Inside Scope
Say hello to Inside Scope — Lakeland Regional Health’s podcast, where our experts share insights on today’s popular health topics, hosted by our own Dr. Daniel Haight.
Inside Scope
Addiction Medicine with Dr. Hastings-Spaine
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Most people try to help when a friend or family member is sick or injured, but it may feel complicated when the illness is addiction. In this episode of Inside Scope, host Dr. Daniel Haight talks with addiction specialist Dr. Lindsey Hastings-Spaine about how to broach this topic when someone is suffering. Addiction is one of the most common preventable diseases in the U.S., says Dr. Hastings-Spaine, and in some cases, addiction may be related to someone “self-medicating” to cope with another illness. If you’re concerned about someone, she says you should let them know you care but carefully avoid being judgmental.
Let's talk about times when you feel a friend needs help or you know a loved one is suffering. On the Inside Scope episodes, we discuss common issues going on inside the body. But you may have heard many times that it's important to consider the body, soul, and mind as three parts of the whole person. With me today is Dr. Lindsay Hastings Spain, a board certified emergency medicine physician and addiction medicine specialist here at Lakeland Regional Health. I am Daniel Hayt, Vice President of Community Health, and the host of the Inside Scope. Welcome, Dr. Hastings Spain. I appreciate you coming today.
SPEAKER_01Thank you so much for having me.
SPEAKER_00You know, I wanted to tell you a story about 10 years ago. Lakeland Regional Health started a program to connect with our local congregations.
SPEAKER_02Okay.
SPEAKER_00And we met with the leaders of the congregation and asked them, how can the hospital help you with the common medical conditions you're dealing with? And we thought we were going to hear about out-of-control diabetes, hip pain, chest discomfort, stroke. A lot said they were inundated by the troubles of everyday life that their congregants brought to them. And often it was, my son is impaired by taking medications or using substances that were changing and getting them into trouble or not allowing them to function. And they they were they were often frustrated that the person felt they were doing okay. But is that part of what you're seeing that that this is sort of a silent epidemic that folks are suffering with?
SPEAKER_01Absolutely. I would say addiction problems in the US is considered one of the highest like preventable diseases, but it's one of the diseases that is often not treated. Um average said that like 50 million Americans suffer with a diagnosable substance use disorder, but only one in ten of people actually get treatment.
SPEAKER_00That really translates to you probably know somebody that's going through and suffering these things. Absolutely. And you know, I often think of um we all learned first aid when we were kids. If if if a if your child skinned their knee, you knew first aid. If somebody sprained their ankle, you knew first aid. I think there's this lack of an understanding mental health first aid. You can help somebody without being a specialist or a nurse or a physician.
SPEAKER_02Right.
SPEAKER_00Um what are tell me a little bit about what kind of first aid can you help with somebody who's suffering? Because it sounds like there is a lot of folks that are suffering from this.
SPEAKER_01Yeah, I would say for any person, specialists or not, or just again, the regular person, being curious, being compassionate, coming from a lens of just non-judgment, I think that's helpful for people to at least have their walls and the barriers down.
SPEAKER_00I I I wonder I wanted to repeat that again because that that first I'm concerned, I'm curious, my friend, I'm concerned about what's going on. And I think the worst first thing to say is, hey, what's wrong with you? Right. Because it's what you just said. Right. That's pretty judgmental.
SPEAKER_02Yeah.
SPEAKER_00And to say to somebody, hey, I I uh what's wrong with you? No, it's what's a better thing to say?
SPEAKER_01Uh I would say just speak honestly, just ask questions.
SPEAKER_00Hey, I noticed that you're showing up uh late and nothing.
SPEAKER_01I noticed that you stopped doing some activities. We used to go fishing, we used to work out or biking or something, that you've noticed a change in its own. I've noticed a change.
SPEAKER_00And then you had that best follow-up is how are you doing? Yeah. You know, I I I think a lot of folks, if they heard that for the first time and something was going on, and you asked me, um, is there anything going on? My first reaction would be, no, I'm fine. Right. But you asked. I think that I think we don't understand how powerful that is. You cared enough to ask me, yeah, hey, are you is everything okay? I noticed that you know you you were doing things a little differently. Is everything okay? And uh and I might walk away saying, no, everything's fine. But the rest of that day, I'm gonna think somebody cared enough to notice. To notice. Yeah. And I think that's the suffering we go through is we feel nobody else notices.
SPEAKER_01Well curious, yeah.
SPEAKER_00What was the what's the follow-up question? Or what's a follow-up statement if somebody says, no, no, I'm fine. Okay, good. What else do you say?
SPEAKER_01Just check on you. Just wanted to show you that I'm here. I can be a listening ear.
SPEAKER_00Oh, I'm here. Call me if you need anything. Yeah, that that's a nice read. And then that person says, Well, somebody cared. And then if things don't improve, you're there, and then maybe the second time the person will say, Here's what's what's going on. Where do you what other problems are you seeing that are happening?
SPEAKER_01Definitely, again, as you we touched on, there's just not enough people that one realize that what they're suffering with is an actual addiction. I think a lot of people, mental health, as we know, is also very much so underutilized, not treated enough. There's not enough providers, there's a huge stigma, and then lack of understanding. Lack of understanding. And then as a consequence, a lot of people are self-treating, right? Using substances, using alcohol.
SPEAKER_00So you may have an another very real issue. Like the ups and downs in life can be pretty down and depression. Exactly. Or um there might be some trauma like uh like a post-traumatic stress.
SPEAKER_02Exactly.
SPEAKER_00I guess on top of it, if using a substance that makes you feel better, you're describing that's a pathway down the wrong direction. Exactly.
SPEAKER_01We've got exacerbating the problem.
SPEAKER_00And you're just putting a like a band-aid on it.
SPEAKER_01Simply a band-aid.
SPEAKER_00And then that becomes the additional problem.
SPEAKER_01Exactly. But both need to be treated, though.
SPEAKER_00Yeah, I've always worried about folks that are getting help with substance use disorder.
SPEAKER_01Yeah.
SPEAKER_00But it's very important to also say, but this is a whole person. They are dealing with a stress from the past or episodes of depression, absolutely or bipolar where you have these ups and downs. Right. You've got to be a detective to help persons and say um, or help the help the person be their own detective to say, uh uh, understand going back in time. Right. What's good, what else is going on.
SPEAKER_02Exactly.
SPEAKER_00There's so many silent barriers. I think you mentioned the other thing is the tipping point. We're all starting to understand these issues more.
SPEAKER_02Yeah.
SPEAKER_00I think the tipping point is when the person thinks everything's okay, but they just flipped their car over. Or they they just uh lost a job or they got in trouble. Do you find that friends and relatives might see it, but the person themselves does not see it, or or is that what has to happen?
SPEAKER_01You'll be surprised. And and honestly, what you're talking about is the underpinnings of addiction. Addiction, if we were to define it, I would define it by four C's. Okay. C's meaning basically behavioral changes that come a result of repetitive uh substance use. So one of them would be increased cravings. A person is having intense or irresistible urge to use craving, um, to use substance. So they have the craving. Right. Another, the weather uh C would be um compulsatory use. Okay, so basically a person is being driven to use out of kind of relieving their anxiety. Simple sim similar to how we see with the other.
SPEAKER_00I have to do this, I have to take this pill or recreational drug or to make me feel better, to relieve my tension and anxiety.
SPEAKER_01Similar to how we see in OCD patients, how they have to wash their hands ten times before leaving as out of compulsion to relieve themselves of that stress. Um the third C would be loss of control. Okay? So it's a difference with somebody who uses one drink of or intends of saying, I want to take one sip of alcohol or one drink and then ends up drinking eight.
SPEAKER_00Yeah, and then either saying something or doing something that shows that that's not in control.
SPEAKER_01Exactly.
SPEAKER_00Okay.
SPEAKER_01And then the fourth C would be the negative consequences. And that's going back to your initial question or your next whole point. People who are have actually diagnosable substance use disorder or addiction, they're often having negative consequences, and despite the negative consequences, they're continuing in their use. And that could look as, you said, loss of job, maybe threat of divorce from their spouse, um legal consequences, DUIs, getting arrested, all type of things, and still they're continuing to use.
SPEAKER_00So this is hugely important for loved ones and family members who are seeing a little bit of these things and are worried about overreacting. Right. Which they know sometimes the person is going to say everything's fine, and and that's an implying that you're overreacting. But then when friends and family sees the this kind of craving and compulsion to go for these uh d substances that are having bad outcomes and they're losing control, you know, that's where the the friends and family you know do mention is everything okay?
SPEAKER_02Yeah.
SPEAKER_00It's the one thing to have friends and family recognize the problem, and that's almost like first aid and offering, hey, you need some help. What does the person have to come to to sort of see that? What helps them get to that point to say, I see it now?
SPEAKER_01Every person is different. You know, sometimes it would be the marital stress that's coming about. It'll be the threat of, let's say, their spouse is leaving them or the threat of losing a a career that they enjoy. Unfortunately, with every person, it's vastly different. And you want to get the house earlier before or before the medical consequences stick in.
SPEAKER_00Well, and then you look at that the stress on the heart, and we've talked about the stress on the kidneys and the lungs for all these things, but that's the the functioning in life if something's impacting a job or your loved ones or your children to really come to do that. You know, the one of the things that I think is so important that as we're training young doctors and you're training young psychiatrists here at Lakeland Regional in our residency program, is that our primary care doctors, they are not just focused on where does it hurt or the blood pressure. They're also realizing that are you at risk for substance use disorder? Are you going through anxiety or depression? I'm finding that more you know, primary care doctors there's they're screening their patients for anxiety, depression, even substance use. What do you see happening in primary care?
SPEAKER_01A mix. I would say a lot of them are starting to refer. I think the issue, at least from what I'm hearing, was that there wasn't a direct person to refer these people to. So, for example, if they did the screening tool and they saw, okay, this person is at risk or has a diagnosable substance use disorder, who do I send them to?
SPEAKER_00So with smoking, you always get asked if you're smoking in your doctor's office, and if you are, they offer. Right. And and sometimes they'd say, well, they always say no. But some good doctors say, you know, it costs about a thousand dollars a year to smoke one pack of cigarettes a day, or just an estimate. And are you interested in in addressing that for health and financial reasons? And that's it might be the seventh time they're there. They'll go, actually, now I am interested. I'm coughing a lot. I'd like to quit smoking. Getting a little deeper into these other kinds of questions. What what are some questions that primary care doctor could ask in the in the clinic to help them in a in a in a good way?
SPEAKER_01And I would say, again, just trying to really take a approach where you're kind of zooming out. You know, there's a lot of things that you wouldn't even think that are linked to addiction. For example, a patient's um treatment-resistant hypertension. Maybe the reason that they're on their third beta blocker or third medication and it's not working is because they're drinking a lot at home. And that's not going to change.
SPEAKER_00A little drink at night.
SPEAKER_01Yes.
SPEAKER_00If you take a little alcohol at night, you're not you might fall asleep, but you're not getting normal sleep.
SPEAKER_02Exactly.
SPEAKER_00And and you might worsen your sleep apnea. You might be waking up the next day more tired, and it was that alcohol taken just before sleeping. Your reflux might be getting worse. Exactly. So a lot of those questions that doctors may have asked five years ago when they met you the first time.
SPEAKER_01Exactly.
SPEAKER_00It's so important that doctors go back and ask those questions again.
SPEAKER_01And don't just get focused on the numbers, whether it's the blood pressure, or they're this or they're that. Kind of see what is actually the underpinning, you know, of why this person is manifesting the way they are.
SPEAKER_00I even know a local dermatologist who asks their patients these questions, and they have gotten great feedback from patients who didn't realize that three drinks a day was too much and that it could impact their life and could impact other things. And even though it wasn't skin related, they really appreciated someone who cared, someone who asked and was willing to help recognize the problem.
SPEAKER_01And you brought up a good point about the education. Far too many patients do not realize what actually technically constitutes its misuse. Um having those type of conversations and being like, actually, this is unhealthy drinking or this is unhealthy use, and we want to kind of nip this in the bud and change these behaviors before we delve off the cliff into full-blown addiction.
SPEAKER_00Well, yes, before you get to those consequences and you start to, you know, you want to before you you get to that point, you recognize there's an unusual craving, there's this unusual got to do this. Right. And that's the the red flag.
SPEAKER_01Or the medical consequences, yes.
SPEAKER_00And I I wish everyone the best to recognize those kinds of things is where friends and family can in a nice way, in a in a successful way, help their friends and relatives. Absolutely. Yeah. So when it comes to seeking help, I have seen a lot of barriers that are starting to improve or get better. But these barriers in the past were, well, this is private. How how do you get past that barrier?
SPEAKER_01Oh. I would if this was a patient of mine who was seeking out help, I would definitely encourage them or just solidify that everything that's shared within our discussion is going to be private. There's going to be, again, a non-judgmental approach. I'm going to speak with you with compassion. I'm not going to, you know, aid in solidifying the stigma that comes around seeing the city.
SPEAKER_00And I think bringing it up too is to is that if you're worried about privacy, if you're worried about anything, bring it up and mention, well, how is this, how do you protect and respect privacy? Exactly. And and yeah, and I often this comes up with patients I treat, and I'll say, you know, as long as there's that you're safe, you know, things are private. If I see something where you're in danger, exactly. Harm to yourself, harm to someone else. Exactly. Because I do want to know if somebody is, and I ask them, are you considering harming yourself? Absolutely. And they'll honestly tell you, and that's where we do have to get help to prevent anything bad. Now, also folks are like, well, it goes in with the privacy. It's like people will think of me differently. It's a stigma. So what how do you help that? I mean, again, that's harder for me to bring up as a as a patient. So what would the patient say about uh what would you say if you think stigmatizing is a worry?
SPEAKER_01I will try to normalize it in saying that this is a medical condition. No different than someone who has chronic asthma, no different than someone who has chronic diabetes. Um you wouldn't expect if you went to your primary care doctor and you're a diabetic and your A1C initially was like a 6.7 and then you know, after two months it went up to 6.9 or a seven. You wouldn't expect that your primary doctor would dismiss you or berade you and saying, you're not following the treatment, you're not doing what you're supposed to do.
SPEAKER_00Where are the ups and downs of medical conditions, ups and downs? And I feel that a person who's sought help two times or three times, it's okay. It might be the fifth time.
SPEAKER_01Absolutely.
SPEAKER_00The seventh time. Absolutely. And that's where I think parents, when they see their children suffering this, they will do it the hundredth time to help their loved one overcome an addiction or substance use disorder.
SPEAKER_02Absolutely.
SPEAKER_00And and it's that kind of faith that you can't always quit smoking the first time you try.
SPEAKER_02Right.
SPEAKER_00It could be the seventh time, but hallelujah, the seventh time you're now an ex-smoker for the rest of your life. And it took seven times. And I I had a patient I was treating, and he had a lot going on. A loss of a spouse, he had a serious medical condition, he was living with folks that weren't treating them well, and he had some obsessions about uh hand washing and other things. And he said, I'm not gonna seek help because no one could possibly understand my personal story.
SPEAKER_02Right.
SPEAKER_00And and um I didn't want to say, hey, the professionals out there have seen it all. Yeah, and and I felt, no, that probably wasn't the right wording. Yeah, but what how would you word that to the person who says, no one could possibly understand what I'm going through?
SPEAKER_01Again, normalizing the experience. And even I uh think that is also important, the peer navigator space. Yeah. There's many people who are, again, um also suffering with addiction. Again, addiction is a lifelong illness.
SPEAKER_00So this is these are folks who have gone through it and have had some success. Exactly. And they're peers. Exactly. They are undergoing the similar things that you're going to. I think what I ended up doing was saying respecting their uniqueness. Exactly. What you have is unique to you, but there are folks that care and help.
SPEAKER_01And have been through similar situations, probably even worse situations, and yet they've come to the other side and are taking this journey in recovery day by day.
SPEAKER_00So that's an important part. See the peers. And also the I said to the patient is you've come to the point of wanting help. Right. That's a huge step, I think, to come through with all that. Um you have a great team working with you. Tell me a little bit about your practice. I want to ask you a little bit about yourself and hobbies and things you like to do, but where's your where's your practice right now?
SPEAKER_01So I'm located in the Harrell Behavioral Health Center. Um, it's an outpatient practice. It's on the same campus grounds as the main hospital.
SPEAKER_00Like the regional. Okay.
SPEAKER_01So as myself, again, addiction medicine physician, but I cannot do the work that I am doing without the team that I have. We have psychiatrists, we have psychologists, we have therapists, a therapist who actually is trained specifically in addiction medicine or addiction treatment or addiction therapy, rather. Um these are all the people that I lean on because again, if you know anything about addiction, it's not just the addiction. Usually there's a lot of, again, underlying stressors that are. That might have led the person.
SPEAKER_00That might have led to self-treating and have that. And I think it's that sort of all-encompassing kind of approach. To me, it's it's very therapeutic.
SPEAKER_01Right. You're putting the patient in the best position for long-standing recovery.
SPEAKER_00Well, and have this expertise at Lakeland Regional Health right here in the community. I believe there's also some uh, you know, sites opening up in downtown Lakeland. Yes. What are some things that you like around in the area or some pastimes or hobbies that you like?
SPEAKER_01I love to be outdoors. I'm a new Floridian. I just moved in the last two, three years. You like the weather. I I love the weather. I love going to the beach, just spending time outdoors, really. Oh, terrific.
SPEAKER_00Well, there's a lot of that here too. But you know what I what I also like is the um just the conversation we're having today sounds very therapeutic and relaxing. Absolutely. At the Harrell Center uh for wellness um here at Lakeman Regional. I think that that's the kind of setting um I'm glad this facility is up and running and has been doing great for the last few years.
SPEAKER_01So it's been good. I'm happy to be there.
SPEAKER_00Excellent. Well, thanks so much. I look forward to talking to some more about other um uh issues that we could help in the community. Absolutely and I I appreciate everything that you do for us.
SPEAKER_01Thank you so much for having me.
SPEAKER_00Thank you. Take care.