Thoughts on treating the rise of substance use disorders, addiction in Minnesota

Addiction is at an all-time high in the United States. During the COVID-19 pandemic, binge drinking increased by 21 percent and drug overdoses claimed more than 100,000 lives in a 12-month period.

Yesterday, MPR News shared “Substance Use & New Paths to Recovery,” a special broadcast from Call to Mind, American Public Media’s initiative to foster conversations about mental health.

In today’s follow-up episode, MPR News host Angela Davis talks with members of a Minnesota peer support network specifically for nurses struggling with substance use. And we’ll also hear from a group that is working to expand access to treatment using telehealth.

Guests:

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Carrie Kappel is co-chair of the board of Minnesota Nursing Peer Support Network. She is also the manager of operations and addiction services at Allina Health.
Peyton Pollard is a local ICU nurse and a convener for Minnesota Nursing Peer Support Network.
Chris McCalla is the CEO of Partners Behavioral Healthcare.

Here are five key moments from the conversation.

The following transcript has been edited for length and clarity. Click the audio player above to listen to the full conversation.

When you hear these numbers [about binge drinking and drug overdoses], what goes through your mind?

Carrie Kappel: We need more treatment; we need many more options available. We need harm-reduction options available. We need providers that have medication-assisted treatment, available options to prescribe medications. And we need to embrace and connect people to recovery. Addiction is a disease of isolation and separation. And often families even separate themselves from their loved ones because of the consequences and the actions of the person’s inactive disease. In recovery, it really is about connecting people, so that they don't feel so isolated.

Peyton Pollard: One of the organizations that our organization works a lot with is the nurse health professional services program. So if any healthcare provider in the state struggles with substance abuse issues, they have to work with them. Looking back at the pandemic, the increase in relapse from my friends and my circles in recovery, it's just been astronomical. It was really sad to lose so many people. When you get sober I don't think anyone really tells you about what you're gonna see. There are a lot of sad stories out there.

How was your situation and how were you able to be in recovery now?

Carrie Kappel: I didn't have something like the nurse’s peer support network when I got well and into recovery. I did my first go-round into recovery in 2001 and was sober for more than 4 or 5 years. But I relapsed with alcohol, which was not originally my drug of choice — opiates were my drug of choice. And for those of us with the disease of addiction, any mood-altering substance can either become addictive or we can return to our drug of choice. And so I went back into recovery in 2009 and did some really hard work looking at myself and my recovery, and the things that I needed to do to get well.

At work, many of my colleagues didn't know. My family noticed differences in my behavior, but they didn't know what was going on. Sometimes it's the elephant in the room and nobody wants to say anything, or they don't really know what's going on. We're afraid to make questions.

Peyton Pollard: I grew up deep south in Louisiana, and alcohol was my way to cope with life. I didn't have any other coping skills, and then I added this profession which is stressful and emotionally draining. It started out being manageable, and then eventually for a lot of people it becomes unmanageable. I got help from my family, a bunch of wonderful nurses, and a recovery surrounding me.

It's hard to look at yourself like this. We see alcoholics and addicts at work all the time, and we know the exact prescriptions, and everything you do to treat that, and yet we can't solve our own problems.

What do we need to know about medical assistance as part of treatment?

Carrie Kappel: “Medication-assisted treatment” is medications that assist with recovery. So those can be medications that, for instance, help people reduce the craving for alcohol. Those medications in themselves won't eliminate the disease but can help make it easier for someone trying to abstain from use and to get into recovery.

Peyton Pollard: I believe in a multimodal approach — that's how we do things in basically any phase of healthcare, any diagnosis. If you can get a hold and control the neurochemical aspects of addiction in the earliest stages, that can take a little bit of the burden off of someone that just got sober so it's not such a steep uphill climb the first stint of recovery, because that's kind of the hardest.

What is the level of need you are seeing right now for treatments and what are some of the barriers to accessing treatment?

Chris McCalla: The statistics are that roughly one in 10 people with a substance-use disorder are receiving treatment in the U.S. COVID has just increased what was already a significant problem. And so we're responding to about 10 percent of the need right now. And an underlying issue that I would like to bring to the table is that we're reaching 10 percent, but our staffing capabilities are stressed to the limit. Currently, there just are not enough Licensed Clinical Professionals.

Historically, there have been significant barriers to accessing effective services. Some of these might be single parents or caregivers with children, persons with disabilities, or even something like the cost of commuting to treatment, public transport, gas, and weather conditions. There are also mental health barriers, for instance, if you have generalized anxiety, the idea of sitting in a group of 16 people can just be overwhelming. A lot of people in smaller towns might have access to treatment in person but they don't want to necessarily go there yet. There are many barriers.

How has telehealth affected access to treatment for substance use disorders?

Chris McCalla: It’s a game changer. All of the barriers that I just listed are effectively removed with telehealth. We're at this pivotal time and it's different for all of the parties involved. Telehealth changes everything. My aim is to be accessible to every person in the state of Minnesota who needs or wants behavioral health services. So currently, as already pointed out in this show, it's really important to do integrated care.

Peyton Pollard: I think that's the way of the future. Basically, every facet of healthcare had to rely on telehealth when COVID started. I was going to my therapist via telehealth and that accessibility is just vital. It is used even in ICUs: You can have a camera on a sick patient, and doctors can direct a code or direct advanced care from another location.

Carrie Kappel: COVID pushed us to look at virtual options. We weren't using virtual meetings prior to that, but now one of our largest meetings is an entirely virtual meeting through a platform called Intherooms.com. We started originally as a six-month pilot to determine whether it was going to be an effective way to reach nurses in outstate Minnesota that we couldn't reach by in-person meetings. We now have 80 to 100 nurses that attend that meeting every week and they are from around the world.

Your stories

Listeners called into the show and shared their stories. Here are some of them.

John from Grand Rapids

Throughout my life, I've dealt with pretty serious addictions to opiates, cocaine and to alcohol quite a bit. I've had long periods of sobriety and I've functioned as an active user. I worked as a minister for years and was doing drugs and alcohol on and off throughout that. There were some times when I got pretty bad and I continued to do it.

I tried a bunch of different ways to get sober, with some success, and then it wouldn't work. In 2020, I lost my job, my mother died and my 13-year relationship fell apart. These are not excuses but I went off. It was a lot. I relapsed really hard and I was trying to commit suicide.

I finally started going to AA and I think it's really awesome that I get to do this because I see people from all different walks of life, different income brackets, different colors, and different religious and political beliefs that maybe wouldn't hang out with each other, but share this common ailment.

Anthony from Eveleth

I've been in recovery for over 5 years and sober for over five now and I just wanted to put a couple of thoughts in for recovery in nursing in particular. The aspect of Big Pharma and anti-anxiety meds such as Xanax or Klonopin, and benzodiazepines, affecting drinking and relapse rates.

Also, the new treatment modalities of using medicated assisted treatment which utilizes medications that stabilize people to get them sober enough so they can work on their mental health issues or other issues surrounding their addiction.

For opioid use disorder, I know in Duluth, they do suboxone and methadone, but it seems like just a quick fix to get people out the door and not treat the mental health aspect and the emotional and family aspect of it.

Anne from Edina

I've been an ICU nurse for about 30 years and I myself have never been addicted to drugs. But in my career, I've seen three nurses go down that path. And all of them, I was surprised and shocked to hear it.

One of the male nurses was discovered to be using substances at work, and he wasn't fired, he was put into treatment, and was relocated to a department that would give him no exposure to narcotics. And in the other two cases, it was two female nurses who, at work, were taken down to the emergency room, blood tested, tested positive for narcotics and both were fired.

One of the nurses was outed by a fellow nurse and she was almost villainized, for having outed this other nurse for using narcotics. I think if you suspect that, you'd probably need to report it, because you can't have someone altered providing care for a critically ill patient.