though the crafting of their questions told me we had lost the narrative battle,

and I think when you're talking about harm reduction, especially in the Midwest United States, there's a narrative battle. My view is we have to be a little bit more proactive and put the message out there in front otherwise that vacuum is going to be filled by proponents of harm reduction who are going to put misinformation, bad statistics and narrative, and really lean on the stigma that already exists for addiction to help turn the tide against what really is common sense public policy.

Chris Langley: That's what it isn't it? It is just, it's just common sense. So why do you think that harm reduction has such negative press or opinions when it comes to helping people with an addiction? It seems so [00:29:00] basic.

Ryan Carruthers, PhD: Yeah, it does. It does seem basic. My years of, teaching, whether it be at college or new staff, interns, out to doing seminars with other professionals, I've targeted, pro-harm reduction messages. I was told very early on when I did a harm reduction presentation, because I was taking the approach of attacking the abstinence only approach and the feedback that I was given by a mentor of mine, was "that's where you're losing people because you're attacking what they believe in. If you just went out and said, [00:30:00] here's what we believe in and here's why, and not attack what's already pre-existing, then you're going to have some ears open bit." I took that to heart. That's been my approach is been not to attack the abstinence only, approach, although I've got a whole line of attacks

that I could put out there. It's really more about how do we open people's minds to something that for whatever reason they have the belief that there is something wrong with this approach and instead of attacking what they believe, just promoting the heck out of, common sense, public policy, [00:31:00] that promotes the wellbeing of

our community.

Ryan Carruthers, PhD: Then the other thing I think that's really powerful, and the abstinence only approach has cornered the market on, positive stories of people who have received the services, right? Everyone knows someone or multiple people or dozens of people who have recovered through the 12-Step Program, right? It's just so inundated into the culture around addiction. Everyone knows someone who's in recovery in that method of recovery. So finding opportunities for people who have benefited from harm reduction

strategies to tell their

stories and [00:32:00] to invite those positive stories of people who have changed their lives, only because of these harm reduction practices, I think that is something that our field needs to get better at in order to open people's minds to it.

Chris Langley: What I love about harm reduction personally, Ryan, is you, meet a client where they're at and you work with them from that point. Then you move on. You don't immediately go in and say, "you've got to stop using." It just doesn't work. My experience in the UK was very harm reduction bases, which is I'm something I'm incredibly passionate about.

So it's nice to meet a professional such as your good-self that has this true passion for harm reduction and sees the real benefits of what you're doing every day. I'm just going to move on a little bit because a word that you mentioned earlier, and it comes up in every interview I do is "stigma."

So why do you think that in this day and age that stigma stops people who are suffering from addiction from entering treatment and seeking help?

Ryan Carruthers, PhD: [00:33:00] Yeah. I think, again, we've done ourselves a disservice, especially in the United States where we do have this abstinence only mindset, because for instance, if I have a severe opiate issue, right? And that's in the news all over the place, is, the problem with the opiate epidemic. I have this opiate issue, right? But I know if I go into treatment, they're gonna tell me I can't smoke weed. We have to train our staff when they come in to say. "Okay, you want to stop the opiate issue. Great. Let's work on that. Now, while you're in our residential program, we don't even have a smoking, area.

So we're tobacco free, and we provide nicotine replacement for people [00:34:00] that desire it. We don't even have a smoking area, yet alone like a marijuana smoking area, right? We're going to ask that you not smoke marijuana while you're in treatment, in a residential one." But in our outpatient environment, we work with people who continue to smoke weed, and, we do that work without judgment, right? We say, "look, yeah, you want to get off the opiates? That's a really good goal. And if, if you, are able to do that", then, I said earlier, our mission is to help the people we serve get better sooner for longer. The two phrases, and you just mentioned one of them that are synonymous with harm reduction, are

Ryan Carruthers, PhD: meet .them where they're at and the second one is better is better.

Right.

Yep.

If someone is able to stop using opiates, my goodness, [00:35:00] right? What a, wonderful thing for their life. Their risk of overdose using marijuana. that's

not a concern

Ryan Carruthers, PhD: for them.

So I think it's, that, right? It's meeeting people where they're at, like you said. and because there's so many programs that don't do that, people get this idea that, I'm going to go in and they're going to make me stop everything, no matter what, even if I don't identify that as a problem. They're going to tell me I can never use that again. Then I think just in general, in American society, we have a hard time asking for help sometimes. Even when people are having symptoms of diabetes, sometimes they don't want to go, ask doctor [00:36:00] for help. You're always fighting that in healthcare in general but addiction continues to be

so stigmatized.

One thing I think we've done that has helped significantly, and I think as long as we continue on this pathway, we'll benefit from it and see people more willing to ask for help in, in years and decades to come is getting away from the war on drugs

Ryan Carruthers, PhD: and moving out of the incarcerate ourselves out of the drug problem. , We fought the war on drugs and we lost. Drugs won, and they were always going to win. One of the things I think I always bring up when talking about it though is, I think we're remiss if we don't at least acknowledge, [00:37:00] the fact that this is, kind of move towards treatment and away from incarceration is coming alongside a different segment of our population being impacted by the opiate drug epidemic. When, you have young people in suburban white America dying, because of a drug epidemic, "now, oh

Ryan Carruthers, PhD: They need treatment." When it was the crack epidemic that was raging in the eighties in inner cities, with a largely, black American population, totally different response to that. Although, I think it's good that we've moved in the right direction, I also think there's some socio-political dynamics there that are very telling about our approach towards, [00:38:00] drg addiction and why it

has shifted The other thing along these kind of cultural lines that I'll say is, research has continuously supported the idea of people wanting to be helped by someone. They want to see themselves in their helper, right? In, whatever way. The addiction professional field is very underrepresentative the population of the United States, that we have a whole lot of people that look like me, and we're on a podcast,

so I'm white. It's a whole lot of people that look like me and not nearly as many people, so the facility I'm right at right now is actually in Omaha, Nebraska. We're located in the [00:39:00] middle of the innercity in Omaha and a very diverse area. Yet the staff is nowhere near as representative, especially the professional level staff. I think that's an issue that our approach is not necessarily culturally representative of where people are coming from.

Chris Langley: Wow. That's, an incredible description, so thank you for that, Ryan. I just want to ask you, you've gone through a lot of the amazing services and such a wide range of services that you provide Centerpointe, but do you have any plans for the future? What are the future plans for your organization?

Is there anything going on in the next 12 months? Maybe that you're going to be planning.

Ryan Carruthers, PhD: Oh yeah. About a year and a half ago, we opened up a brand new facility for our outpatient services. We had been in a really old dungy, outpatient facility for, [00:40:00] long preceding myself, for a long time. It was just not a place where, you would want to come and receive behavioral health services, but in May of last year, we opened up this brand brand new facility, renovated an old historic building, brought it up to date. That project, I think has us a little leery after 3 years of construction and all that of huge projects. Now with that being said, we're, always, listening to the community and asking what needs to be done. The vast majority of our services, as I said, are in Lincoln, Nebraska, but we do have, three really residential programs here in Omaha, all in one facility. [00:41:00] What we're working on right now is putting together a proposal, so that we can have the adjunct outpatient services to go with it. Because one of the problems with having a harm reduction, approach in a residential environment where we're meeting people where they're at, in Omaha is we don't have those same services available with that same philosophy. So they get that while they're here in the residential, but then for their ongoing outpatient services, they have to go to an agency that's probably going to have an abstinence only mindset. We're really trying to provide that full continuum in the Omaha community as well. That's one of our next, strategic plans and goals.

Chris Langley: That sounds pretty huge to me. Last couple of questions, right? I've seen on [00:42:00] social media that you're having a winter essentials donation drive through November, the 22nd. Can you tell our audience how they can, actually contribute to this really great cause?

Ryan Carruthers, PhD: Yeah, absolutely and thank you for, bringing that up. We've done this now for years. Our street outreach team, like I work with people who are unsheltered. and often, because of the nature of our shelters, they're not even in the homeless shelters. In Lincoln, Nebraska, talking about harm reduction, you have to be not under the influence to go into any of our shelters. and so one of the things we're also trying to work with the county on is the development of a low barrier shelter where people can come into the shelter while under the influence. We're working with people that are staying in tents and encampments, [00:43:00] and in Omaha and Lincoln, Nebraska that's potentially fatal in, these coming winter months. Every year we gather, coats and, socks, socks, socks, socks definitely one of the highest needed items that people have. All the other things, gloves and hats as you said, winter essentials. Really any one of our locations in Lincoln our outpatient, office has a big bin, right when you walk in and staff to thank you as you walk in, but we have 14 different locations between Lincoln and Omaha and really you can drop it off with staff at any one of our locations.

Chris Langley: That does sound like an incredibly much needed cause. Being a Brit living over here and coming to your winters, it's a completely different [00:44:00] ballgame. I have thought of how do people survive out here that were homeless? And it's just, great to hear that you're providing this much needed service.

Last couple of questions, Ryan, do you have a message for anyone listening to this podcast who's going through addiction or a mental health trauma?

Ryan Carruthers, PhD: Yeah. Help is available and treatment works. There are people out there that are willing to meet you where you are at. If you found someone that's trying to help you in a way that you're not comfortable with, that you're not ready for, all that means is you need to find someone who's willing to meet you, where you are at, and to work with you at that point, and that you shouldn't feel pressured towards something that you're not ready for. People that practice harm reduction are still going [00:45:00] to encourage you to be healthy and make healthy decisions for yourself and all that. Telling you that, "you have to stop using everything or we're not going to help you." No one should ever be put in that situation and there are services available. If that's the situation you're in, treatment really does help, people change their lives.

Chris Langley: Definitely. And last question, can you tell our listeners how to best contact you and to find your amazing service?

Ryan Carruthers, PhD: So centerpointe.org is the website. We're on all the socials, CenterPointe Nebraska, a couple of different tags on there, but, look us up, on any of those. My email is rcarruthers@centerpointe.org. I'm more than [00:46:00] happy for you to get in touch with, whomever, it is that, you're looking for, whatever services you're in need of, get you in touch with the, the

Chris Langley: Fabulous. Ryan, it's been a real privilege and honor to speak to you today and to hear about the amazing services that you and your entire team are providing. It seems like you're providing the community of Nebraska such a vital service. Big congratulations to you and your team for everything you've tried.

And thank you for your time staying from your very, busy schedule. I really appreciate it. Thanks so much.

Ryan Carruthers, PhD: Okay. Yep.

Chris Langley: Thank you.

Ryan Carruthers, PhD: Appreciate it. Thank you.

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