The Strong MD | Episode 8

Tackling Substance Use Amongst Medical Pros with Michelle Hruska

Watch The Podcast

Dr. Jaime Seeman: Welcome to the Strong MD podcast. I’m your host, Dr. Jamie Seeman. On today’s episode, I’ll be sitting down with Michelle Haruska. Michelle has over 23 years of experience working in the field of mental health and substance use disorders. She has worked with children, adolescents and adults in a dual diagnosed treatment setting ranging from outpatient to residential treatment centers. She has provided alcohol substance use assessments and alcohol and substance use counseling for individuals, families and groups. Michelle is a licensed independent mental health practitioner and a licensed alcohol and drug counselor in the state of Nebraska. Michelle holds a BA in human services from the College of St. Mary and a master’s of science in community counseling from the University of Nebraska at Omaha. I hope you enjoy today’s episode. Michelle Haruska, welcome to the Strong MD podcast.

Michelle Hruska: Thank you for having me.

Dr. Jaime Seeman: It’s great to have you here today, and we’re going to have a super important discussion today, about addiction, about doctors, about the lives that we lead.

You work as a licensed independent mental health therapist and a counselor in drug addiction

But, I want you to kind of give the listeners a little bit about your background. You work as a licensed independent mental health therapist and also a counselor in drug abuse and addiction. Tell people what that really entails, and maybe a little bit about how you ever got into this as your passion.

Michelle Hruska: So, licensed independent mental health practitioner and licensed alcohol and drug counselor. So I’m what would be considered duly credentialed. So as a li MHP, we can work with drug and alcohol, but we like to have people that have that additional, training or experience. so that’s the licensed alcohol and drug counselor. I got into this field after I, lived by a foster home and had a neighbor, basically, that lived in that foster home who had been through the system. Drugs, and alcohol and, domestic violence. He grew up with that. And so I became a counselor, thinking I would be working in that part of the field more so with, domestic violence, but then got into working with alcohol and drugs more deeply and absolutely love it. so I’ve just continued my career now for 24 years now in drug and alcohol. so I really like that.

Dr. Jaime Seeman: And in your current job set up, you actually work with? Well, you haven’t worked with me yet, but hopefully I never make it to your office. Michelle. But now you work with doctors and healthcare professionals who are in need of your assistance. So tell us a little bit about what that looks like, because I think there’s probably some medical professionals that don’t even know services like this even exist.

Michelle Hruska: Absolutely. There’s a lot of healthcare professionals that don’t know we exist almost until it’s too late, until they have to have our services or need our services or are referred to. It’s the way Nebraska is. It’s a statute through, Nebraska that they have a licensee assistance program is the actual title, and that they have a licensed alcohol and drug counselor, as well as a mental health practitioner that facilitates that.

Dr. Jaime Seeman: So available to every doctor in every healthcare professional. Healthcare professional.

Michelle Hruska: So that includes anyone, of course, doctors, nurses, kind of what we think of healthcare professionals, but it also includes cosmetologists, estheticians, tattoo artists. So ones that anybody that has a Nebraska license that falls under that unit, credentialing, can access. Credentialing act.

Dr. Jaime Seeman: Is it free to them or is this paid?

Michelle Hruska: The drug and alcohol assessment itself is free. Our monitoring services are free. If we make any recommendations after you come in for the evaluation to have treatment or counseling, then that would be paid through either your insurance or private pay. We do not offer counseling or treatment as part of our program, but then I would monitor that. But all of those services that we specifically do are free.

Dr. Jaime Seeman: And you work for a health system here in Omaha, Nebraska, that provides, these type of services to their employees, is that right?

Michelle Hruska: So, I work for Methodist, and under Methodist is the employee assistance program. And the employee assistance program provides services for about 250 different companies throughout the United States. and then under kind of the AAP portion is my portion of the licensee assistance program. And so I can work with healthcare professionals for any agency or hospital throughout Nebraska.

Dr. Jaime Seeman: Is this unique to Nebraska, or if there’s somebody listening in another state, is there likely something like this in every state?

Michelle Hruska: Yes, every state has some sort of physician’s, ah, health program or professionals health program. There are, differences in ours compared with the majority of other states, such as we cover all of those professions. I mentioned there’s about 30 professions.

Dr. Jaime Seeman: That we, not all states cover.

Michelle Hruska: Correct?

Dr. Jaime Seeman: Everybody with a license. Correct.

Michelle Hruska: But Nebraska does most cover just kind of doctors, mds of any sort, nurses, dentists? trying to think of some of the. I think what most people, when we think of health care, what we think that to mean is what most states will cover. and they also, in other states, also cover mental health. So the difference with our program, the licensee assistance program, the way the state statute is written, is it can only cover drug and alcohol. So as a duly credentialed therapist that I mentioned, I have ever in my career, met a person who just has a drug and alcohol problem. there’s always something else that goes with it.

Doctors and dentists have some of the highest suicide rates amongst professionals

Dr. Jaime Seeman: So let’s talk about that. Why would such services exist if they weren’t being utilized, or if they weren’t needed and necessary when it comes to a healthcare professional? why is self care, how do we do self care for mental health and addiction? Why should a doctor listening even care? They’re like, no, I’m not addicted to anything.

Michelle Hruska: Because they’re the ones that have all that stress and burnout. And, especially, I know one of the things that we had mentioned, earlier is talking about medical students and fellows, residents, and the fact that particularly residents that have those long shifts where they’re not getting sleep, they’re not taking care of themselves, they’re not, being able to spend time with family and friends all of their time, is specifically, to their job, and as healthcare professionals, and I’m included in that as well. When I talked about the healthcare professionals, that includes licensed mental health practitioners as well, who we all should know exactly how to take care of ourselves, just as doctors should know how to take care of themselves. But we don’t. We’re always about, as healthcare professionals, taking care of our patients or our clients and putting forth all of our effort into that, that we forget that we have to have our own self care. and that leads to burnout, stress, compassion fatigue, depression, anxiety, substance use disorders over time, suicidal ideations that can all lead to, if we’re not taking care of ourselves, leads to those things.

Dr. Jaime Seeman: I’ve heard statistics that doctors and dentists have some of the highest suicide rates amongst professionals. Is that a real thing? Is that something I read on the Internet?

Michelle Hruska: It’s true. I don’t have a statistic particular number, but it is true. and anesthesiologists fall in that as well. for nursing, it would be your crnas fall into that higher suicidal rate as well.

Why do healthcare professionals not seek help? You mentioned that sometimes people don’t know

Dr. Jaime Seeman: Why do healthcare professionals not seek help? You mentioned that sometimes people don’t even know about your services until it’s too late. Why are they not seeking this type of service if they’re having an issue?

Michelle Hruska: I’d say probably the main thing that I see in my practice is stigma. Even mental health practitioners don’t come in for it because they’re. You’re a mental health practitioner, you should.

Dr. Jaime Seeman: Know you can’t have these problems.

Michelle Hruska: Yes. You should know how to get depression or anxiety.

Dr. Jaime Seeman: Right.

Michelle Hruska: but stigma is a big piece of that. There is one statistic that, I thought was very interesting that, I mean.

Dr. Jaime Seeman: Doctors are horrible patients. Let’s be really careful here. Yes, we joke about it, but it’s true to a point, too.

Michelle Hruska: And so are nurses. my husband’s an ICU nurse, and so I hear a lot just in talking with him about different things that make me think of things very differently than I probably would have if I didn’t have somebody in my life who was a practicing healthcare professional, in a hospital. but this was in October of 2020. The American College of Emergency physicians did a poll, and it was kind of small. It was 862 emergency department physicians. But of them, 73% said that they felt there was a stigma about seeking mental health treatment in their workplace. 57% of them reported they would be concerned for their job if they sought mental health treatment. That is what we see a lot of is that stigma, as well as, oh, my gosh, I might lose my license. what happens with my insurance? as you know, health doctors have to be, well, and other healthcare professionals, too, have to be covered by different insurance panels. So what if they find out, that I’ve gone to treatment or that I have problem with my alcohol use or my addiction to opiates? and so that’s a big piece of it. The fear of just their licensure piece, the fear of losing their jobs, fear of their family, too. What’s my family going to think? Because a lot of times they’re hiding it. and so that’s what I see.

Dr. Jaime Seeman: Yeah. I mean, I think that our biggest vulnerability is our medical license, because it’s our livelihood. And for many doctors, they may be providing for their family, their spouse may not work. I mean, I can totally see where that you feel like there’s a really large burden on you to be able to go to work and do your job. if you lose your license, you can’t work. And then, yeah, you’re right. Other things, medical malpractice, disability, and just the social stigma of this isn’t something that we talk about a lot. Around the water tank, around the coffee table. Is anybody feeling anxious today?

Michelle Hruska: Right. And a big piece of not talking. And that it’s been, for so many years, starting in med school, it’s pushed down and pushed down, and we don’t talk about it. And I wouldn’t even say, just say med school as a whole, people do not talk about it because it’s had this stigma. But I think within the healthcare profession, it is the fact that we kind of think that we should be able to handle all of it. We can help our patients. Why can’t we help ourselves? and one of the things that I have always thought about, too, is thinking about med school and then going into residency and kind of the superhuman I have to be everything to everybody, and if I can’t do that, then I’m a failure. So a lot of that, too, is people feel that they’re failures, which very negative thoughts. Not true, but very negative of themselves.

Dr. Jaime Seeman: because there’s prestige, and you’re distinguished. You’re a medical doctor. I mean, this is something that a lot of people do aspire to, and not a lot of people actually jump through the steps to do it. Right. And it’s financially a risk, too. We pay a lot of money to go through training, and you may have large debt to pay off. And that adds another layer of stress, financial stress, to an already difficult job.

Michelle Hruska: Yes, well, and the shame and guilt. So much shame and guilt. and I would say that’s a lot of what my clients will say. When they get to the point where they are feeling that they’re heading towards that recovery, they start talking about the shame and guilt, and that is a turning point for them, which is just amazing to see, because they can break that down. And many people that I’ve worked with end up doing trainings or sitting with, if they have a small practice or if they, are even a partner in a practice, they’ll do trainings with their other partners or even with their, nurses or pas, whomever they kind of have working with them. They will do trainings with them to help so that other people don’t feel the same way, so that if they’re having some problems, then they know they can step forward, too.

Dr. Jaime Seeman: And that’s incredible to use it for good.

Are there particular areas of medicine that see higher suicide rates

You mentioned that anesthesiologists, certified nurse anesthetists, had this higher rate of suicide. When we think about addiction, alcohol, drug addiction, abuse, whatever you call it, are there particular areas of medicine that do we see higher numbers? Like, I’m thinking of subspecialties. I’m an obgyn. is it the anesthesiologist? Is it surgeons? Is it one area that you see more than others, or is it kind of. Not really? Does it touch every little piece of medicine?

Michelle Hruska: So when I broke down, I did do some numbers, just kind of for my own knowledge, too, because I do it every day. So I don’t look at whom I’m all working with as individual people. Right. As individual, specialties. I look at, oh, you’re so and so, when I was thinking about doctors, the way that we break it down is we break it down by board, because I have to report back, not to the board on who’s seeing me, but who’s using our services. So that includes, podiatrists, pharmacy. This is kind of what I put down, or pharmacists, physical therapists, let’s see, optometry, dentists. medical surgical kind of. You would fall under, ob would fall under medical surgical kind, of one who doesn’t have like, a veterinarian who has their own kind of specialty or their own board, and so most of them fall under just that. Medical surgical, and pharmacist. And, then, of course, by anesthesiology, that is a big one, because of the access that they have to the opiates. And one of the things that we see, too, with healthcare professionals, particularly those that are in a doctor role, is I know how in nurses, too, I know how much I can give somebody and what it will do to them. So I know how much I can take myself to get the effect that I need. And so that’s why we see more with the anesthesiologist, with opiates and alcohol. And that was one thing, too. Alcohol and opioid use are our two highest.

Dr. Jaime Seeman: I was just about to ask, what are people addicted to when we talk about substance abuse?

Michelle Hruska: Yeah, alcohol and opiates, those are still our biggest ones. I have some stimulant use in there, and some sedative use, but pretty much alcohol is the number one. I, again, was looking at some numbers for myself and found out just in the last, when I looked at last year. So we do our contract with the state, which is who I’m actually, the licensee assistance program is contracted with them because they’re the ones who have to have it through the statute. and so from July 1 of 22 to June 30, of 23, of the 26 people that had a disorder, 14 of them were alcohol use disorder, 14% or not. Sorry. 53%. So 14 of them.

Dr. Jaime Seeman: Yeah.

Michelle Hruska: So that’s pretty high.

You and your husband gave up alcohol for a year to become sober

Dr. Jaime Seeman: I would love to talk about alcohol. So my husband and I, went on a. I hate to call it a sober journey or being sober curious, because we didn’t really have a problem. But, just working in the healthcare world, and I’m a huge advocate of preventative medicine, we decided to give up alcohol for a year. My father is a, recovering alcoholic, and so from October 1 of 22, to 23, we gave up alcohol for 365 days. And it was such an eye opening experience for us, really, just seeing the world, being able to go to social events, to go to fundraisers, to go to these different places where normally alcohol, I realized how pervasive it really is. I mean, you’re offered it on Friday night when you’re, out with the neighbors, and then you’re at dinner, the first thing they do is bring you the wine list, the cocktail list. Every fundraiser we ever went to was an open bar. We just didn’t realize how much we interacted with it. And although we didn’t have a problem with consuming, I have never in my life had to explain myself so many times. People are like, why aren’t you drinking? Are you sick? Are you pregnant? Do you have a problem? Did you get a DUI? It was like, wow, I’ve never had to explain myself so many times. So how can we use something like alcohol just so openly and so freely in society? and then you’re sitting here dealing with people where alcohol has absolutely ruined their life. So for somebody listening right now, how do they determine if they have a problem with using alcohol?

Michelle Hruska: I always tell people when things start happening in their life that they don’t like that. Could be arguments with family, could be arguments with significant others. When people start saying something to them that, hey, you seem like you had a lot more to drink last night than you’d usually do, or you’re progressively getting more, and when they start feeling that they’re looking at their life, this is kind of where people end up with me. So I’m kind of going to answer two questions, I think, they start looking at their life and they’re not feeling good about it. they might be getting, I wouldn’t say in trouble at work yet, but they’re coming to work late. they’re not feeling 100% when they get there. but prior to that, I think a lot of the people that I’ve worked with, when they finally get to that point again where they’re really looking at that sobriety, they’ll go back and say, you know, I told you that I think this is where I started having a problem. Well, now I’ve learned that, no, it was back here. It was when I would drive home from work at night and I would pass the gas station and go, oh, I should stop and pick up a bottle of wine or a twelve pack of beer. and not really thinking about some of those things or even like you mentioned, they start going to these events, and they determine that, wow, I’m drinking more each time I go to one of these events.

Dr. Jaime Seeman: It does seem to taste better when you’re not paying for it.

Michelle Hruska: Well, you are so right, too, that it’s just offered everywhere we go. And I think one of the things I’m wondering if you found out when you were not drinking for that year, also, is how many tv ads there are for alcohol, how many road signs you see driving down the road for alcohol.

Dr. Jaime Seeman: Yeah.

Michelle Hruska: it’s just amazing to me that it’s everywhere.

Dr. Jaime Seeman: Well, and when you think about, tobacco, for instance, the tobacco companies used physicians and doctors in their ad campaigns to sell tobacco and cigarettes. It’s pretty mind blowing when you think about the marketing and the ploy behind selling these substances. I mean, I don’t think we think of alcohol as addictive as nicotine and tobacco, but certainly it’s very pervasive. And m there are many people that cannot control their intake.

Michelle Hruska: Absolutely.

Dr. Jaime Seeman: Yeah.

What is actually reportable when someone comes to you drunk at work

so when people seek you out, I think something I would be wondering, when you say people are afraid of losing their license or just the ramifications, the stigma associated with it, what is actually reportable? When somebody comes to you and they’re like, oh, yeah, I’m showing up to work drunk. What is actually reportable?

Michelle Hruska: So, as far as just thinking about individuals. So you or I or any of us that have licenses, if we get a DUI or any alcohol or drug related charge of any kind, we have 30 days from the date of conviction. So not 30 days from when it happens. So oftentimes people will get a DUI, and maybe they’ll get diversion. As long as they complete their diversion, they never have to report that to the state medical to the state medical board because they have not been convicted of it.

Dr. Jaime Seeman: Got it.

Michelle Hruska: or any of the boards also. so that’s one thing. so any other types of reportable would be, any suspensions. If we’re suspended from our jobs for any reason, we have to report that. And if we’re terminated, we have to report that to all of the boards as well, again, both having 30 days, because our employer also has to report that within 30 days. As far as my job, when someone comes in to see me, I’d say there’s two times when I have to report. It’s a little bit more than that when you look at it as a whole. But the first time I have to report is if I have first hand knowledge that someone has gone to work under the influence and has actually practiced. I’ve had people who have maybe gone to work, but they haven’t clocked in. They haven’t seen any patients or done anything. They just have gotten there and have either been like, no, I can’t do this. This is the wrong thing to do. or somebody has stopped them. and so they’ve left. so if I know firsthand, and it has to be firsthand knowledge, I can’t have somebody call and say, hey, this person’s been drinking at work. Okay, you need to then go to your supervisor and tell them, the other time that I have to report is if someone’s involved in our program, they sign a compliancy agreement stating that they will follow the treatment recommendations and our monitoring agreement and whatever it is that we’re recommending that they do. So if they become non compliant with that treatment plan, and that can be things from not completing their counseling or treatment, whatever level of care we recommend. That could be not calling me and keeping in contact with me, not returning my phone calls. If I can’t talk to you, I don’t necessarily know what’s going on.

Dr. Jaime Seeman: What’s going on with you?

Michelle Hruska: not doing body fluid screens, continuing to test positive. That’s a question I get a lot is, if I relapse once, are you going to report me? I will not. I have been doing this for a very long time and realized that the recovery process is different for everybody. M and we have bumps along the way. Now, if you continue drinking or using, then at some point, yes, I do have to report that, but typically, what happens if someone has a relapse or a lapse? then I look at that and say, okay, what do we need to do? Do you need to go to a higher level of care? Do we need to increase your counseling? Do we need to increase meetings?

There are multiple levels of care available for people with addiction

there is something I would like to mention kind of while we’re kind of. This is a good spot for it. the licensee support group in Nebraska. It’s very, similar to what I would say a cadacious meeting is, but it’s open to all licensed healthcare professionals in Nebraska of all levels. Lots, of nurses, doctors, anesthesiologists, all the ones that we’ve kind of talked about in there. M it is offered here in Omaha. It’s actually at the Hope center, right behind, Methodist over there in children’s hospital. M on Tuesdays and Sundays. And then, it is also via Zoom, one of the good things that came out of COVID was we’ve been able to open, or they’ve been able. I’m not part of that, and you don’t have to be in our program to be in that. but it is open to everybody now because they don’t have to be able to drive to Omaha. and so that has been something that’s been wonderful for people to be able to meet up with other people that are in their same situation, that are healthcare professionals. And it really helps with that stigma and the shame that they feel that, oh, I’m not the only one. That’s probably one of the one things that people say to me. Pretty much everyone I’ve worked with, I have to be the only nurse who’s ever done this. I have to be the only doctor.

Dr. Jaime Seeman: Who’S ever done this.

Michelle Hruska: I’m sure I’m the only vet that’s done this, right. I guess fortunately or unfortunately, however you want to look at that, they’re not, I’ve always told people that I wish I did not have a job, and that healthcare workers and everybody did not have to deal with addiction, but unfortunately, I will always have a job.

Dr. Jaime Seeman: When somebody enters your program, I mean, program, you kind of said, it kind of depends what level of care they need. I’m just thinking to myself, I’m really busy, I don’t have time. Okay, fine. So, and so said, I have a problem now I’ve got to do this thing, this extra. What does that look like? Is it weekly? Is it multiple times per week? Is it once a month? I mean, what does it look like to go through a program like this if I’m looking for employee assistance?

Michelle Hruska: So as far as the, licensing assistance program, which is separate from the employee assistance, so make sure that’s clear. so as far as our program and working with healthcare professionals and drug and alcohol, there’s multiple different levels of care. So the basic would be our outpatient counseling, which is like one time a week that we kind of think of. When we think of counseling, we think of, oh, you’re going to a counselor. It’s usually one time a week. Week, intensive outpatient is three days a week, 3 hours a day. and the nice thing about that now is it used to always be in the evenings. Now there’s some during the days because we have nurses who work overnights and doctors too, who kind of depending on their on call schedule and things. So having that evening and day one is good. Then there’s, partial hospitalization that’s usually depending on the program. It’s usually five days a week, five to 6 hours a day, and then residential or inpatient, which we always think of as that, 28 days.

Dr. Jaime Seeman: What would require inpatient or residential treatment?

Michelle Hruska: So what I look for, there’s the diagnostic criteria, same as diagnosing somebody and kind of looking at what are their symptoms. so somebody who would need residential, typically is somebody who might need detox. I look at, are they drinking daily? What’s that look like? How much, are they having withdrawal symptoms? Is their tolerance higher?

Dr. Jaime Seeman: They’ve got some sort of physical dependency.

Michelle Hruska: Yes, very typical to have that physical. They don’t always have that physical, but most of the time. and so that’s where we look at, inpatient. The other time would be is if they’ve tried a lower level of care and haven’t been successful, then we would move somebody up to a residential or inpatient. And there is long term residential, which is usually 90 days to six months. we don’t have any of those here in this area. so most often you would have to go out of state for those.

Dr. Jaime Seeman: Does a spouse or a partner or a family ever play a part in their therapy and recovery?

Michelle Hruska: Oh, absolutely. at least that would be the goal. And so a lot of the treatment programs and facilities, if they’re inpatient, have family days, they have family counseling. And again, something, there are occasional things that came out of COVID that were good, and that is the ability to do zoom with your family, and be able to do those sessions that way so that they can be a part of it. I’ve had people that have gone to California for treatment, and their family’s here. So being able to include them, because when that person leaves that residential facility, they’re coming back here, they’re coming back to their family. And the stress and maybe the marital problems that were going on because of the drinking or the marital problems that were going on that led to the drinking, those things are still happening. that is very important. And especially with kids, too. Kids harbor a lot of anger towards their parents, when they’re drinking or using.

Dr. Jaime Seeman: When you dive into these sessions with people, of course you’re trying to figure out why do they have this problem in the first place. Right. And, certainly some of these substances are just naturally addictive, but I feel most people are probably using to get away or hide from some problem. Do you find that it’s more work related with physicians or do you find that it’s still, marriage issues, kid issues, or do you kind of think it’s split halfway?

Michelle Hruska: That’s a hard question. Yeah, because I think it would be splittorial. Correct. But I think that there’s something that makes it begin. And I see a lot of the family piece of it, particularly, with nurses, I guess would be the bigger one who have kind of the crazy schedules of the twelve hour shifts and the overnights. And really, how do you work an overnight shift, have three kids and still try to be a wife and a mom or dad? Wife, husband, and still maintain your own mental health and your own self care? And so I see that a lot. I would say with nursing, one of the things I think that I find different between male and female in nursing and with doctors is the compartmentalization. I’ve talked a lot, even with my husband about that because of when Covid was happening and well, and even now. But just the amount of death that was being seen and men were compartmentalizing that, which not always a good thing. It’s good probably in the moment. but then that, I think is when we look at the work side of it, I feel like that might be where we’re seeing more on the work side is that they’re not addressing how they feel about things that are happening at work around them. And it’s usually I think about a doctor having to talk to a family about some life changing diagnosis or, having to tell somebody that they have a few short weeks to live. That is not an easy thing to do. And so I feel just in my experience and what I’ve seen, ah, not only as in my profession or my position, but also in my own personal life with friends, that those are the types of things that I feel like lead to the work side of it, pushing towards the use as well as what you were talking about as well with going to functions and there being alcohol there.

Dr. Jaime Seeman: Yeah. You’re just exposed to it so much.

There’s a lot of burnout in medicine because patients are demanding

Yeah, I was really asking the question because I, notice a lot of my colleagues, there’s a lot of burnout and of course there is death and there is dying and there are cases that really weigh on our hearts and you kind of talked about the differences between men and women. But I think just medicine in general, it’s hard. We’re expected to see a lot of patients in a short amount of time and the patients are very demanding. And now we have these patient portal systems and there’s more administrative burden there’s so much clicking. So I was really trying to tease out, have we just created this hamster wheel for physicians that is really hard to create resiliency within? Or is it just that we’re busy professionals and it’s hard to maintain all aspects of our life sometimes when we’re not really taking care of ourselves.

Michelle Hruska: Combination. And I do agree with it with the. And you talked about the patient portal, and my thought with that is, I think patients, expect immediate results. And that goes too.

Dr. Jaime Seeman: It’s a double edged sword.

Michelle Hruska: Yes.

Dr. Jaime Seeman: It’s a fantastic way to communicate that saves us from being on the phone, but it allows people access, and, it certainly sometimes can get abused, in its own right, which leads, I.

I think overall, there is a high percentage rate of recovery

Michelle Hruska: Think, what you were talking to about the burnout, too, and the amount of patients I think about in the hospital setting, not only do you have the patient that you have to work with, then you have their family members, and your family members when you go home. My husband walks in at night, and my kids immediately are like, dad, dad. And it’s like, wow, he still has his coat on and his shoes on, and he still got his bag. He hasn’t even made it in the door yet.

Dr. Jaime Seeman: No time to decompress at all.

Michelle Hruska: Right. And that drive home, you’re trying not to think about work.

Dr. Jaime Seeman: when you deal with people, I mean, how often do people really recover? Or is there a large proportion that tend to kind of live in their addiction for the rest of time?

Michelle Hruska: It’s hard on my end because, you don’t know. I don’t get to know. So, with me, if someone is being investigated by the state or if they’ve had to report to the state at some point, the state will typically take over. so that might be they’re on probation. and so I see them, and then I don’t really necessarily know what happens to them. but, yes, I think overall, there is a high percentage rate of recovery. and it goes back to a little bit about what you talked about earlier, is that our profession and our licenses are so important that we lose those and everything changes for us. So people tend to know kind of that’s hanging over their. No, I won’t say hanging over their head, but it’s another reason for them to remain sober is that I want to continue to practice or I want to go back to practicing. And I think there is a high rate of recovery because of that. it’s a little harder to just go down the street and get a different job if you don’t have that license. and so they use that to their benefit to know that if I don’t stay sober, then I’m not going to be able to continue this. And then I think they just get to the point where, people that really look deep within themselves in their recovery find that person that they were looking for and that person that they were maybe before their addiction. I get a lot of response from people of, wow, I was always present at Christmas, but now I’m present. I was always there, but I never knew what was going on. And, wow, just the things that. The memories and all of that that I’m making now are so phenomenal. and they, I think, really focus on trying to remember those things that what was a good thing about getting sober? I’ve also had a lot of people tell me that I didn’t think I could have fun sober. So when people realize that they can have fun and they can do fun things and be fun with their family, and that helps them keep them in that sobriety, too. And meetings for some people, and there’s all sorts of different types of meetings, like, we require them to attend meetings. It doesn’t have to be aa. That might not be for you. There’s smart recovery, there’s social connection.

Dr. Jaime Seeman: Yes.

Michelle Hruska: There’s dharma recovery. There’s the licensee support group. Smart recovery is a big, know, there’s just so many out there now. Again, a positive thing with COVID became opening up all of those different types of meetings to people everywhere. I have people who attend meetings because of their schedule. They might go to a meeting that is actually based in a different country. but a meeting is meeting. When you’re looking at it that way, it is that social connection, and it doesn’t have to be physically in the same room together.

Do mental health disorders and substance use disorders coexist

Dr. Jaime Seeman: Do mental health disorders and abuse disorders tend to, coexist, or are they independent of each other?

Michelle Hruska: I’ve met people who have mental health disorders that don’t have a substance use disorder. But I can honestly say I do have never met anybody who has a substance use disorder that does not have some sort of underlying or primary mental health.

Dr. Jaime Seeman: Yeah. Does the mental health issue tend to precede the addiction and abuse of a substance?

Michelle Hruska: Typically, yes.

Dr. Jaime Seeman: Ah.

Michelle Hruska: I would say a high percentage of that. Just in my experience, too.

Dr. Jaime Seeman: Yeah. So how do I look out for my colleagues if I think that there is somebody in my clinic, in my office, maybe a nurse that I’ve interacted with, that I have some concern. What should I do. Do I approach them? Do I call someone, give me some advice?

Michelle Hruska: Sure. Absolutely. I guess it kind of depends on your role. if there is a manager, typically, what we tell people is to go to that person’s manager or director of nursing, whatever, type of manager, position, supervisor that oversees them. Right. And let them know that there’s a concern. What your concerns are. What have you seen now? if there’s an immediate where, maybe you’ve walked past the nurse and maybe you smell alcohol or. I get referrals from employers because they have an employee, maybe, who was swaying while they were walking or while they were talking, kind, of slurring their words or kind of having their eyes kind of at a slant or closed. So noticing those types of behaviors, things that are not typical of them, someone that’s not having, acting the way they normally would. then at that point, is your position as a physician in that clinic being able to say something to them? I think that would be an appropriate step for you. it’s really hard, though, because typically what’s going to happen is they are going to deny it. But we also tell people they can always call. HR can be a part of that as well. I work with a lot of people who have diverted drugs from work, and so a lot of times, HR is always involved in those, but there is also an investigator, if there’s a hospital setting, that’s involved, through the company, are you seeing less.

Dr. Jaime Seeman: I know from the physician side of it, we now have the prescription drug monitoring program. We have much different systems within the hospital as far as how very risky medications are dispensed, how they’re wasted. Are we seeing less of that with less access to these things, or are abuse addicts just getting smarter about procuring these things?

Michelle Hruska: I think we’re still seeing about the same, yeah. right. They find a way to do it. what I do find over time, though, is they stop being so careful. They kind of become careless. And as I’ve talked with people about that, they will say, I got to the point where I needed to get caught because I wouldn’t get help without it. So they’re still putting saline, if you’re wasting with somebody putting saline in the vial so it looks like, oh, you’re supposed to have two mls left. You have two mls left. so still being able to do that. a big one that we see is people giving, medication, and they go into the patient’s room and they’re like, no, I don’t really need my percocet or my hydro. I think I’m going to deny it for this. So instead of writing it down that they denied it, they will write that they actually gave the prescription, to the patient and then keep the medication.

Dr. Jaime Seeman: Yeah. Okay.

Michelle Hruska: Ah, I think it has helped catch things sooner by having all of those things in place. I don’t think we’re going so long without catching people, but I think it has not really changed the ability to do those things.

How often are people using street drugs or things outside of their system

Dr. Jaime Seeman: How often are people using street drugs or things that are outside of their system?

Michelle Hruska: I see that very rarely. I can’t even think of the last time, to be honest. unless they’re, I guess I can think of one person who was buying, fentanyl on the street, but other than that, again though, fentanyl. So, I mean, it’s still a medical, but you don’t have people that are using heroin. And occasionally I’ll have a cocaine, I guess I’ve, within the last year, had somebody with cocaine, but very rarely.

Dr. Jaime Seeman: We’re hearing so much about the opiate, the fentanyl addiction, and I’ve heard and seen tragedies from colleagues who get it from sources that you don’t know what you’re taking. And we’ve seen deaths and overdoses and narcans, we becoming more available, to the general population. But it’s, a scary time that we’re living in with some of these very powerful medicines in the hands of people who should not have them.

Michelle Hruska: Right. And the fentanyl being laced in other.

Dr. Jaime Seeman: Things, in marijuana, veterinary medicines, car fentanyl, all these types of things. do you have any good stories for us? I hate to be like doom and gloom, this whole podcast, I do. Can you tell us, obviously, don’t give us any information.

Michelle Hruska: so our program, a little bit, we require a year of monitoring, minimum, if anybody comes in with our program and we monitor them. I’ve had a couple people who have wanted to continue monitoring, just to kind of have that little extra knowing that, hey, if I have a problem, I can call Michelle. and those are fun in a way, because I get to see them over time. and I’ve had people that have celebrated five years with me and said, okay, I’m done, you need to cut me loose, you need to let me go. Okay, and people that have come in, and I think about how when I talk to them on the phone the first time, and then see them the first time, and I don’t typically see my people more than once. we do a lot of things by phone or over email, but, when they come in for the evaluation, which now I can do via telehealth, but, I might see them one time and be in their life for two years. and I think about that first or second time that I talk to them compared to maybe where they’re at now a year later. And I can hear it in their voice. I can tell the difference. And those are the things that keep me wanting to do what I’m doing. You have those positives, you have those people that are like, gosh, my life last year at this time, I recently had somebody tell me I didn’t care about the consequences a year ago. Now it’s not about the consequences. It’s about, I love my sobriety and I love my life, and I love that I can feel my feelings and that I don’t have to go drink every time I feel bad about something. I know how to deal with that now. And so those are the things that I love. And then I also love when I see someone that maybe lost their license, that I see it pop up, that they got their license back. I’m like, that’s awesome. because they’re doing what they need to do for themselves. We always say, need what you need to do, do what we tell to do, but I’m not telling you to do it because I need you to do it, or I want you to do it. I want you to do it for you so that you can have all of those positive things in your life again.

Dr. Jaime Seeman: Yeah. Do people leave medicine?

Michelle Hruska: I’ve had some people, and I would say, even before the pandemic, I had people that left, just because they knew that that was either their trigger, or if they worked around, I guess I should say, too, I’ve had people that have changed where maybe they were working in a hospital and had access to opiates and benzos and all of that, and maybe have changed to a different position to where maybe now they’re working in a clinic because they don’t want to have access to all of that, but they still want to practice. And, I see that a lot with nurses, too. A lot of that with nurses.

Dr. Jaime Seeman: You brought up the pandemic. Did you see higher rates of addiction and substance abuse through the pandemic?

Michelle Hruska: We did mostly with alcohol. Yeah, I would say that was the.

Dr. Jaime Seeman: Biggest home and in their four walls and, yeah. it was a tough year for a lot of different reasons.

Michelle Hruska: So many.

Dr. Jaime Seeman: Yeah.

Are there any good resources for people looking for help with alcohol addiction

Well, Michelle, this has been so wonderful for somebody listening. That’s not in Nebraska. Well, first, I guess, let’s talk about somebody who lives in Nebraska. How can they find you or the licensed assistance program?

Michelle Hruska: Absolutely. We have a website, it’s la pne. So lap Nebraska, basically, lapne.org. or they can just type in Nebraska licensee assistance program and our information will be there. calling me, I work a normal eight to 430 or 830 to five job, but definitely can leave messages, send emails, and get something set up if need be, or if they just have questions. I have a lot of employers that call and just say, like you were talking, what do I need to do in this situation? I have this employee and I don’t know what to do. and oftentimes I’ll try to get them to call me and people can call me and not ever give me their name, and I can work with them through just a phone call and try to get them in the right direction if they’re looking for something specific or if they have questions. Sometimes people are very afraid to come into our program because they know that piece of reporting to the licensure board is there. and I get that that would be very scary to know that that could happen. so I try to help people find other avenues if they need help. it doesn’t have to be through us, but yeah, on the Internet.

Dr. Jaime Seeman: And for people outside of Nebraska, are there any good resources? I mean, gosh, these days with social media and with the mean, we have so many things at our fingertips. Are there any good resources you can think of for people that might just be needing some help or, looking for more information?

Michelle Hruska: Oh, I think whatever you’re looking for, if you’re looking for opioid use disorder, if you type it in, so much will come up. You’re right, it’s amazing. I think the center for Disease Control has a lot of information, trying, to think of some of the other ones. Nida has lots of information out there. so I always try to tell, know, make sure it’s a good place. But you can also go to any addiction sites, like recovery places, and they always have information on, what to look for. they might have some tests out there. There’s online testing that you can do the mast, which is a screening test for alcohol, the dast for drugs, or those types of, assessments that you can do right there online that will help you determine sort of self assessment.

Dr. Jaime Seeman: Well, I can say that, through our one year of being alcohol free, we have seen the non alcoholic beverage market skyrocket. So some days I want to take total personal responsibility for that, that I made it cool or something like that. But it is true. We’re seeing more nonalcoholic beers. I just saw the other day some advertisement for non alcoholic seltzers. Really, I’m excited that we’re starting to offer these things that allow people to still kind of engage in social situations and still kind of be present in their life and not feel like, you got to order water.

Michelle Hruska: and you mentioned, too, that people were asking you, I think, for women, they immediately go to, oh, are you pregnant? Yeah, but men don’t have that.

Dr. Jaime Seeman: It’s like, oh, what happened?

Michelle Hruska: What did you do wrong that you’re not layer of stigma, and I should be able to walk around with the water or a Diet Coke or whatever and not have anybody ask me why I’m not having something alcoholic to drink.

Dr. Jaime Seeman: I got pretty savvy at, ordering club soda with a lime and nobody asked, but, I was amazed. And people sometimes would say too, oh, wow, I think I could do that for a month, but I could definitely not do that for a year.

Michelle Hruska: Right?

Dr. Jaime Seeman: And these are people that I would not identify as having a problem, but they fully admitted there is no way that they could cut that out for a year.

Michelle Hruska: Well, dry January. Everyone talks about having dry January and not drinking anything. And there’s people who struggle with that. I’ve had people that I know in my personal life that give it up for lent, and I think for some people, it’s their thought that if I can do it for Lent, then I must not have a problem. Or if I can do it for January, I must not have a problem. and maybe you don’t. I’m not saying everyone does, but you could still potentially have a problem, even though you can give it up for shorter periods of time.

Dr. Jaime Seeman: I thought it was a great experience to just kind of see, does it add value to my life? Does it take away value? And I was amazed what we got out of it. We could, we could still have fun. We still were able to vacation. We were able to really experience all the things that we experienced. And it was interesting what you said about somebody saying, like, they were more present at Christmas when they were sober or clean. my husband and I didn’t really drink heavily, but even one or two drinks, it was amazing how much it would affect us the next day when we have to be parents, and we have to be at the basketball games or be at places and just your brain working that, even if it’s 1% or 2% less. it was amazing to not ever feel that way and to just feel like, us all the time. That was an incredible feeling. So I think for anybody listening, if you’re, we’ll call it sober curious. I guess that’s the terminology. there are a ton of groups out there. There’s pages, there’s Instagram pages and Facebook pages with mocktails and all these things. And so I think it’s just something, if you’re interested in it, go explore it. even if you don’t think you have a problem, and if you do, for sure, reach out and find somebody that can help you.

Michelle Hruska: And I think something like that, too, gives people that don’t have a problem an idea of what it’s like for people who might have a problem to go to these functions. And I feel like it made you just feel more aware of how much it was around you, and you didn’t even really realize it. Think about someone having an addiction, and maybe they’re only 30 days sober, and they have to go to this event for work, and here’s all this alcohol. and then on top of that, you have people asking, well, why aren’t you drinking? Oh, here. Why don’t you have. Or directly handing it to them? So I work with people, too, just in phone calls. I talk to my people at least once a month, but some of them I talk to more frequently, and we talk about those things, especially as holidays are coming up, as, New Year’s, New Year’s, 4 July, St. Patrick’s Day, all of those ones. Memorial Day is another big one. And what can you do to keep yourself safe? So making sure that you bring your own drinks is bring your own car. Make sure you drive yourself so that if it gets too out of hand or you get to the point where you feel like you’re starting to feel triggered, you can. You can just get in your car and go. And you don’t have to worry about being under the influence driving home, you can just get in and go. because that is hard. It’s very hard. Or bringing someone with you that’s also sober, that’s part of your support group, and so that they can be there with you.

Dr. Jaime Seeman: Yeah. We tend to really mimic the behaviors of the people we hang out with. So sometimes it’s just finding friends that are doing really healthy things, and it’s tough, though.

Michelle Hruska: And those are the people that you know are your friends, too. Is that when they are not asking you why you’re not drinking, but they’re supporting it, they’re not teasing you about it, or they’re, know, handing it to you and say, oh, you can have one.

Dr. Jaime Seeman: Yeah. Find a tribe that supports you. M for sure.

Dr. Jamie Seeman: Thank you for listening to strong MD podcast

Well, Michelle, this is so wonderful. Thank you so much.

Michelle Hruska: Absolutely. I enjoyed this.

Dr. Jaime Seeman: Thank you so much for watching and listening to today’s episode of the strong MD podcast. If you’d like to find more information, you can find links in the episode description. Please make sure that you like and subscribe to this podcast so you guys will never miss an episode. I’m your host, Dr. Jamie Seeman, and I’ll see you on the next episode.