EP6 Dr Pamela Tambini,Chief Medical Director and Board-certified Medical Internist

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[00:00:03] Chris Langley: Welcome to the Addiction Recovery Place, the podcast championing addiction treatment specialists around the globe. I'm very pleased to introduce today's guests. Dr. Pamela Tambini, a board certified medical internist. In addition to her role as chief medical director in Florida, she continues to practice internal medicine is also the Co-host of the Real Recovery Talk Podcast. Welcome to the podcast, Dr. Tambini. And thank you so much for joining me today.

[00:00:29] Dr Pamela Tambini: Thank you for having me. I appreciate your time.

[00:00:33] Chris Langley: No, it's great to have you here. So we're going to jump straight into just some questions today. So tell us about your journey and about your career and kind of how you got to where you're at now today. Okay.

[00:00:45] Dr Pamela Tambini: Okay. So I'm, my original tract was internal medicine, the residency here in the United States. With that residency, I had a lot of exposure to substance use and addiction medicine. On top of that addiction is very close to me. My father was, had a lot of mental health issues, but also had a gambling addiction.

So kind of lived through as a, a loved one experiencing it, right? And then I also, on the other side of it, learned. as a provider and that kind of sparked my interest. My father passed away about 10 years ago now mental health related gambling addiction related stuff. And so that's what really triggered me to go head, you know, on into the, to the field.

[00:01:35] Chris Langley: So how long have you been practicing?

[00:01:38] Dr Pamela Tambini: So I've been practicing about eight years.

[00:01:41] Chris Langley: Okay. And where did you start? Where did you start your career from? What? Because you're based in Florida, obviously. So, so have you always been

Based in Florida? Based in

[00:01:50] Dr Pamela Tambini: based in, yeah, based in Florida and then Florida I would say is the hub, it started the treatment realm for treatment centers in South Florida where I live and train. So I got, you know, my feet wet in that and then a few of the other places that I do some consulting for are in Georgia, Tennessee, Mississippi, you know, all over the Southeast United States.

[00:02:16] Chris Langley: So you're very busy.

[00:02:18] Dr Pamela Tambini: Very.

[00:02:20] Chris Langley: So what addictions do you help treat specifically? What are your, what kind of specialties that you, that you, that you help yourself?

[00:02:27] Dr Pamela Tambini: All of them you know, primarily substance use. So every single substance that you can think of that falls in the DSM 5 or the ASAM criteria all of those things.

[00:02:39] Chris Langley: Okay. So, okay. So what are your views on harm reduction? Cause it seems such a wide range of options around treatments. And do you believe that this is an effective treatment model for for addictions, harm reduction? Yes. Mm hmm. Mm hmm.

[00:02:53] Dr Pamela Tambini: So that's a very debatable topic, but I, I've kind of learned working in this field. What we do and how we provide care is harm reduction because you are providing care for people who are in harm's way. Do we, do I personally practice harm reduction? I, you know, with, you know, I would consider suboxone maintenance sublicate injections, Vivitrol injections, stuff like that, harm reduction.

With relation to harm reduction in terms of needle exchange programs, You know, the things that go out of my practice realm, I think what people are doing to help, whether it's overdose prevention, prevention of communicable diseases like HIV, hepatitis C, homelessness. I think it's great for what they do.

I just don't partake in that side of harm reduction.

[00:03:46] Chris Langley: Because it's such a, it's such a wide ranging subject. I think people, I mean, from, I'm, I'm from England. We have a very different approach to harm reduction to say that some places here in America that I've been kind of getting to know, so it's, it's quite interesting. I always ask everyone about harm reduction and kind of where they're at within their state and within their profession.

So what do you consider to be some of the best treatment options for addiction to stimulants and not opioids? What, what, what practices would you say work the best for that?

[00:04:16] Dr Pamela Tambini: Like in terms of medication management or just,

[00:04:20] Chris Langley: general treatment, kind of a therapy groups or, you know,

[00:04:24] Dr Pamela Tambini: yeah, so stimulants, just like any other substance, I think the, the biggest things are going to be group therapy, obviously, individual therapy for understanding their own personal demons when it comes to their addiction. And there's a lot of, again, there's a lot of programs out there that, the 12 Step programs.

So you have NA, Smart Recovery, Celebrate Recovery that are not necessarily 12 Step based, but, you know, everyone has to find what works for them in terms of working a program because that's, you know, That's very important for people.

[00:05:01] Chris Langley: definitely, definitely. Okay. So everyone knows and understands that many people who are affected by addictions are in full time work, be it the pressures of work or the pressures in life in general, how does someone who is in full time work manage to access treatments for their addictions and what are the options that are available to them if they're, if they're in, you know, doing a 40 hour week?

[00:05:24] Dr Pamela Tambini: So if they're a working professional, obviously their addiction, I'm sure it's, again, I can't gauge the level, but it hasn't harmed them enough to interfere with what they're doing with work. Some people are unwilling to give up work. So you have to kind of meet the person where they're at. Regarding that specific question, there are outpatient programs where that work with patients and you know, they can do three days or five days a week where they work with their work to get them on a reduced work schedule.

If they have to maintain the 40 hours a week. A lot of facilities have night programming and night groups and night therapy, even weekend in order to help accommodate the person where they're at. New Spark in treatment that's coming about that I think many people will see is virtual outpatient services.

So virtual is maybe a little bit easier for people. They don't have to, you know, travel somewhere or live somewhere that's not their home and they can do Zoom or, you know, any other HIPAA compliant form to complete their treatment.

[00:06:34] Chris Langley: Did you see a boom around, especially around COVID with the virtual therapy idea to kind of, have you seen that grown since say 2021?

[00:06:44] Dr Pamela Tambini: Yeah. Exponentially. Whether it's just, you know, You know, counseling therapy, but addiction, a lot of the treatment centers down here that I work with or that I've been exposed to are now starting. Well, they did start back then it wasn't so heavy, but it's really starting to boom now because of that.

[00:07:04] Chris Langley: So I guess that's made access to treatment kind of a little bit easier for people as well since since obviously the pandemic and how kind of Zoom has had a big impact within connecting with therapy around the world. So no, that's, great to hear. Do you promote the 12 step program yourself? And, and which. tried and tested model which has proven very successful in overcoming addictions for many, many decades. What is it in your opinion, that's made the 12 step program so widely accepted and used with huge success?

[00:07:36] Dr Pamela Tambini: So twofold one is, do I promote it? Definitely. Again, I don't try to push anything on anyone. I just tried to educate, break barriers with, with people, whether it's patients themselves or family members and loved ones whether it's AA or NA or the other, you know, Celebrate Recovery or Smart Recovery if people don't, you know, want to get into too much spirituality.

I try to let them know it's, it's a group of their peers and they're isolating, lacking support and the, the easiest thing to do because there's meetings every day, all day, any time. To lean on if they're not willing to do treatment or, you know, maybe they just relapse and don't want to go back to treatment.

That's something they should really, because you meet people, you gain support, you build sober, sober support and a sober community, which is very important for loved ones and family members who are supporting those through addiction. I, I do tell them about Al Anon because. Addiction is taboo. It doesn't matter where you live or where you come from.

I tell everyone it's, it's, it's like cancer. It doesn't discriminate. So a lot of people don't like to talk about it. And it's still to this day in the world we live, people don't want to acknowledge it, I guess. So it gives them a safe space to go into to learn more about themselves and about the person that they're dealing with.

trying to help. So that, that's what I'm trying.

[00:09:09] Chris Langley: Yeah. Do you, do you feel that Addiction is becoming easier for people to talk about, whereas 20, 30 years ago, it was a very, I mean, it was very taboo in England, certainly. And do you think it's become easier over the last, say, 10 years to discuss addiction and be more open about it?

[00:09:27] Dr Pamela Tambini: In a way, I mean, if you live in South Florida, where addiction, you know, is all around us, it's a very open thing. But you, if you go to, let's just say like Alabama or the very Southern religious states, you know, those places, it's still not easy to talk about. It's still taboo. And it, across the United States, it's going to ebb and flow based upon.

Where they're at and what, how they were brought up.

[00:09:56] Chris Langley: Yeah, it's it's quite I'm I live in Iowa and it's quite taboo here as well. So I know exactly what you're talking about. So okay, excellent. It's, it's not only adults that you help treat with with addictions. And have you seen any new trends in drug use amongst the younger people that you help treat that are so, you know, sadly affected by by addiction?

Have you seen any kind of new new drugs or new kind of? Ways kids are getting access to their drugs because of the online stuff as well.

[00:10:25] Dr Pamela Tambini: The biggest thing we're seeing are like fake, what we call fake or pressed pills, such things like kids, you maybe they're experimenting and they think they're buying a Xanax bar from someone, but the Xanax bar is not Xanax. It's fake. Fentanyl that was created, you know, what, and any other, you know, China, wherever they bought it on the black market or the dark web, and they think they're buying Xanax.

And then, you know, you have 16 year old kids, 17 year old kids that are overdosing. So I would say that has been a big issue in the last couple of years, especially down here that we're seeing. Even patients coming into the treatment centers, they're saying, Oh, I was using Xanax and Valium and Klonopin, and their urinalysis comes back and it's just Fentanyl.

And they're shocked because they're like, Wow, I didn't, I could have died, one, two. Obviously, I didn't know what I was buying from the street or the dark web. So. That's a big problem that's come about.

[00:11:30] Chris Langley: So, so you've obviously noticed there's big, big new trends within drug use around Fentanyl. Is it a major problem, would you say in Florida?

[00:11:38] Dr Pamela Tambini: Definitely.

[00:11:39] Chris Langley: And

[00:11:40] Dr Pamela Tambini: a huge

[00:11:41] Chris Langley: yeah, I mean, it seems to be, it seems to be growing around internationally now. I mean, I think we're even getting it over in England, which I was quite, I was quite surprised at.

So so how do you help those they're affected by fentanyl? What's the kind of? You know, what are the options for them? I mean, it's such a destructive substance.

[00:11:59] Dr Pamela Tambini: It is. So there's multidisciplinary approach, right? If it's an, if it's in, in a treatment setting, you have your medical team, you have your clinical team, which is comprised of a therapist where they, you have concurrent medication management, therapy groups, things like that. If it's in the outpatient setting and they're just going to like their primary care doctor, It's, you know, most doctors will also refer to a therapist because patients need the best of both.

Medication wise, there's people who choose abstinence based, you know, treatment, but that's very hard because your risk of overdose is there. Medication management, most people have seen Methadone Buprenorphine, which is Suboxone maintenance, a Sublocade, which is the injection. Those are partial opiate agonists.

That are, you know, and then you have your opiate blockers, and that's Naltrexone or Vivitrol medication management. And then we also try to concurrently manage. If they're suffering any mental health issues, such as depression, anxiety, sleep issues, whatever might come along with

[00:13:07] Chris Langley: Mm-Hmm, .Okay. Excellent. Could you tell our audience about any of the other therapies that you offer that you, that you strongly help promote?

[00:13:17] Dr Pamela Tambini: So, therapeutically, or personally, because I'm a physician medication management's big for me. Motivational interviewing is a big thing for me to help people. Understanding the stages of change, the trans theoretical model. And understanding where you're meeting a patient, where they're at in their addiction is important.

But some of the things the treatment centers offer are, you know, cognitive behavioral therapy, group therapy with psychosocial skills. People learn, forget, or lose the ability to like get up, have a job, make a schedule, time management. So these are the things we help people reintegrate into life. with or financial management, things like that.

Trauma therapy, EMDR dialectical behavioral therapy or DBT for patients who have a personality disorder. So there's so many realms that we like have exposure to and offer

[00:14:17] Chris Langley: Wonderful. That sounds absolutely fantastic. Um, So what are you, what are your future plans for your career or your work? What have you got kind of in the pipeline?

[00:14:26] Dr Pamela Tambini: future plans. I have no future plans of leaving the addiction medicine realm. I plan to continue to work in the field one of the things that I started doing as well is the Real Recovery Talk podcast.

[00:14:42] Chris Langley: Yes. I was

[00:14:43] Dr Pamela Tambini: We're trying to, yeah, we're trying to provide a program for people with addiction, their families and loved ones.

So support programs to help educate, you know, people like promote guides. Family therapy, things like that.

And then eventually I want to be an educational provider to other, you know, physicians, nurse practitioners, physician assistants in the field to help guide them and educate them to break barriers so it's a more common practice.

[00:15:16] Chris Langley: That sounds like you've gotta be very, very busy. So tell uh, where, where could people find your podcast as well, if,

[00:15:23] Dr Pamela Tambini: And on any Spotify, YouTube, Apple,

[00:15:28] Chris Langley: okay. And who do called Real Recovery Talk

Okay, so who do you have on as guests for your podcast?

[00:15:34] Dr Pamela Tambini: Anyone in the field we have people themselves who, who've been in addiction, who are now in recovery and they share their stories. We have professionals in the field that are currently working or that, that, you know, I've worked with or my team has worked with and, you know, even people who don't necessarily work in the field, but are prominent in other fields, like, because we, I like to focus on exercise, nutrition, things like that.

So people who are in that field that are also in recovery, cause I can share their stories and how alternative therapies benefit them.

[00:16:10] Chris Langley: Wonderful. Excellent. So how can people needing support for their addictions find you online? And contact you or your service directly?

[00:16:20] Dr Pamela Tambini: They can reach us at, I have the website. So realrecoverytalk.com. We, I also have an email info@realrecoverytalk.com is our email that they can reach out to us, send us an email if they're looking for help for themselves or for loved ones. We're more than happy to. We read all our emails, we, you know, respond and go over everything.

[00:16:45] Chris Langley: Excellent. Thank you very much indeed for that last question. Is there anything else I should ask that I've maybe forgotten to tell you that you'd like to tell our audience about?

[00:16:55] Dr Pamela Tambini: No, just that. I mean, I would say to everyone who doesn't, is not a believer, addiction is a chronic disease. And the way that I look at it is like someone who has high blood pressure or diabetes. It's something they're going to face for the rest of their life and they have to work at it. And they need support of their family members and their loved ones to get them through.

And we're here to provide that support for people.

[00:17:23] Chris Langley: I'm sure many, many people are glad that you are there doing the wonderful work that you do Dr. Tambini. Thank you very much indeed for your time today and we'll catch up again soon. All right. Thanks very

much. Cheers.

[00:17:34] Dr Pamela Tambini: Thank you. Bye.

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