Ep7 Addiction Treatment 3rd Phase of Opioid Crisis

Ep07 Alicia Shirakbari-Leslie, MD, President, Central Kentucky Addiction Treatment

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

Chris Langley: Hi, welcome to Addiction Recovery Place, the podcast championing addiction treatment specialists around the world. I'm very pleased to introduce today's guest, Dr. Alicia Leslie, the president of Central Kentucky Addiction Treatment based in Danville, Kentucky.

Dr. Alicia Leslie is a physician and president of Central Kentucky Addiction Treatment. Her 27 years as an emergency room physician exposed her to the growing epidemic of opioid addiction, along with a lack of treatment resources, so she felt the need to join a practice where patients are treated by a caring physician with professionalism.

Dr. Alicia started addiction treatment and management in 2014. She became board certified in addiction medicine in 2019 by the American Board of Preventative Medicine. In July 2022, she bought the practice where she worked for 10 years in order to expand treatment services for patients. And she also has a special interest in pregnant, pregnancy opioid management.

Dr. Leslie, we're [00:01:00] truly grateful for your presence and insights, and we look forward to hearing about your service today. Thank you very much indeed for joining us.

Alicia Shirakbari-Leslie: Thank you so much for having me today.

Chris Langley: we really appreciate it. Before we start, Dr. Leslie there's a wonderful quote on your website that I would love to read. And it reads

"When you help that one person, you're not just helping them. You help everyone whose lives they touch." This pretty much sums up working in addiction services perfectly.

And I just wanted to add that because this is what this podcast is all about. It's championing the great work that you all do. So I just wanted to add that. So no, thank you for that.

Alicia Shirakbari-Leslie: No, yes, you're so welcome. I think that's really important for people to understand that, you know, changing one life, you know, it's not, it's a lot more than just changing one life because someone becomes sober, right? It affects the lives of all of those who touch that one

Chris Langley: Yes, absolutely. Absolutely. So we're just going to jump straight in. Tell us about your journey and how you started Central Kentucky [00:02:00] Addiction Treatment.

Alicia Shirakbari-Leslie: Well, you know, I, I also had. My own experience with a loved one who was an addict, and I think that, you know, while I was a physician, you know, you think you learn a lot in medicine and then you're faced with, you know, a medical crisis within your own family. And, you know, I had a loved one who was an addict. Um, He struggled with addiction for years and I was always there every single day fighting to save him, you know, fighting for him and, you know, it was basically almost like living in hell for me because it was painful watching someone destroy their life and feel like I wasn't able to stop it. You know, unfortunately, he was addicted to both cocaine and Vicodin. And despite my efforts, he ended up overdosing and died. And I carried a lot of guilt as, as a doctor and felt like, you know, I couldn't [00:03:00] save him. And I think that his death was sort of the catalyst that helped me shift my career from being just in emergency medicine to addiction medicine. I wanted to be in a position where I could really help others. You know, there was a realization too, that I was an enabler, you know, as I've learned a lot more about addiction over the years, I realized I also, you know, didn't do things the way I probably should have and I'm not saying that that, you know, that I, I am at fault for what happened, but I do think that I probably could have done things better. And that pushed me to learn and to get better and to do better. And I ended up. You know meeting these physicians that were starting this clinic at about 12 years ago, and they had started the clinic. And then I joined them 10 years ago and spent a lot of time really learning. One of the psychiatrists that was in the office was my mentor.

I learned a [00:04:00] lot from him. You know, about the psychiatric aspects of addiction and the management. And then went on to just do my own self study program. I was able to grandfather in to the American Board of Preventive Medicine pathway program and became board certified in 2019. And then that, you know, that of course moved into me, you know, eventually buying the practice, which I have now.

Chris Langley: Well, firstly, congratulations. I mean, for, for, you know, going so far about to something so tragic in your own life and then progressing to help others with addiction. I mean, that's hugely admirable. And you know, I think that's an amazing story to where you're at now. Obviously with. Offering the services that you do to your community in Kentucky, that's, that's testament to the great work that you do.

And no, that, that's, that's a pretty, pretty amazing story to hear. So, so thank you for explaining that.

Alicia Shirakbari-Leslie: it helps people. Well, you're welcome. And I think it helps people understand that, you know, I have, especially family members, [00:05:00] because I have experienced what they're going through. I know what it's like to be fighting for someone and wanting them to have success. And. So it becomes very personal for me because I have experienced it and I do understand, I think on a different level than a lot of other, you know, people in the medical profession that maybe don't have direct experience as I do.

Chris Langley: Absolutely. Absolutely. And I suppose that obviously, you know, you said it transfers to your own, to, you know, your own personal experience. You can then relay that to your. to your, to your patients as well. And that, that puts a whole different slant on, on, on treatment, I think. And that's, that's a, that's, that's a wonderful story.

It really is. Dr. Alicia, what is, what is an addiction to opioids and does this affect, and how does this affect someone's physical and mental health as well as their lives with their family and the community? Mm hmm.

Alicia Shirakbari-Leslie: but, you know, opioids are, you know, narcotic pain medications. Right? And we, we know them. [00:06:00] More familiarly as morphine, codeine, hydrocodone, oxycodone, and then heroin and fentanyl. And, you know, addiction is a chronic brain disease that is characterized by both physical and psychological dependence. And what you see in addiction is that we see the use of drugs despite the harmful consequences, right?

And we see people who actually lose control over their using. And that's unfortunately coupled with the development of tolerance over time. And so we see increasing use of the drug. And then what happens to patients over time as they continue to use is they start to develop problems with focus, memory, the ability to learn, they start having changes in their decision making abilities, we start to see poor judgment and all of these changes [00:07:00] will eventually lead to really, you know, negative consequences the loss of their jobs. You know, we, we see people lose their cars, their homes. They destroy relationships with their spouses, their parents, their siblings. I mean, and of course we see a lot of people who eventually, you know, lose their children or lose custody of their children, all because of, of addiction.

And so what you see is that addiction really kind of impacts every aspect. Of someone's life, not just, you know, the financial. And so the, the beautiful part of, of addiction is that you can really help someone turn all of that around if you do it in the right way. I mean, I have a patient who was actually homeless. He used to sleep in, you know, empty post offices at night. And now, you know, he's been my patient, you know, seven years later, you know, he's sober. He has a really good job. He has, he manages about 50 people underneath him at his job. [00:08:00] He's owns his own home. He has, you know, several cars. He has his, you know, all of his children.

He's married. I mean, he has a wonderful life. So, you know, you can take someone who's, who's had all of the negative consequences from drug use, and you can help them turn their life around. You know, when you talk about addiction, you also have to talk about, you know, the impact on the community. Right. So It affects crime rates, hospitalizations, child abuse and neglect cases, and obviously, you know, the communicable diseases like HIV and Hepatitis C that's in the communities.

So when you look at, you know, opioid addiction it's going to affect sort of every aspect of not just someone's individual or personal life, but it does affect the entire community as a whole

Chris Langley: Yes, indeed. I mean, it's something that can happen so quickly as well. And without many warning signs, to be honest, sometimes and, you know, it's, it's always lovely to hear real success stories [00:09:00] from professionals that are very dedicated to their work. And, you know, you've the chap that you were just talking about who you work with for seven years.

I mean, that's, if you had told him seven years ago, what he's now doing seven years later, he probably wouldn't have believed you. Which is, yeah.

Alicia Shirakbari-Leslie: You know, and his, his brother's actually my patient as well. And they were both sleeping in post offices together and they're now both, you know, sober and living very productive lives. And he says to me on a regular basis, as a lot of my patients have, you know, you saved my life. And I always say, no, I didn't save your life.

You saved your life, right? You came to me for treatment. I just helped you. And. It's, it's a beautiful thing because this is where the whole idea that you brought up in the beginning, which is, you know, when you change the life of one person, you change everyone around them. If you look at him, I mean, you look at all of his family, his friends, everyone who has touched his life has now been affected by this positive change. [00:10:00] And that for me is the most rewarding part of treating addiction.

Chris Langley: Definitely. Definitely. It's always, it always gives you a nice warm glow when you know that your work is doing some something positive where my own experience of working with people in addiction, it's a very, it could be such a negative environment. So you've got to take the positives and kind of push those positives.

So, you know, this is possible for you to do this. That's, that's my own personal view. When I was working with, with, with people in London. Thank you for explaining. That's a, that's a perfect description of opioid addiction. That really is. That's, that's, that's wonderful. Your, your, your program provides a vital service of people experiencing addiction in Kentucky.

Can you describe in some detail what you offer and how the program works in terms of your service delivery?

Alicia Shirakbari-Leslie: Yeah, so, you know, we're really a really, really small practice. I only have about 200 patients, but the reason for that is that I really [00:11:00] individualize to the patient what their specific addiction is and tailor the program around what their specific needs are. You know, some people like to say it's a type of boutique type of practice. Because they only see me when they come to the office. I am their physician and I am the only person that they actually see. And the office is kind of set up, you know, what we call a DPC model, which is a direct primary care model where, you know, patients do pay a cash fee to see me. They don't put it on their insurance. We do this for privacy reasons. A lot of patients don't want there to be. Any type of, you know, implication or on their insurances. So we do it all kind of as a, as a private model and this is also to ensure, you know, patients, privacy since addiction can be such a sensitive topic. We've developed the clinic to encourage people to [00:12:00] work and to keep working and so I've adjusted the clinic when I took over. I adjusted the hours so that we have evening hours for people who work swing shifts. We have weekends we do 1 Saturday a month so that people who have Monday through Friday jobs can come on a Saturday.

That's why we also have evening hours and then we have regular office hours and we do this so that patients don't use their PTO time or vacation days and can be able to work without, you know, any interruption. Because I feel like. Being able to work and provide helps build confidence, self esteem, and we're helping them rebuild their lives.

And so our, our office accommodating that is extremely important to me and that, you know, we're providing a service. But we're also doing it very, very in a very personal way.

Chris Langley: That's so, so basically you're, you're working around your [00:13:00] clients.

Alicia Shirakbari-Leslie: I

actually do. Yes. I work around their schedules.

Chris Langley: That's, that's, I mean, that's, that's quite a unique opportunity for people to, to kind of enter that kind of treatment. So that's, so how many, so how many Saturdays? It was one Saturday a month that you, that you work, that you, do you have your office open for people in full time work, so you're.

Alicia Shirakbari-Leslie: Yes, I absolutely. It's one Saturday a month. But again, we will accommodate what they need. So if they're traveling for work or they're sick, I'll do a telehealth visit. So that again, they don't miss work. Because for me, that's extremely important. And I don't want them using, you know, their vacation days to go to the doctor.

I don't, I don't feel like that's conducive to long term treatment. Right, we want to set up a program that patients are able to do over the long term, not just, you know, temporary because it starts to feel difficult.

Chris Langley: Yes, definitely. That's, pretty unique opportunity. And I think that's absolutely [00:14:00] wonderful that you're able to offer this. So thank you for explaining that. What are your views on harm reduction? And how does this play a pivotal part in addiction treatment?

Because harm reduction globally as, you know, got quite a different variance. I mean, it's very different here to what it is in Europe and the UK or, you know, I'm kind of learning myself. So I'd love to hear your explanation around your views on harm reduction.

Alicia Shirakbari-Leslie: Obviously, everyone wants harm reduction, right? And basically, the whole goal of harm reduction is to save lives and then protect the health of those who use drugs. You know, there are obviously a lot of programs, you know, needle exchange programs and providing, you know, Narcan, the reversal drug that people can use during, you know, if someone is overdosing.

And so those are types of harm reduction programs. But I feel like, you know, 1 of the biggest harm reduction, you know, tactics that we can use is treatment. [00:15:00] And the biggest obstacle that I find for that is sort of this misperception and misunderstanding of MAT, medication assisted treatment, which is extremely important.

So I will commonly hear people who are not very educated in the world of addiction say things like, "Oh, well, you're just replacing one drug with another," and this couldn't be further from the truth. We know that MAT or medication assisted treatment has been proven to decrease opioid related overdoses and deaths. There was 1 study that found that those who are not receiving any type of were actually 8 times more likely to die of an overdose than those who are in treatment. Right? So you look at harm reduction can be in a lot of different forms and my particular office. We focus on MAT, you know, for people to understand, you know, what Suboxone is, you know, it's a combination drug, a Buprenorphine and [00:16:00] Naloxone and Suboxone can, it can decrease pain, and it decreases pain perception, and it does a lot of things in the brain.

It increases the reward related behavior in the brain while reducing someone's cravings to use drugs. So, there's neurobiological evidence that the levels of the dopamine in the brain, which are typically low in a lot of addicts, and that can be from a lot of reasons from the, you know, the start of, using drugs at a really young age so that the frontal cortex of the brain doesn't develop as well. It can also be partially genetic. So what we see when we start using drugs like Suboxone is that patients actually, for the first time, will say, I feel normal. They're not getting a high. They're actually raising those dopamine levels to normal places in the brain. So they actually start to feel normal and they're able to now function. So it's hard for me to. When [00:17:00] I hear people say, "oh, you're just replacing 1 drug with another," that's frustrating to me, because if you look at insulin and, you know, oh, well, then why, you know, they need to get off the medication as soon as possible. And there's all these mental, you know, or misperceptions of the community.

And I'll give you an example. This is what I always tell my patients because they come to me and they're like, well, I really need to get off this drug by a certain time. And I say, look, depending on your genetics, the age of use of you started using you may or may not be able to come off the medication. And there's a lot of factors that go into that. So, one of the things or examples that I use with patients is insulin, right? So people are diabetic because their pancreas doesn't make enough insulin. We give them insulin, right? And we get their blood sugars level and then they, they, they function. We don't give them insulin for let's say three years and then take the insulin away and expect the pancreas to be able to make insulin.

It doesn't work that way. The brain is the same way. We can't [00:18:00] just give a drug like Suboxone for two or three years and then just take the drug away and expect the brain to produce the appropriate levels of dopamine, especially if they have a long history of addiction, or they started using drugs when they were 13, 14, 15, because those dopamine levels may never, ever be within normal because that frontal cortex, that, that reward pathway in the brain never developed properly.

Right. So if they are using that medication or they're on that medication and they feel normal, it's like the brain insulin, you know, I always say, why in 3 years when I just take that away from you and then expect you to function normally in society.

Now, I'm not saying that patients can't do that. This is why while they're on medication and they're in an MAT program, like what I have, we spend a lot of time on the psychological, right?

Because the brain and the medication is helping with the physical dependence. Now we spend a lot of time focusing on the psychological dependence. [00:19:00] That being, you know, do they have PTSD? Do they have trauma related issues that we need to work through? Do they have depression? Do they have anxiety? We, we address all of these things, right? And then over time, we create an environment where the patient feels comfortable. Now, if they want to then taper and try to come off the medication, of course we support that. But I think when you look at treatment if you look at studies and you look at it, which is in contrast, just straight detoxification programs, abstinence based programs, and those that are just psychosocial therapies alone, they have consistently failed in comparison per the medical literature.

Right? So I feel like it's extremely important that we educate families, friends, law enforcement, even those in the medical community, and most importantly, the policy makers, those in D. C. who make decisions, because eventually, changing these [00:20:00] misconceptions will actually lead to better access for treatment, for treatment for everyone.

Chris Langley: Absolutely. Absolutely. So Suboxone was a real game changer for treatment especially in the UK. It's a very different medication to say the old school methadone. And there there's a lot more success stories around Suboxone that I. I've experienced, so you've just, you just explained it perfectly as to why this works.

And it's, it's, it's probably the most successful out of all of the medication on offer that, you know, people can have. My, my own view on methadone, it's, it's, It's a little bit old school and suboxone for me was I saw the changes in my clients when I work with them as well and I, I realized that it's a, it's a very different style of therapy.

So no, that's, that's, that's wonderful. You've, you've, you've actually answered my next question as well. So thank you very much for that.

Alicia Shirakbari-Leslie: Well, I do want to

say, because I think in the next question, we were going to talk a little bit about why it's important.

[00:21:00] Let me also say this. Now, now, and our program is MAT based. Um, And we don't use methadone in our clinic, although it is offered other places in the community. We do offer a Vivitrol, though, which is an

injection. And now, of course, there is the Blockade, which is the brand name version of the Suboxone injection and there's a new one out. I think it's called Brixadi which is also another injectable type of buprenorphine. So that patients who are not comfortable necessarily taking, you know, the sublingual tablets or strips can get a once a month shot.

And, and the, my patients that do that actually love it. They say that they feel free. But again, yeah, I feel like it's not just using MAT. It's MAT with a lot of therapy and counseling so that the patients feel supported. And it's about rebuilding self esteem and competence in people so that they can rebuild their lives in a way where they don't want to use.

Chris Langley: Most definitely, because the therapeutic [00:22:00] side of it has to come along with the medication side of it as well. I think counseling and therapy is a vital component for someone to help with their addiction. So since you started your practice and career in this sector, what changes have you noticed in drug use and the additional risks that this is posing to communities around, around the, around the country, really?

Mm hmm.

Alicia Shirakbari-Leslie: Yeah, I think if we look at addiction, right? I believe that addiction, especially in the United States has kind of been in 3 phases and I've, I've, I've witnessed all 3 phases, right? The 1st phase was this whole pushing of narcotic pain medication by the pharmaceutical industry. And at the same time, there was this, you know, this big shift in hospital policies to get physicians to control patients pain and this led to what I call the prescription opioid addiction phase. We, we, we know a lot about this phase. There's movies out there, Painkiller, the movie Dopesick. It kind of represents that phase of [00:23:00] addiction in the United States. So that was the 1st phase where we see all this prescription opiate addiction. And then people became more aware of it and they started implementing the state monitoring programs in Kentucky.

It's called CASPER, which is a program that monitors how many opioid prescriptions patients are getting. And those started appearing all over the United States and physicians, as they became more aware, they started prescribing less and less and less. It became much more difficult to get pain medications. And then there was a spike in heroin use. And that's what I call the second phase was the Heroin Phase. So everyone now, because it's a lot cheaper and it's a lot easier to access, we start, they start moving now into this Heroin Phase that we saw. And so there was this. This drastic increase in heroin use and heroin overdoses a lot more, you know, IV drug use at that time. And now we've moved into what I call the third phase. And this is now what we call the synthetic opioids. [00:24:00] This is the phase now where we started seeing this shift into fentanyl and other synthetic opioids on the street. And that's the I feel like that we're in now, right? And that. Is dangerous because what we see now is there's so much fentanyl coming in from international, you know, destinations.

I mean, most commonly, you know, we hear stories about it coming from China and this isn't, you know, regulated fentanyl being made in a pharmaceutical, you know, a regulated pharmaceutical, you know, factory. This is coming from kitchen labs where it's not regulated. There's no idea of the potency of what's being shipped over here.

It's being shipped over here at massive amounts. And then we're seeing it change forms. It's not just cutting of street heroin. We are seeing now garage pressed pills where people can actually take fentanyl and they can press pills to look like oxycodone or or hydrocodone or [00:25:00] norco the street the three even valium and they garage press them, and they make them look like real pills and then they sell them on the street So now people you are now really in a dangerous zone because we have people that think they're buying pills that aren't buying pills and then the pills aren't what they think they are. I can tell you that in kentucky, which was really really high area with Eastern Kentucky and the Appalachia and opioid addiction. You know, we used to see so many pills and we still do. The problem is, is that patients will tell me, okay, yes, I took an oxycodone. Well, then I expect to see that on the drug screen. I, that's not what I see. I actually see fentanyl. I realized at that moment. What they thought they took versus what they actually took was very different. And unfortunately we see this time and time again at the hospital. I haven't even had a real heroin on a drug screen in probably three years. It's all fentanyl for me. That is extremely dangerous for [00:26:00] people who are buying drugs off the street. And this is why we've seen this drastic increase. So, in each phase, the number of overdoses and overdose related death is increasing over time, despite the fact that we're making treatment more available. And that's because of the unpredictability of fentanyl. And the amount that's on the streets,

Chris Langley: So you, let me just get this right. You said that you've not had a positive heroin on yours on a drug strip for three years.

Alicia Shirakbari-Leslie: it's been about three years. Even when patients tell me, "oh, I did heroin, I'm sorry." Or at the hospital when I'm, you know, have resuscitated an overdose and they say, "oh, I shot up heroin." And then I get the drug screen and it's not heroin. It's almost. Always a hundred percent fentanyl, at least in Kentucky.

And I can't speak for other parts of the country, but what we're seeing here is I'm not seeing heroin. It's all fentanyl and we, we see other mixed [00:27:00] overdoses. I mean, obviously we see, we'll see meth and I'll see an occasional cocaine. We'll see the, you know, oxycodone, hydrocodone, some of the morphine derivatives, things like that, but actual heroin, I haven't had a positive heroin on any of my drug screens for my patients in three years.

Chris Langley: So how, that must be quite a thing to go back to your patients and explain to them. And that must be a real reality check for them as well to think, my goodness, me, I've, you know, I've, I've took her thought I was taking heroin. I'm taking probably one of the most destructive drugs. You know, that can, you know, they can kill me basically very quickly.

That must,

I mean, that must be a real reality check for them. What's, what's their response when you tell them, you know, this is your test results, you know,

Alicia Shirakbari-Leslie: Well, obviously there's a lot of disbelief, right? Because, and, you know, there's no honor in, in drug dealers.

Chris Langley: Oh no.

Alicia Shirakbari-Leslie: And a lot of times I don't think that they know what they have either because things are, are [00:28:00] just past so much on the street. It, you know, we, I kind of say, it's like the wild West. You don't really know what you're getting.

You don't know where things are coming from. Most patients are very surprised. They are. They do realize that the awareness of the severity of fentanyl is out there and patients do know. But again, you know, addiction will get in the way sometimes of their decision making. And of course, their continued use, but they do become more aware.

And, you know, I talked to him about it and I'll say, look, you know, there was no heroin. It was all fentanyl. And they do all seem very surprised. None of them say, oh, well, I expected that. They are all genuinely. Surprise. I've even had patients say that they took a Valium you know, what they thought was a street press Valium, or was a Valium, and it turned out was street press fentanyl. And, you know, Prince, let's look at what happened to Prince. Everyone knows who Prince is. Everyone knows that Prince died of an overdose. When they did his autopsy, [00:29:00] what may not be complete public knowledge, but what we know is that he thought he was taking Norco. Which is a hydrocodone acetaminophen combination drug. It turns out that on his autopsy, it was fentanyl, which we know more than likely came from the streets and was garage pressed somewhere. So

Chris Langley: Okay.

Alicia Shirakbari-Leslie: even Prince was

Chris Langley: Mm hmm.

Alicia Shirakbari-Leslie: of

street fentanyl.

Chris Langley: it just shows how this can get anyone really, doesn't it? So do you see the fentanyl epidemic to be one of the biggest threats in the communities when 20 years ago the main drugs of choice were heroin and crack? Because it's kind of really ramped up, as you said, it's kind of like a massive epidemic now with high risk.

Alicia Shirakbari-Leslie: it's absolutely, it's massive. And what's happening is it's all coming into the country. It's extremely cheap. It's not regulated. And. It's everywhere. [00:30:00] I mean, it is everywhere. Like I said, when people are buying pills off the street, they think they're getting something that came from, you know, a pharmacy somewhere, but most of the time, it's not unless you actually, and I'd even tell my patients, unless you pick up the prescription yourself from a pharmacy, there is no guarantee whatsoever that what you have, or what you think you are taking is going to work. Actual hydrocodone or

oxycodone it is more than likely if you have bought it off the street, it's going to be fentanyl or have some fentanyl in it. It is absolutely rampant.

Chris Langley: That's a very important message to get out to people, isn't it? Really? That what you're buying, what you're buying on the streets really isn't what you're what you're experiencing. It's very different to propaganda. This is like the real deal. What's going on in this country where we're seeing it in Europe now as well with with fentanyl and these other drugs that are coming in.

It is quite scary, really. [00:31:00] When I was in the UK, we had a scare with anthrax. Heroin laced with anthrax and we had overdoses left, right, and center. It was, it was quite a time to be working in the sector. And, and fentanyl is just another thing that's just, you know, ramping all this up and it's, it's, it's, it's truly tragic.

I mean, what have you found to be some of the challenges of working with people suffering from addiction and how have you overcome some of these hurdles, Dr. Leslie?

Alicia Shirakbari-Leslie: You know, I think one of the biggest challenges we have is that a lot of people think that when they go into treatment or they ask for help that it's a personal failure. And I spend a lot of time trying to help people change their perception of what treatment really is and help their families understand what treatment is and that it's a long process.

It's not an overnight fix. I think it's imperative that we destigmatize the idea of getting treatment. It is a brain disease. It is not just [00:32:00] something people can willfully just, okay, well, you just need to quit using drugs. You know, that really frustrates me when someone says that, when there's so many more you know, complicating factors that go into it.

It is a chronic brain disease. That we need to treat as such, I feel like the idea that it's just something people can will themselves to do is probably to me, one of the biggest challenges that I have when it comes to getting people to accept treatment. And this is, again, why I've really sort of tried to develop a really personalized program so that I can kind of get to know my patients in a way to understand what in their mind has been the obstacle to getting help before. And what can we do to change that so that they can start to value their treatment and what it's giving them and change their perception of themselves sober as well as understanding. What addiction did, you know, addiction isn't who they are. It's [00:33:00] what their past was, but that's how you, you know, all of these things come into play and how you move forward.

But I feel like the biggest challenge that we have is that people view treatment as kind of a negative thing, because they feel like, well, if you have to ask for help, then that in and of itself is another failure when it's really the opposite, right? The person that can ask for help is doing the right thing.

They're actually going to set themselves up for a lot more success.

Chris Langley: And you, you, you, you said a word earlier, stigma. I think that's one of the, unfortunately. That's one of the biggest, that's one of the biggest hurdles around family and friends and I think, I think stigma has to be removed from drug addiction. I think, I think that's a very important thing.

Alicia Shirakbari-Leslie: You look at addicts, right, people have this idea when they say what an addict is and people's minds go to this place of like some kind of scraggly looking character in the back of an alley, you know, you know, shooting up because movies have given us this sort of negative perception. [00:34:00] What I see in my offices, I see moms, I see professionals, I see college students.

I mean, it is everywhere. Every person that you see in some shape or form could be an addict. It is not this sort of meant that this picture that people have developed in their mind of what an addict looks like. It's not people who they perceive as the dredges of society. It is people who are very successful. It is students. It is your brother, your sister, your friends, you know, your. your. your college buddies, your coworkers, even your bosses. I mean, I can't tell you how many high level professionals that I have that I

treat. It's everywhere. And the idea of this, of treatment being negative is, is just, for me, it's the biggest challenge that we have.

It's how do we change perception of the community [00:35:00] to believe that treatment is a good thing?

Chris Langley: it's, it's probably one of the most positive things anyone can do who is addicted to, to, to something is to enter those into the, you know, to walk through that door and ask for help. That's probably one of the hardest, one of the hardest challenges because they know how tough it's going to be to address the many, many problems.

It's not always about, it's not about the drug use. It's the whole, the whole kind of, you know, that the whole lives basically. So your, your, your service in Kentucky doesn't only help those experience addictions to opioids. What are the other addictions that you help with?

Alicia Shirakbari-Leslie: Well, you know, I'm board certified in addiction medicine, so we can really address any type of addiction. Obviously we see people who suffer from alcoholism, but then we also treat people with, you know, sex addiction, gambling addiction, internet addiction, gaming so we treat all types of addictions, but I personally have a soft spot for people who have an opioid [00:36:00] addiction and they're pregnant.

That's kind of where I've become a little bit more of an expert in our area as well as treating those and managing patients who are pregnant with their opioid addiction and coordinating their care with their obstetricians and coordinating the continued medications while pregnant and during and after delivery.

Chris Langley: That must be incredibly rewarding work to do to, you know, you're not only helping the mother, but you're helping the baby, you're helping the father, you're helping grandparents. And you know, it's, it's a very specialist area to help pregnant women through, through addiction. So, you know, I certainly take my hat off to you.

That's, that's, that's wonderful to hear. Are your practice, do you promote peer support and how do you ensure that your clients receive the best support to overcome addiction, even after completing the program or. You know, as you said, people on this for life, but some people move on. I mean, how do you, you know, how do you ensure that people can come back to you if, [00:37:00] if they do relapse?

Alicia Shirakbari-Leslie: Well, absolutely. So we don't have a set number of days to complete a program. I individualize the treatment to the patient's needs. And I do think that many of my patients will be in treatment and definitely, you know, in terms of like the peer support programs such as like AA and NA, we used to offer those, you know, in my office.

And then when Covid came, we kind of stopped providing those meetings. The feedback that I got from my patients is that they loved not having to go to meetings. They chose some of them chose to continue meetings outside, but the majority of my patients actually preferred not to participate in meetings. And some actually even reported that for them it was counterproductive to always hear people talking about addiction and the things that they did over and over and over and recounting stories and for them, that sort of was [00:38:00] were triggers. So we modified the program and I've always focused on just individual one on one type of therapy focusing on whatever their, you know, PTSD, their anxiety, their agoraphobias.

I have a couple of patients with that. Their OCD behaviors, all of the things that they have that sort of impact their sober life is what we tend to more focus on and I do, you know, I encourage them to do meetings. If that's what they're comfortable with. I don't require it. And as far as, you know, completing a program for me, sobriety is a journey.

It is an ongoing process. If they decide that they don't need the medication anymore, or don't need to see me, we help them transition out. But they are always 100 percent welcome to come back anytime. I will always take a patient that I've had before back. And actually I'll take any patient that comes to my office and wants help. And I give my patients access to me. I mean, most of them have my personal cell [00:39:00] phone. They'll actually text me, or they'll call me if they need me for any reason we answer the, the phone after hours to read, you know, in a reasonable space, but patients that are in my alcohol outpatient treatment programs, they do get 24 hour access to me just because. Sometimes people feel like drinking late at night, and I've noticed that sometimes if they need me in that moment, they can always give me a call and I'll always answer the phone to try to provide them with that immediate support.

Chris Langley: my goodness me, that's, that's incredible. That's, that's, that's, that's wonderful to hear. So how does someone in your community enter your program and what is the process for this? How does, you know, Wonderful.

Alicia Shirakbari-Leslie: simple process. They can call our office. Our office phone number is 859 238 0018. And they can make an appointment. We do a lot of our preliminary forms and sort of intake screening things. [00:40:00] Digitally, we send it through the computer and they can answer some questionnaires before they come and then they make an appointment and I will see them in person.

They will come and sit with me, and we'll do a full intake and we'll go through every part of their, their history. And then eventually I will, will get to know them and I'll develop a program. I will share with them what I think the ideal program is for them and for their success. And then we move forward. So anyone can come to my office and be my patient.

Chris Langley: Thank you for explaining that to us. So where can people find you and your work online?

Alicia Shirakbari-Leslie: Our, we have a website. It's www.kyaddictiontreatment.org. So that's KY is for Kentucky, kyaddictiontreatment.org

Chris Langley: Fabulous. And lastly, is there anything I should have asked or that you'd like our audience to know about?

Alicia Shirakbari-Leslie: The only thing that I'd like to say is that if you [00:41:00] are out there and you're struggling with addiction and you're thinking about getting help, let me just say this. Every person that has 10 years of sobriety, five years of sobriety, had a first day. Everyone. So you can let that day be today. It is never too late.

Chris Langley: Well, I couldn't have thought of a perfect end to end this podcast. Dr. Alicia Leslie, thank you so much for joining me today. And we look forward to hearing about more of your work in the future. Thanks so much.

Alicia Shirakbari-Leslie: Absolutely. Thank you so

much.

Do, do, do, do, do.