Ep37 Addiction Treatment Harm reduction enables living

Ep37 Addiction Treatment | Harm reduction enables living

[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 Lisa Peterson. Lisa is the Chief Operating Officer at VICTA in the state of Rhode Island. Lisa uses her 27 years of experience in providing direct clinical care leadership and a variety of treatment settings to inform her work as a Co-founder and Co-chair of the Substance Use Policy Education and Recovery PAC. Lisa is also a member of NAADAC and has just been awarded Advocate of the Year. Welcome to Addiction Recovery Place Podcast, Lisa. It's so good to have you join us today.

Lisa Peterson: Thank you so much for having me, Chris. It's great to be here.

Chris Langley: Yeah, we really appreciate it. Obviously you're very, busy, so I'm just going to get straight in. So can you tell us about your career and how you started working at VICTA?

Lisa Peterson: Yes, absolutely. So as you mentioned, it has been a 27 year career this month, actually, which is just mind [00:01:00] boggling, and throughout the course of my career, my goal has always been to fill in gaps in the system to make sure that we are taking care of the whole person to help people get all of their health care needs met, be it mental health, substance use disorder and physical health. I actually came to VICTA through the Substance Use Policy Education and Recovery PAC when we were holding community meetings to inform our legislative advocacy for the upcoming year. At that time, the CEO of VICTA had not yet opened his doors, but he attended as an interested community member and we got to talking, and he told me about his vision for fully integrated mental health, substance use and ambulatory medical services, and I was sold. So five and a half years later, I'm still sold. It's my dream job, and I think we're doing phenomenal work.

Chris Langley: Goodness me. So you've been there for five and a half years now. So that's pretty incredible stuff. So can you tell us about some of the services that you offer at Victa?

Lisa Peterson: Yes, [00:02:00] absolutely. So we do a full continuum of care from medications for opioid use disorder, including methadone and buprenorphine products, medications for alcohol use disorder. We are doing some work with stimulant use disorder, and then we have the supportive services like mental health and substance use counseling.

We have intensive outpatient counseling for substance use disorder, both during the morning and the evening so that we can meet people's schedule needs. We have psychiatric services, and because we're licensed as an ambulatory medical center, we can do urgent care type things. So if somebody comes in for their doctor's visit for their buprenorphine, and they have a wound, we can take care of that.

Last year I finally realized my long term dream and we onboarded a gynecologist so we are able to provide reproductive health care and routine screenings.

Chris Langley: That's one heck of a list. That really is. That's incredible to hear that's all available within, one service. So obviously you've got an incredible staff. [00:03:00] behind you. Can you tell us about some of your staff members and some of the roles that they do, please?

Lisa Peterson: I was just talking yesterday about how we really have found the dream team, as a newer organization, there have been some fits and starts, but the team that I have working right now is incredible. They are so responsive to our client needs. So we have, our medical director is a physician, and he's here one day a week, but oversees all of the medical policies and procedures.

We have another physician who is the gynecologist. She also does addiction medicine. So she was just like a unicorn who came to us, and then we have a nurse practitioner who is here for four days a week. As a mid-level provider, she can essentially do all of the other medical services, and she came from a family practice background.

She's got a lot of really whole health experience. So that's our primary medical team. We've got a team of nurses who do our medication dispensing, as well as take care of some of the other medical supports. They are [00:04:00] in dual role as dispensing nurses and nurses who respond to other things as they arise at the window. They are both very skilled, have a lot of experience, and are great for triage, know when they can handle something, when they should tap in one of the prescribers. Then we have our clinical team. We have a clinical director who's been phenomenal. He came on board about a little over a year ago, and he really spearheads all things clinical.

So he does clinical supervision for newer clinicians coming in. He's a resource for students and interns. We do lots of professional development here. We have a team of five counselors. I had to stop and think because I'm not involved in the hiring anymore because of our clinical director, which is great. All of them are really, they're either already duly licensed in mental health and substance use disorder, or they are working towards that. So when we talk about integrated treatment, we really don't want [00:05:00] co-located treatment. So it's great if you have a mental health counselor in the same office as your substance use provider, but it's even greater if you only have to go to one office for those two services.

Then we have a fabulous admin team who supports all of the things that keep us running day to day, checking people in and managing crises at the window, et cetera. Everybody does a little bit of everything within our scope, but everybody's willing to pitch in no matter what's going on.

Chris Langley: Wow. That does sound like the dream team to me. That really does. That's incredible. It's wonderful to hear that this service is available. So you mentioned, MAT, so how can someone access this and what's the process? So someone requires a buprenorphine or methadone, how do they come to you? What is the process for going through that?

Lisa Peterson: Most people call first. That is not always the case. If somebody calls, and they're not currently on medications, we work to expedite them and get them in same day / next day, so [00:06:00] that we don't miss that window of opportunity. Our prescribers are very flexible in that regard. Sometimes we have to double book. Sometimes we will tell people, "come in tomorrow." You might have to wait, but somebody is going to miss their appointment, and you will get into that slot. So we get really creative to make sure that the people who are most vulnerable, not currently on anything for their OUD, get in the door as quickly as possible.

Other times people are either transferring, or they are less acute. So they will call schedule a routine appointment, initially with the counselor, usually within the week. The counselor will then triage and decide what level of care they might need, what ancillary services they might need, and start the process of bringing those on board as part of their overall treatment plan.

We really try to prioritize people who are in crisis or at highest risk of drug poisoning or overdose. Then we also take more routine, mental health substance use concerns as well.

Chris Langley: [00:07:00] You mentioned something I've not heard of before, the Stimulant Use Disorder Program. How does that work? Because I've never come across that before. that's good to hear.

Lisa Peterson: It's very innovative. There are no currently FDA approved medications for the treatment of stimulant use disorder, but we are seeing that surge here in Rhode Island. It's disproportionately affecting black and brown communities. We're seeing overdose rates in that community increase while simultaneously our overall rates are decreasing.

So for us, it's really important that we don't leave behind the anybody who has an SUD, regardless of what that substance happens to be. So our prescribers, have gone to ASAM conferences, the American Society for Addiction Medicine, partnered with experts in the stimulant use field. They are using some off label but appropriate medications to try to manage things like cravings, agitation, et cetera.

[00:08:00] Simultaneously, we work with contingency management, which is the only evidence based practice for stimulant use disorder. That really involves identifying the individual's goals, and then rewarding steps towards those goals. It might be keeping appointments. It might be showing up at the dosing window every day. It might be showering every day.

It's really individualized, but we, at the end of the week, if they've met their goal, they get a chance to win a prize, and some of the prizes are small, and some of them are pretty significant. So it really reinforces, "I want to keep making steps towards my recovery."

Chris Langley: That makes complete sense. That's so good to hear. I've worked in this sector for many years, and I've not come across a service that offers that. That's what I wanted to ask, Lisa. You mentioned that you work with, clients with dual diagnosis. Can you explain to us how this could be more complex than working with people experiencing addiction, and what additional help is required?

Because you seem to [00:09:00] offer a real. banner of services. Working with dual diagnosis clients must be very rewarding for you, but how is this more complex?

Lisa Peterson: As a therapist by training, the more complex, the more I enjoy working with people. I've been in this field long enough to have seen the progression from a time when no psychiatrist would treat your comorbid mental illness, unless you had a year of abstinence based recovery. Even as a very young clinician, I thought, "How are they going to get a year's worth of abstinence if they have untreated depression, bipolar, panic disorder, PTSD? That makes no sense." And it didn't. Many people didn't make it to that year to get their psychiatric illness treated. so for us, rather than playing what came first, the chicken or the egg, which is a bit of an impossible task often, because people start using at such young ages, we just dive in and treat both.

So as long as it is [00:10:00] safe to do so our psychiatric prescriber will see and treat somebody's mental illness wherever they're at their stage of change for their abstinence. So we don't wait unless there's a concern, if somebody's drinking heavily, we're not going to put them on benzodiazepines.

We never want to cause harm, of course, but we really say, whatever you're willing to work on, let's start there. Then we integrate the treatment plan to say, let's talk about how maybe your substance use has been helpful in managing your mental illness, and how are we going to manage your mental illness if you decide to say goodbye to that?"

So it's really a constant conversation, and it changes very rapidly because both

conditions are long term, chronic, often experiencing recurrences. So it keeps us on our toes.

Chris Langley: Yeah, it sure does. I love what you said about chicken and the egg because that's exactly how I, I used to say when I used to work in the sector in the UK. It's one of the problems we had was working with mental health teams [00:11:00] and drug services and one would fire off between the two of them between, "are they still using drugs?" It was a very complicated, service to provide, but it's really nice to hear that you're providing this in Rhode Island.

One of the questions I wanted to ask, how is your service funded?

Lisa Peterson: We are overwhelmingly funded by third party payers. Rhode Island is a Medicaid expansion site. So our uninsured population is fairly low, not zero. We also offer sliding scale and do a fair amount of charity care. But most of our clients, I would say about 95% probably have some kind of a third party payer managed care or insurance.

Most of those folks have a Medicaid or managed Medicaid plan, probably about 80% of our clients. We are finally fortunate to say that we just got a Medicaid rate increase in October for the first time in nearly 15 years. [00:12:00] Funding has continued to grow. Funding has always been, an issue throughout my career, but certainly here in Rhode Island.

We're hopeful that is a trend that will continue, and we can continue to adapt to the changes and costs of everything so that we can really reimburse our professionals at the rate they deserve and keep stability in our team so that clients have that stability.

Chris Langley: So you've just had a raise after 15 years of being flat.

Lisa Peterson: Which obviously equates to cuts every year because of

Chris Langley: Yes, of

Lisa Peterson: everything is increasing. Yes,

Chris Langley: My goodness me. When we first met Lisa, you told me about recovery houses. How's this project going, and how are you funding this vital part of recovery? It sounded amazing.

Lisa Peterson: It was an exciting project. Unfortunately, the state decided that it was taking too long, and they tabled the funding. But because we are VICTA, we are still in the process of figuring out how we're going to do it with or without state funding. We [00:13:00] have been looking at possible houses, what's affordable, what we could get a loan for because we really see a gap in the treatment realm where not everyone needs to go into residential treatment, but it is difficult to do an intensive outpatient program when you are unstably housed or unhoused, and consistently attend your appointments. If we can get roofs over people's heads, low barrier, and then start engaging them in treatment, that's really our.

And That remains on our radar, and it's something we're working really hard to realize because we believe in the model of get a roof over your head and we'll figure it out.

Chris Langley: Absolutely. That sounds absolutely vital. I do hope that you can get some funding for that because that just sounded such a logical answer to a big problem. One of the words that comes up whenever I meet people on our podcast is stigma. Can you explain to us why this is such a problematic term and how this [00:14:00] affects someone who wishes to enter a program for an addiction or a mental health trauma?

Lisa Peterson: Absolutely. I think it's really far reaching, and I think stigma is almost too gentle of a word. It's most known probably and people have a general sense of what we say when we say stigma. But over the last, maybe decade, and I have to give credit to the former director of the Department of Behavioral Health who really championed this change in language, we've started to call it what it is, which is fear, bias, and discrimination.

Our clients are discriminated against because they have a substance use disorder. That is so important to call out and to name specifically because stigma is a vague like, "Oh, I might judge you." But that judgment in turn creates real tangible harm in how we act and how people are perceived and whether or not people get care.

So it's a real challenge. I think about when people have, a cancer diagnosis in the family, they share that with people and they get, [00:15:00] rightfully, lots of support and people are there for them and creating meal trains. When people have a substance use disorder in the family, they're secretly reaching out to me and not telling anyone.

It's really unfortunate because the more we talk about it, the more we normalize it, the more we talk about it's not other people. These are our friends, our neighbors, our moms, our loved ones. I think that even within the behavioral health system, there remains discrimination that our clients have experienced and felt and it is off-putting.

And if had a bad experience in treatment, and you are already a very vulnerable person, why on earth would you try again? I think that we need to be really mindful. I think of it, there's the umbrella of healthcare. Under that umbrella is behavioral health care, within which we've made some strides in terms of talking more openly about mental health, and it's okay to not be okay.

Under that umbrella is [00:16:00] substance use treatment, which still has an element of, "I'm a mental health counselor. I don't, deal with that, or I don't work with those people." Then even within the substance use treatment realm, being on medication that assists or supports your recovery goals is still frowned upon in some circles. So we've got all of these layers of intersection of bias that leads to discrimination. So that's why VICTA is created the way that it is, because if we refer out, and I've experienced this as a clinician in other types of settings, if we refer out, they're either not going to go, or they're going to go and potentially be treated badly and then any further referrals are not going to be accepted.

Chris Langley: Yeah, I love that answer. That was brilliant. Perfect. I agree with everything you said then, because it does frustrate me so much that this is just a word that's used, but it has such a big impact on someone's life and their future. It really does. So thank you for that. Lisa, last question about VICTA [00:17:00] Life. What future plans do you have there? Because it sounds like you're just doing some incredible work for your community.

Lisa Peterson: We are. I'm really proud of the work that we're doing collectively, and we are doing that not only with our dream team, but in community collaborations. So our very next project, which I am incredibly excited and have worked really hard for years towards, is the first state regulated overdose prevention center in the United States.

What that means is that we will be partnering with a very well established and respected harm reduction organization to offer the full scope of services from syringe exchange to clothing and food, to a place to take a shower, and there will also be a space where people can use pre obtained substances under supervision.

So in that space, people can respond to an overdose much more quickly than simply coming across someone in a bus stop or a dumpster. So we hope to make it safer for people who do use drugs and are not seeking abstinence based recovery, [00:18:00] make that a safer experience for them, keep them alive first and foremost, and keep them as healthy as we possibly can while they investigate what their recovery path might look like.

Our role there will be to be on site as a satellite mini-VICTA, but we will provide our full scope of services. So the day that somebody says I think I'm done I don't want to go to the second floor. I want to go to the first floor and get started on medications for opioid use disorder, we will be there, but we will also be there for a crisis with somebody who doesn't want to stop using drugs. We will provide that kind of counseling engagement care for medical issues, whether or not they're engaging in anything clinical or therapeutic.

We'll be doing wound care. We'll be doing hep C testing and treatment, things like that. So it's all starting to come together. Our target date is December.

Chris Langley: Oh,

Lisa Peterson: Yes. This is something I've been working on since 2019, at the [00:19:00] legislative level initially and now trying to get it done. So fingers crossed, doors will open in December and we will start saving lives in a whole different way.

Chris Langley: I wasn't expecting answer.

Wow. That's incredible. It really is. It seems like because of your service, your state isn't running away from this problem.

Lisa Peterson: Yes,

Yes, our state is so small, and it's a little bit of a joke that anywhere you go, if you say you're from Rhode Island, someone will say, "oh, do you know my cousin so and so who lives there?" And probably we it's do.

But because of that, the legislature is very much touched by this issue and has been very responsive to listening to the experts, people with lived experience, people who are doing harm reduction, people who are doing treatment and recovery.

They've been great partners in helping us change the landscape so that we can practice what we know is right for our clients, which there's a long way to go, but we are [00:20:00] very fortunate to have the accessibility that we do at the state house.

Chris Langley: It's very inspiring hearing you talk today, Lisa. It really is, and it's lovely to hear that, you've got representatives that are actually prepared to deal with this. It's great to hear, and I'd love to have you on maybe again in six months time to hear about this, cause that's really exciting stuff. It really is. I'm just going to ask about NAADAC. Because you've been a long time member of NAADAC. Can you tell us how being a member has benefited your career and what support you get from NAADAC?

Lisa Peterson: Yes, I have really loved. I will be transparent. I came to NAADAC because of the CEUs. We always need CEUs. It is one fee for an entire year worth of unlimited CEUs. That was very appealing to me as a practicing clinician, and I have found that CEUs, the webinars are valuable.

There are all kinds of sites that you can take a webinar on demand and just [00:21:00] skip through and take the test and you get your credits. I am a lifelong learner, and I really want to challenge myself and grow as a provider. So I found that within NAADAC. As I started to take advantage of that, there was a call to revitalize the Rhode Island affiliate, which had been dormant for 10 or 15 years, I think.

So me being the over committer that I am, I said, "Hey, I can probably get that started again," because I was already getting into the advocacy realm. I thought this was the natural progression of that and this kind of brings the support of NAADAC at the national level, but operationalizes it at the state level, which is where we can be most effective. It took a couple of years, and it was through COVID, but we got the Rhode Island affiliate launched again, got a board going, started doing some events and activities, got some committees started. Through that process, I became closer with some of the NAADAC leadership, and most [00:22:00] recently, was elected to be the Northeast Regional Vice President. It's just one of those things that I keep stumbling deeper and deeper into it, but I love it. I love the team. I love gathering. We had our conference, last month. It was phenomenal, and it's great to hear what other people are doing in others states. It's great to hear people's program innovations. It's just really inspiring to have a collection of really dedicated and specific professionals. Addiction is a very unique specialty and sometimes we get lost within the conversation of behavioral health, and I think it's important that we celebrate addiction professionals unique skill sets and personalities and the work that we do is so important to highlight.

And NAADAC really helps do that at both the state and national levels.

Chris Langley: Yeah, most definitely. You attended Hill Day as well at the, at the conference. So you met with, a [00:23:00] representative for the Senator Jack Reed staff members. Can you tell us about this experience and what happened? It looked really exciting.

Lisa Peterson: Yes, it was great. I was the only Rhode Island attendee, which meant that I met with all four of our elected officials who of course were on opposite sides of Capitol Hill, But muchlike our luck with state level legislators across the board, our four federal delegation members have been so supportive of addressing the overdose crisis in meaningful, tangible ways of they show up for rally for recovery in September, they show up for events.

They are really interested in hearing how what they're hearing at the national level plays out in Rhode Island in the provider realm. So I'm very grateful to all of them. Unfortunately, the timing was not great because the legislators themselves were on recess. So they're all off running their reelection campaigns, but the staffers are phenomenal.

So [00:24:00] each legislator has almost a specialty staffer for health policy or something along the lines of what NAADAC was advocating for. I got to meet with staffers from all four offices. Senator Reid's office, and luckily, that was a staffer I've worked with previously. Then I literally ran over to Representative Magasiner's office.

He is one of our newer elected. and then Representative Amo, who is our newest elected official, and then trucked back across Capitol Hill to meet with Senator Whitehouse's team. It was a great day. It was exhausting, but everyone was really receptive and really asked questions that showed me that they meant they were not giving me the yes, nod and go away. They asked really important questions, and so I provided them with some follow up when I got back. They really feel like partners in this work at the federal level, which we need so much.

Chris Langley: Yes, most definitely. Congratulations on that. It [00:25:00] sounded an incredible experience for you and to get that opportunity, but it's testament to the amazing work that you do, Lisa. So congratulations on that. That's wonderful.

Lisa Peterson: Thank you. Next year you should join us.

Chris Langley: / Oh, I'd love to. I really would. Maybe next year.

Maybe next year. That would be awesome. Last couple of questions for you Lisa. I ask all my guests this because I get such a varied and wide response, but can you tell us what your opinion of harm reduction is and how it plays such a pivotal role in recovery?

Lisa Peterson: I don't think we can do treatment and recovery without it. I am a harm reductionist through and through. However, I'll take the hate from some people who still don't understand it, who see it as enabling or encouraging people to use drugs. The only thing that harm reduction enables is living.

I want to meet people literally where [00:26:00] they're at, and a lot of people give lip service to that, but expect people to come into treatment ready for abstinence. If they were, they wouldn't need treatment. They could just do it. I have really been passionate about increasing harm reduction.

We practice harm reduction here at VICTA. So if somebody is still using cocaine, but they're really stable on their methadone for their opioid use disorder, we're like, "that's awesome. You're not going to die of fentanyl poisoning. That's wonderful, and if you would like to eventually talk about your cocaine, wonderful.

But in the meantime, here's safe smoking supplies. Here's fentanyl and xylaxine test strips." We really educate people. Actually, we also do a little bit of drug checking like pre-consumption. I have someone coming this afternoon to drop off a sample of what they believe is fentanyl, but they have concerns that it might be cross contaminated, so I'm going to test it for them. I guess you could say I'm a strong believer. I am all in.

I love it.

Chris Langley: Me [00:27:00] too.

Lisa Peterson: It's critical. I can't help someone heal who's not alive, and it is harder for me to help someone heal who's developed all kinds of health conditions because of their active use by the time they come into treatment. I just want to keep people as healthy as they can be and work with them wherever they would like to be to maximize their functioning and participation in their communities.

Chris Langley: Perfect answer. Thank you for that, Lisa. do you have a message for anyone who's listening to this podcast who's going through addiction or experiencing a mental health trauma?

Please reach out, and if you don't have a great experience, reach out again. I know it's really difficult, but there are good providers out there. The most important thing for your recovery is the relationship you have with your provider. FInd someone that you really fit with, be as open as you can, and know that change doesn't happen overnight, and anything that you're doing to improve your quality of [00:28:00] life deserves applause.

Thank you. Last question. Can you tell our listeners how to best contact you and to find your service online, please?

Lisa Peterson: Sure. So our website is www.victalife.com. You can reach me at lpeterson@victalife.com I am always happy to field questions, to provide feedback, provide information on what we're doing, both clinically and legislatively. It is my goal to really share far and wide the great work that we're doing.

Chris Langley: Yep. Lisa, it's been a genuine pleasure and an honor to speak to you today. The work that you're all doing in Rhode Island just sounds incredible. It really does. I want to congratulate you and the team for everything you're doing because you're saving lives daily. There's, no other way of putting it.

So thank you very much for joining me today. I really appreciate your very valuable time today. Thank you so much.

Lisa Peterson: Thanks for giving me the platform. I [00:29:00] love to talk about this great work.

Chris Langley: Thanks Lisa

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