About the Episode

Sarah Wakeman, MD, is an addiction medicine specialist at Mass General and a national thought leader in treatment for substance use disorders. As the medical director for the hospital's Substance Use Disorders Initiative, she is committed to changing how addiction is understood by the public and how it is treated at Mass General.

About Dr. Wakeman

In addition to serving as the medical director of the Substance Use Disorders Initiative at Mass General, Sarah Wakeman, MD, leads the Addiction Consult Team, co-chairs the Opioid Task Force and is clinical lead for the Partners Healthcare Substance Use Disorder Initiative. She is also an assistant professor in medicine at Harvard Medical School.

Dr. Wakeman’s clinical interest and expertise is in the care of patients with addiction within general medical settings. Clinically, she provides primary care and office-based addiction care, as well as inpatient specialty consultation for addiction. She teaches locally, regionally and nationally about addiction and has led workshops and delivered symposia at national conferences. She was appointed by Governor Charlie Baker to serve on his opioid addiction working group and is secretary for the Massachusetts Society of Addiction Medicine and chair of the group’s policy committee.

She also conducts research devoted to physician preparedness and attitudes related to addiction and evaluating the impact of the addiction consultation on addiction severity, health care costs and utilization.

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Q1: Joining me today in this discussion, I have Aswita Tan-McGrory, who is the Deputy Director of the Disparities Solution Center, and the two of us are speaking today with Sarah Wakeman, who is a doctor here at Mass General. So, welcome Sarah.

A: Thank you. Thanks for having me.

Q1: Can you talk a little bit about who you are, and what you do here at the hospital?

A: Sure. So, I’m a general internist, meaning I provide general medical care, both in an outpatient and inpatient setting, and I’m also an addiction medicine specialist, so I provide care for people struggling with substance use disorder, or addiction, both in one of our community health centers, and then I run our inpatient Addiction Consult Team here at the hospital.

So, that’s my clinical work. Administratively, I help oversee, and implement a program that we call the Substance Use Disorder Initiative, which has been an effort to redesign care for people with substance use disorders across the entire hospital system.

Q1: You mentioned the inpatient consult program. What does that mean?

A: As many people probably know, if you get hospitalized for any reason, if you have a more specialized medical problem, so, let’s say you have a massive heart attack, you will see a team of specialized doctors, cardiologists in the case of having a heart attack. Yet for a long time, and still across most hospitals, there is no specialty team for patients suffering from addiction. And so, often when people came into the hospital, we would treat the complications of untreated addiction. So, we might treat their infection from injecting heroin use, or take them to surgery from some complication of their drug use. But we often did very little to actually address the reason why they were having these medical problems, which is their untreated addiction. And so, part of our effort that began in 2014, was to start an Inpatient Addiction Consult Team, so that a patient can see a team of specialists for their addiction problem in the same way that they would see a cardiologist, or an infectious disease specialist. It allows us to really utilize the hospitalization as sort of a reachable moment, a time when we can really connect with patients, and actually start treatment in the hospital bed.

Q1: And you also mentioned the Substance Use Disorders Initiative. And that’s a big, long name. What does that mean?

A: Yeah. So, that is this broad effort that began in 2014. It came out of the hospital’s strategic planning process, so the hospital, like many businesses, every ten years or so, comes up with a plan for what areas they’re going to focus on. MGH is really unique among academic medical centers, because community is an explicit part of our mission. So, many hospitals have a three-part mission of clinical care, research, and education. MGH added community to be an explicit part of that.

Because of that, when we started the strategic planning process, community actually had a seat at the table. And so, that group really looked to our community members to ask them what was it they thought that the hospital should focus on in the coming ten years? And so, they looked to these assessments we do in the community of getting feedback from community members in the areas that we serve, and in 2012, long before the headlines were full of news of the overdose crisis, 75 percent of our community members said substance use was the most important issue in their community, more than crime, or public safety, or housing, or employment, or other health issues. So, it’s very clear what the community thought the hospital should focus on. As many people probably know, thankfully the health care system is beginning to think about how to keep people out of the hospital, and keep them healthy, and that that is, first of all, it makes a lot sense from a cost perspective, and obviously, it’s in the best interests of the patient. And when we looked at people with substance use disorder, who got admitted to the hospital, they actually stayed longer than expected, and they got readmitted more frequently than expected. And so, that really paints a picture of sort of the opposite of value in health care. We’re spending a lot of money on a vulnerable patient population that was only getting sicker.

And so, because of those two reasons, the hospital really recognized not only is this the right thing to do, but it’s actually the smart thing to do from a financial perspective, too. And so, that led to what we call the Substance Use Disorder Initiative, which really was this effort to look across our entire system at every touchpoint with the health care system the patients have, and to think about how do we do a better job of delivering evidence-based addiction treatment in the moment when a patient is coming to see us. So, that could be in the primary care setting; it could be in the hospital bed with our consult team; it could be in the emergency room, or it could be in the obstetrics office when someone is coming pregnant, so we’ve begun this system-wide approach under that umbrella.

Q2: And you know I think this is very similar to some of the challenges that we see in addressing racial and ethnic disparities in health care, sort of this not treating the whole patient, right? If the patient has a lot of chronic disease conditions, multiple comorbidities, and then they come in for one thing, but they’re not actually being treated for everything else that’s going on.
So, it’s really wonderful that you’ve been able to lead this effort to integrate this more. What do you think has been some of the resistance to people really wanting to deal with the substance abuse issue in the health care space?

A: Yeah. So, a couple of things. First, just to play off what you said, I think that’s absolutely true. Historically, addiction has been something that’s seen as outside of the health care system, much like racial disparities, or other inequities. It’s not something that physicians have been well-trained to address, or to treat, or nurses or any other health care providers. And I think often it’s sort of a human nature thing that if you’re facing a really daunting problem, and you feel like you don’t have the tools to manage it, we tend to either avoid it, or even worse, sometimes we blame the patient, or the person. We think this is their fault. It’s an issue of bad behavior, or bad choices. And that’s how we as a society have approached people who use drugs, that we have thought of it as a social problem, or criminal justice issue for really 100 years across this country. And there’s a lot of history of racism, and how that came to be, and what our drug policy looks like across the country.

So, undoing that, physicians/health care providers are people, too. They’re influenced by all the same societal stigmas everyone else is. And, in particular, when there’s an absence of knowledge, or training, many health care providers don’t have much more knowledge about addiction than the average layperson. And so, a lot of our efforts has been around education and training, and I think this kind of two-part approach of, one, having huge support from leadership, so having the president of the hospital say, “This is our number one priority; this matters,” obviously goes a long way. But you can’t just say, “Someone has to do something,” or, “It’s important,” unless you provide them the tools for how to actually address it.

And so, our effort on the ground has been: How do we actually give the frontline staff – primary care doctors and nurses, medical assistants, front desk staff – the tools to feel like this is something that they can actually address? And some of that is just simple education. A lot of people, for example, think that addiction is untreatable, or that it’s a bad prognosis illness.

In fact, addiction is a really good prognosis illness. Most people with heroin addiction will get better, and will live long lives in recovery. And that’s not the image any of us have of what we see in the media, or read in the newspaper, or see in our emergency rooms, because we only see the patients that seem to keep coming back and getting sicker and sicker. So, I’d say that kind of combination of leadership support, on the ground kind of skills building and tools. And then bringing back kind of that voice of optimism. So, we do a lot with having patients in recovery actually come back and share their story. And I think reminding people of that sort of message of hope of actually this is something you can do something about, and it’s actually inspiring, and rewarding to be a part of this has also gone a long way.

Q2: You know, it’s interesting because my brother struggled with addiction for probably the last 20-30 years, and he’s heading towards his fifties, and it’s been interesting sort of to know what the health care system is like, because I work in it, but then also to see it from a personal side, the lack of help that’s available, because really the only time he went to rehab is when he was picked up by the criminal justice system, and then they assigned him to rehab. So, you know, I love the work that you’re doing to sort of put a more human face to this, and to see it as something that we can treat, rather as something that we should persecute people for, and penalize them for.

A: Yeah, absolutely. I think too many people across the country have stories like that, where they received little to no help from the health system. Even now as we talk about addiction as being a public health issue, or this being an epidemic, or a crisis, we still lock people in prison for drug use. So, there’s a bit of a tension between how, I think, we want to act, and how we’ve historically acted. And there’s also this mismatch where we make it really easy for people to stay sick. You can get heroin 24 x 7; you can order it on your cell phone. It’s immediately available. There’s no wait time to get heroin. And yet, if you want to get into treatment, many people have no idea where to turn. If they lucky they find a place where they have to get on a waiting list. They’re hopeful their insurance will cover it. Then they may get kicked out, because they don’t follow some sort of rule. So, we make it really, really hard for people to get well. So, part of our goal has been how do you drop those barriers, and actually make treatment the easy choice, not the hard choice, and really welcome people into care, rather than making it difficult for them to come in?

Q2: Yeah. There’s a lot of barriers. If you don’t have the resources, then getting help is really difficult, and it’s not just interventions for the patient, but also the family, which oftentimes doesn’t happen.

A: And that’s actually another effort we’ve been doing in our health centers is to actually train our behavioral health staff to learn evidence-based models to help families, because there’s actually ways that you can support families that are suffering, too, when they have a loved one who’s affected by substance use disorder. I think recognizing the toll it takes not just on the person, but the whole family unit is crucial.

Q1: So, can you – you’ve mentioned a few times this idea of evidence-based medicine. What does that mean?

A: Yes. Evidence-based medicine is what we practice in every other area of medicine, but often don’t talk about, because it’s sort of assumed, which means that the care that we deliver is based on what’s been shown to work in science. So, back in the day doctors believed in evil humors, and bile, and lots of things that weren’t necessarily based in science. And we’ve made huge advances over the last centuries, where we really understand the pathophysiologic basis of disease. We have rigorous clinical trials showing us what treatments work, and what clinical outcomes we should be targeting. And then, we translate that into the actual care that people receive at the bedside, or in the primary care doctor’s office. In addiction the challenge has been – there’s actually a lot of research out there. There have been decades of studies showing us what works, and what doesn’t work. And yet, very little about it has been translated into what people actually receive when they walk into a place asking for care. And much of what gets called treatment in the addiction world is actually driven by people’s opinion, or by ideology, or belief systems, and is not really based on science.

Q1: Sort of the tradition of the way it’s been done –

A: Yeah.

Q1: – for years and years, and –

A: Yep. And lots of – you know, I think people are probably familiar with lots of kind of clichéd sayings that are said around addiction, like, “Well, patients have to hit bottom” that we want to wait for them to get terribly ill before we offer them help, and that’s ridiculous. We would never say to a cancer patient, “You have to hit bottom before we’re going to offer you chemotherapy.” We actually want to identify people early, and start treatment early, or this idea of tough love that somehow if we just punish people, and make it harder on them they’re going to get well. And yet the definition of addiction is compulsively using a substance despite bad things happening to you. So, making more bad things happen to that person is probably not going to help them get well, and in fact, when substance use is a coping skill, and is one thing that’s always worked for people when they’re in times of stress. If you throw someone in prison, and you take their job away; you take their kids away, they’re probably going to be more likely to use substances, not less likely. And so, there’s been this really backwards approach to how we’ve thought about caring for people with this illness.

Q1: So, when it comes to addiction, what are those evidence-based approaches?

A: Yes. I, particularly as an internist, I think of addiction treatment as very similar to other chronic disease management. So, diabetes, I think, is a really great example, where first when you think about the risk factor for getting diabetes, it’s about half based on the genes you’re born with, and then half based on environment, or lifestyle, or behavioral choices, so, things like diet, and exercise, and what food you have access to, and your socioeconomic status, and where you live, these kind of environmental pieces. Addiction is very similar. It’s about 50% based on your genes, so you can’t change that component, and then 50% based on environmental exposure.

So, for example, adverse childhood experiences are hugely predictive of developing a substance use disorder. Having a co-occurring psychiatric illness that’s untreated, and being around peers who use drugs, or the age at which you’re first exposed to drug use. All of those things, then, increase or decrease that person’s risk. So, the sort of basis of the disease is very similar, and then treatment is very similar. So, some people with diabetes, they can simply change their lifestyle, or their behavior, and get their illness under control through kind of behavioral interventions, like diet and exercise. Other people can try just as hard, and no matter how badly they want to get better, they need to be on medication to get better. And we make those things equally available, and we don’t judge people for which type of treatment they need. With addiction, with opioid use disorder, alcohol use disorder, and tobacco use disorder, we have highly effective medications, and people do better if they’re on medication treatment. That doesn’t mean everyone needs to be on it, but it is the most effective treatment we have, and yet there’s a ton of stigma and misunderstanding about the idea of medication treatment and addiction. And I think people have a really hard time getting over this idea of using a drug to treat drug addiction. And again, when we think back to sort of our ideology, and kind of the common phrases that people are used to, that’s not a framework that people have heard about. And so, undoing some of that stigma, and helping people understand what does the science show, and how do we make sure that all evidence-based options are available to people, and then that care is tailored to the individual personl.

Q1: So, I think as I said before, and you’ve mentioned a few times, this comparison to other sicknesses, or other illnesses that people are more familiar with, and that are a little more neutral, one might say, is helpful, and really hopeful, because if you think about addiction, or heart disease there’s things you can do, and we have not cures, maybe, but treatments. Is there a world, do you see where we could think about sort of pre-addiction the way we think about pre-diabetic?

A: First, just to point out, I think one misperception is that everyone who uses a drug will develop addiction, or particularly drugs like heroin. The reality is a minority of people who use drugs ever develop addiction, so even when we look at heroin, only 25% of people who use heroin ever develop addiction. So, that’s not something we talk about much, so that’s really important. So, when you think about the umbrella of kind of people who use drugs, or people use substances, there is a tiny fraction that have addiction. There are many other people who don’t. There can still be health-related risk to people who don’t have addiction. So, you can think about with alcohol, someone can still get into a car accident while driving while intoxicated, even if they don’t have an alcohol use disorder. So, there can be trauma; there can be other risks that come along with that. So, the overall kind of health impact is more broad.

So, amongst people who are using any drugs, obviously being exposed to a substance increases the likelihood that you’ll develop a substance use disorder, because if you’re never exposed you never will. So, simply screening for substance use is a very easy thing that can be done in primary care settings, and emergency rooms, and hospitals, and it also over time, I think it takes time, can normalize it. We may get like vital signs, or like any other questions that we ask that this is a part of your health care, and we’re asking not because we’re judging you, or not because we’re going to punish you, but simply because we want to make sure we’re taking care of your comprehensive health needs. So, that’s one easy thing that can be done in a health care setting.

Just to note, I think, we talked a lot about kind of stigma and bias. It’s a tall order to ask people to be honest with you about their drug use, particularly when the reaction, again, in most of our society if you’re honest about your drug use is that something bad happens to you. You lose your job; you lose your kids; you go to prison; you violate your parole; your family kicks you out. So, to ask to have a person trust a total stranger to be totally honest is a lot to ask, so oftentimes I’ll have doctors say to me, “My patient lied to me. They told me they weren’t using, and then their toxicology was positive.” And there are many factors there. First, of course people lie. I lie when I go to the dentist. I say I floss all the time, and I don’t, but I want the dentist to like me, and approve of me. So, there’s many reasons why we say things, and then understanding the context around drug policy and responses toward drug use in this country, particularly from marginalized populations, communities of color where our war on drugs our response has been to incarcerate people and do really terrible things in response to that. So, building up that trust over time, I think, is really important.

The other piece is a little bit trickier in sort of the pre-addiction state, which is really identifying some of the risk factors that are outside of exposure, so things like adverse childhood experiences. There actually is a screening test called the “ACES,” Adverse Childhood Experience, where it’s high predictive, the number of adverse childhood experiences you have off that survey is highly predictive of developing a substance use disorder later in life. The problem is it’s really hard to know what to do for a person in that moment, and I think our – we kind of alluded to this – but our health system, traditionally, hasn’t been equipped, or necessarily wanted to ask those questions, or known what to do to respond to respond to them. So, I think as we begin to think about sort of the bigger picture of people, and the worlds that they inhabit as we think about how to help people stay healthy, addressing those early childhood factors is probably more important than screening for substance use.

Q1: That’s incredible. So, we can figure out kind of who, but then not what we do next?

A: Yeah, yeah.

Q1: Earlier you mentioned the media, and these images we get from the media, and there’s a stigma, and those are so entrenched, and how do we, or how do you approach fighting back against that, or changing that perception?

A: One is to work with media. I recently spoke at the National Press Foundation to a group of journalist fellows about language, and reporting on substance use disorder, so I think that’s hugely important. The AP stylebook guidelines actually changed recently –

Q2: Oh, really?

Q1: – to update what sort of language journalists should use. It hasn’t yet been translated into what we always see in the press, but in particular the idea is to get away from terms like “addict,” which really labels the person as their illness. So, we don’t say “the breast cancer,” or “the heart attack,” we would say, “A person who has breast cancer,” or, “A person who had a heart attack.” And so, the idea that people are people first, and they may have an illness, but it doesn’t define them. And then other terms like “abuse” or “abuser,” which is frequently used – the term “abuse” actually comes from a word that means “a willful act of misconduct,” and it’s used for things like domestic abuse, or child abuse, or sexual abuse, these like terrible violent acts of willful commission, and no other medical conditions do we use that sort of language for.

And it sounds maybe like this is just kind of politically correct, or an issue of semantics, but actually one of our researchers here did a really interesting study, where he took highly trained clinicians – a PhD or master’s level therapist – and he gave them a description of a patient, and the only thing he changed was the “substance abuser,” or “person with substance use disorder.” And the clinicians who read about a person described as a “substance abuser” were more likely to recommend punishing treatment. So, it actually influences the way we think, the way we make judgments, and actually the clinical decisions we make. And they’ve done similar studies with the public, that if you describe a person as a drug addict, versus a person with drug use disorder, the people in the public have more stigmatizing views of that individual. So, beginning to think about how we can change language to fight against some of the stigma, and increase awareness is important.

Q2: So, this is really about unconscious bias, right? Because people have an unconscious bias to certain terms that we use, and consequently that affects the kind of care that they might get.

A: Yeah, absolutely, and I think we have so much to learn from other fields that are much further in thinking about unconscious bias, and also other examples in the past of conditions that were much more stigmatized. So, if we think about many mental health conditions, we used to call people “lunatics,” or “hysterics.” We would never use language like that today. We would say, “A say person with bipolar disorder,” or, you know, “A person with schizophrenia.” Or even if you think about HIV AIDS, where early on it was referred to in newspaper headlines as the “gay plague.” Again, we would never use terminology like that, and part of the importance of sort of advances in care, and also undoing the stigma has been thinking about language, and how we change the language we use.

Q2: Do you think that’s a signal that we are making some progress in this field when you see that progression from the initial ways that we describe people or patients, and then change that, because we realize like if we call them that, then we’re messaging a certain thing, which can lead to different kinds of treatments.

A: Absolutely, and the fact that we have things like the AP style guidebook that is changing its language. The White House Office of National Drug Control Policy under Obama put out a position paper on language and addiction. So, it’s beginning to make its way up into more mainstream recognition of the importance of language. And so, I think that’s really a positive development.

Q1: I think putting it in context, as well. Like we would never call someone “a heart attack,” or you know, when we use “abuse” it really is this violation of a person, and when you stop to think about it, it really means something.

A: Yeah, absolutely. And I think Aswita is right that most people don’t intend to say something stigmatizing. They just simply don’t know, and so a lot of it is around just calling people’s attention to that, and the importance of words.

Q1: I’m curious, you talked a little bit about a lot of doctors don’t know a lot about treating addiction, and what to do with these patients, and there aren’t a lot of people specializing in that. So, how did you end up in this niche?

A: So, I think I was always sort of interested in caring for vulnerable patient populations. When I was in medical school, early on I was interested in doing global health work, and focusing on HIV and infectious disease work. And then the summer between my first and second year of med school, I did a National Health Service Corps summer internship, where you have the opportunity to work in underserved populations for the summer, and one of the choices was the state prison in Rhode Island. I went to Brown for medical school. And so, I was in the state prison for the summer, working in the HIV clinic, and I went there initially just interested in HIV, and found very quickly that literally every person, and every patient that I saw had a history of a substance use disorder. And also, really, kind of burst open my own preconceived notions about what it took to end up in the criminal justice system. You know, the vast majority of people that I met were victims, themselves, of trauma, of poverty, of really terrible circumstances in their own life of mental health conditions of addiction. So, I got increasingly interested in it, and throughout medical school got more and more involved in the prison system, and in caring for people with addiction.

And then still came, actually, to Mass General thinking I wanted to do infectious disease, but then I would sort of focus on addiction. And then, throughout being here my clinical practice was in one of our health centers in Charlestown, where a lot of the primary care doctors have been deeply committed to caring for people with substance use disorder for decades, really.

And it also felt like an area where there’s an opportunity to make a real difference. We have a lot of tremendously well-trained infectious disease specialists and HIV doctors across the country, and across the globe, and yet very few people that focus on addiction medicine. And so, over time that became more and more the place that I wanted to focus my attention.

Q2: I think you’re really trying to change the face of this disease. So what’s the biggest challenge for you, as you’re working within MGH, just trying to change this perception, and the fact that we’re an institution that have been doing things for a very long time, very supportive, but as within our own work there’s always challenges to getting people on board, and seeing this, this new lens of how to treat addiction?

A: Yeah. I think – and it’s a great question – I think when I – our experience of kind of working with people across the system, and providers, there tend to be kind of three camps: There’s people that are already kind of passionate and interested in this area, and there are many people who have been working in addiction for much longer than I at Mass General, who are deeply committed to this work. There are people that haven’t really thought that much about it, and once you start educating them, and talking about the issue, and providing tools, they’re very engaged, but wouldn’t have come to it on their own. And then there are folks that are resistant, and I think that’s true everywhere, and sometimes that’s because of misunderstanding or stigma; sometimes that’s because of other barriers. It can often be perceived as you’re asking me to do one more thing. I’m already really busy. This is way outside of the field of what I consider to be an area that I focus on, and I can’t take on something additional.

But another barrier can be many people themselves have had experiences with loved ones who’ve had a history of addiction. And as we kind of touched on briefly, it’s really hard to be a family member of someone who’s struggling with active addiction. And for some people that can channel into a lot of empathy and compassion for other people in that position, and for other people they may have had really terrible experiences in their own life, and it can be hard to feel that sort of empathy for a patient.

And so, I think there’s lots of nuances in how we address this. I think our biggest effort around the stigma piece has, one, been increasing awareness for the folks that just haven’t thought much about it, and increasing the sense that we can do something. But the other has been really spreading this message of hope, countering the kind of common area that if people don’t get better that they stay sick, that the images of people dying, or injecting in public are all of these kind of – what people see in the newspaper. With this message of hope and recovery, and inhumanity because there’s that saying that it’s hard to hate up close. I think when you bring the person into it that this is a person; these are your patients that you’re already taking care of. This is not some stranger. This is the person that you see already for their diabetes care, and we’re simply trying to take better care of them. And I think framing it that way sometimes can help.

Q2: And we live in a society that still firmly believes in “pull yourself up by the bootstraps.” And so, that sort of doesn’t align very well with what may be the root causes of addiction. A lot of it’s about trauma. And so, people think oftentimes that this is a personal choice that there isn’t something that happened earlier on in childhood that led up to this.

A: I think one useful strategy we use a lot is comparing it to other illnesses. So framing it that way, and showing some of the science, like some of the imaging of the brain that we can show, literally, that someone’s brain gets affected, and so, asking that brain that is injured by an illness to just choose to get better, would be like asking a heart that’s had a heart attack to just pump harder. You can’t willfully choose part of your body that’s sick to do something that it’s not able to do. And so, I think those kinds of metaphors can help, because many people know someone with diabetes, or know someone with heart disease. It kind of frames it in a different way.

Q1: Something I’m really curious to ask you about: So, you are fairly early on in your medical career. You’ve been out of training a few years now, yet you’re leading this really big initiative at a really big organization. What has that experience been like?

A: So, I finished residency in 2012, so six years ago. I trained here at MGH, so I think I’m incredibly fortunate to have had the opportunity to join this initiative so early on in my career, and be a part of leading it. And of course, that comes with great opportunity, and also some challenges. I’m a relatively young woman, which of course, in many field, and medicine included, is something that can be a barrier. It’s just worth acknowledging. I also have a two-year-old, so I’ve got other priorities in my life in addition to thinking about our Substance Use Disorder Initiative, and my husband’s a physician, so I’m kind of juggling all those things.
I think I’ve had really tremendous support here, which has allowed me to be in the role that I’m in. Our two administrative leaders of the initiative, Joy Rosen, who’s the Vice President of Behavioral Health, and Joan Quinlan, who’s the Vice President of Community Health are obviously both women, both total powerhouses, really supportive; also, both have children, and so I think having role models, and mentors who are women who’ve been leaders in health care has been really supportive. And we have a team, so everything we’ve done has been a team effort. It’s never been me alone, and so having that kind of group process, I think, has been really important.

But there are still challenges. I was on a panel where I was speaker not too long ago, where an older gentleman that I know, a physician who doesn’t work here, came up to me, and said, “Good luck, kiddo.” [Laughter] But you know, I was thinking in my head, that’s not really what I would want someone to say to me, as I’m about to deliver a speech, but overall the support here at MGH has been incredible.

Q2: And those two women that you mentioned that have been sort of models and mentors, are there particular habits or practices that you’ve learned from them?

A: I think, you know, deep passion and commitment to the work, and yet also a total respect for work-life balance, and the fact that it’s not only about work, but we are all people, and have lives, and that kind of self-care is really important in all fields of medicine, but especially this work. This is heavy stuff that we’re dealing with, and so, sort of like the old oxygen mask thing on the plane. You put your own mask on before you help the person next to you. And so, making sure we’re all taking care of ourselves is really important. And so, seeing that role model, I think, then gives you permission to do that in your own life.

Q1: One other thing I wanted to ask you about, and it’s kind of come up a couple of different ways, but you mentioned when you were in med school you went to the prison, and that was sort of your bubble-bursting moment. What are ways that people can kind of burst their own bubble, and get a sense of this world?

A: Yeah. So, I think first thinking what the public can do, what family members or loved ones can do, one is just learning more. There’s a small handful of journalists that are really great on this topic. Many of them are in recovery, themselves, and report really accurately about everything ranging from policy issues to treatment. So, one example is Maya Szalavitz, she’s written a book. She writes in the New York Times, and other publications. So, figuring out some people that you can kind of read up, and learn more.

And there are some organizations that are trying to work to change kind of stigma, and misunderstandings. So, there’s a group called “Many Faces, One Voice,” which is an organization that’s national that’s about really spreading the message that there are 24 million people in this country in recovery, who are doing well, and we don’t hear those voices, and so they have lots of videos of people sharing their story, and they also have a lot of advocacy work for people in recovery around how to talk about their story, how to advocate for themselves. The Legal Action Center has done a lot of work around violations of the Americans With Disabilities Act for people with addiction. So, there are certain organizations that are doing really interesting work in this area. So, I think there’s many ways to kind of learn more, hear more, even if you’re not directly affected.

Q1: And before we wrap up I just have my fast five questions.

A: Oh, okay, great.

Q1: So, for kicks at the end. What’s the best piece of advice you think you’ve ever gotten?

A: Oh, my goodness. Probably the oxygen mask one. My mom always said that. Yeah, take care of yourself before you can take care of other people.

Q1: Great. So, we’re calling this podcast “Charged.” I’m curious to know in the context of the work you do, what does that word mean to you?

A: Yeah. To me it brings to mind sort of being energized, and passionate, and I think when you get charged about issues and really being dedicated to the work we’re doing.

Q1: And so, then the other side of being charged, we often need to recharge. What’s your best recommendation for how to recharge?

A: I would say be with people you love, and who love you. I think we all – most of us feed off other folks, and being surrounded by people who care about you is probably the best way.

Q1: When and where are you happiest?

A: Again, speaking of people who love you, and you love, probably with my husband and my daughter at home.

Q1: Great. I have one more, do you have any rituals that help you have a successful day?

A: Oh, when I can, I exercise before work. Yeah. I get up early, so I always eat breakfast. Yeah, I would say making sure you eat enough and exercise are probably my rituals.

Q1: All right. So, thank you so much for joining us today. It’s been such a pleasure.

A: Thank you guys for having me here. It’s been a real pleasure to be here. 

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