Hear the story of our beloved Louisiana Medical Director, Dr. Susan Julius. Her experiences with substance abuse has made her an indefatigable force in the Louisiana recovery community. She has dragged so many to sobriety and her endless devotion and singular passion has changed hundreds of lives.
In recovery? Helping others find recovery? Looking to learn about recovery? Another can’t miss episode of Rubber Bands from Avenues Recovery.
1:32 – Tickets for cocaine – Flushing away the evidence
00:10:16 – Marriage under stress
00:11:40 – Divorce to med school to full blown addiction
00:13:03 – Dee – You – Eye
00:19:00 – Bosses noticing
00:20:37 – Arrested again
00:24:31 – The power of consequences
00:28:49 – What can we do better?
00:42:43 – Final message
[beginning of recorded audio]
Introduction [00:00:12]: Welcome to Rubber Bands, an Avenues Recovery podcast, conversations about the push and pull of addiction and recovery. And now, here’s your host, Shlomo Hoffman.
Shlomo Hoffman [00:00:26]: Hello everybody, welcome to Episode 9 of Rubber Bands, conversations about the push and pull of addiction and recovery. We continue to shed light on the world of addiction treatment by talking to the people who make up its heart and soul; those who have gone through it and those that have helped them get through it, sharing their experiences and insight on how people can find their way back from the darkest places and light up the world for themselves and for those that love them. Today, we have the pleasure of welcoming Dr. Susan Julius, affectionately known around here as Dr. J. Our Avenues Regional Medical Director is living testimony that addiction treatment works and creates an impact far beyond the person in recovery herself. Her dedication and daring ‘do has earned her the respect and affection of every member of the Avenues organization and everyone she interacts with in the field of addiction and recovery. She is in-studio today to discuss her own story of addiction recovery, how medicine and clinical treatment intersect, and her vision of how addiction treatment moves towards the future. Dr. Julius, welcome. How have you been?
Dr. Julius [00:01:19]: I’m great, Shlomo. Thank you for having me, it’s great to be here. How exciting.
Shlomo Hoffman [00:01:23]: Well, Dr. J, you know we’re happy to have you here from out west. So tell us – let’s start from the beginning, so to speak. Today you are a highly successful physician and running our Avenues medical program in conjunction with the clinical treatment. But how did you get there? What was your story? Did you start off first with your struggle with addiction? Did you start out first as a doctor? Sort of run us through how your story happened.
Dr. Julius [00:01:53]: I’d be glad to. Well, since addiction is genetic, I was born with it. So as a young kid, I used exciting things in life to make me feel better. I was into sports, I liked sweet foods, I was the class clown, I liked to joke around, I was the center of attention. I used to love to make people laugh and be happy, and I was a people pleaser. I had two brothers that were not well. One was down syndrome, he was my oldest brother, Mark, and my second and other sibling was my brother Michael who was, we didn’t know at the time, but as he grew up, he was diagnosed with schizoaffective disorder, bipolar. So I guess I was always the one in the family that was hopefully going to shed some happiness and I was a caretaker. I was always watching out for my other two brothers and I had to stand up for them.
Shlomo Hoffman [00:02:50]: Where did you come in? You were the oldest?
Dr. Julius [00:02:52]: I was the youngest, actually. So we call it – in the medical field, we call it being parentized early. So they would leave me in charge of babysitting, I don’t know if that always was a good idea, but I would take care of my brothers. So I was always a pretty good student too, I got A’s and I kind of was anal about once I started to get an A, I wanted to keep the A.
Shlomo Hoffman [00:03:18]: You wanted to keep the A’s, fill up the A column.
Dr. Julius [00:03:21]: The A column. And they say A is for assholes, B is better, but I always wanted the A. And then it was not enough to get an A, I wanted to get the top A. So I started putting pressure on myself as the years went on. But in ninth grade, I was 14, that’s when I picked up my first most effective reward which was Boon’s Farm Strawberry Wine. We would go down to the local 7-11, we would all use the same fake ID card and we’d go in and buy a bottle.
Shlomo Hoffman [00:03:56]: It all started with strawberry wine.
Dr. Julius [00:03:58]: Strawberry wine, which I really didn’t even like it, but it was sweet and it would get the job done. And we’d chug it and then puke and then chug some more and we’d do crazy things and stay out late at slumber parties. And then spin the dial, a couple years later, I tried marijuana for the first time, I was 16. And that was the basis of my repertoire until I hit college. And then came the pressure of trying to stay awake and study and cram for exams. And back in my day, they had the white crosses, the yellow Dex C’s, which was capsules, speed, amphetamines, yellow bennies, Christmas trees, black beauties. And I would only use them right before an exam so I rationalized that it was no big deal. But back then, I even – it changed me. It made me feel great. I felt powerful, all-knowing, and I could cram through an exam, stay up all night, and I was young enough my body could take it.
Shlomo Hoffman [00:05:06]: Was there an awareness that an amphetamine was a dangerous thing – a dangerous place to go in those years?
Dr. Julius [00:05:13]: There was, yeah. And it was not easy to score. You know, we would do the frat parties on the weekend, drinking. I can remember my first time I ever did acid, it was unintentional. I went to a frat party and I looked down in my cup and there was a piece of brown blotter floating in the cup. And I was like, holy cow.
Shlomo Hoffman [00:05:28]: I just did acid.
Dr. Julius [00:05:29]: Yeah, I just did acid. That was kind of scary. So I was mostly, you know, a drinker, some pot smoking, for many years. My addiction didn’t take me down to the depths of hell yet, but…
Shlomo Hoffman [00:05:42]: And throughout this, you were progressing through your education, so you were going to medical school…
Dr. Julius [00:05:48]: Yes, I was pre-med. I majored in psychology to bring my GPA up because the sciences were always harder for me and I minored in theatre and modern dance because I always liked that aspect of the culture and it brought my grade point up. But this was back in – I’m kind of older, so this was in like 1975, ’76 when I graduated from college, and there was a high demand, a lot of competition for getting into medical school. And I met with my dean and pre-med advisors and their job was to weed out at the time, and that’s all I needed, was somebody to tell me, “Hey, I don’t think you can do this.” The dean told me to take eight science classes my last semester of college and get an A in all of them. And I’m like, are you kidding? And he said, “No, that’s what med school is like.”
So that’s all I needed. I chickened out of taking the MCATs, and that turned into 14 more years of my life, waiting and debating and procrastinating, which is another symptom of addiction, is we procrastinate.
Shlomo Hoffman [00:06:51]: So what was that 14-year window? What were you doing?
Dr. Julius [00:06:54]: So that 14-year window, I did research because back then, of course, if you did research and you got published, that would help you get into medical school. And the art side of me, this was when aerobics was a craze, back in 2000 – I’m sorry, 1980s, I’m sorry, aerobics was a big craze back then, so I started my own aerobics dance business and I would work in research during the day. And finally I got published, but I just wasn’t happy. I was working in the basement of Case Western Reserve University, University Hospitals, working with lab rats.
Shlomo Hoffman [00:07:28]: Up in Ohio?
Dr. Julius [00:07:30]: Over in Ohio, working with rats all day long.
Shlomo Hoffman [00:07:32]: My stomping grounds.
Dr. Julius [00:07:33]: Yeah. You’re from up north too, right?
Shlomo Hoffman [00:07:36]: I’m a Cleveland native, yeah.
Dr. Julius [00:07:37]: Yeah. So I liked what I was doing but I knew it wasn’t what I wanted to do for the rest of my life. But I was still too scared to apply to medical school. Low self-esteem; that’s another major symptom of addiction, not feeling like we’re part of or enough, and so I doubted myself. And my dad used to always tell me, you’re not going to get a job majoring in psychology. And of course, he was right, but who wants to listen to their father, right? So he said…
Shlomo Hoffman [00:08:10]: That’s a problem older than addiction.
Dr. Julius [00:08:12]: Exactly. He said, what about physical therapy? So I applied to go to PT school. And because I didn’t have enough pre-requisites, I actually had to go to school for a whole other year and then I got into PT school at Cleveland State University and I became…
Shlomo Hoffman [00:08:28]: The Vikings.
Dr. Julius [00:08:29]: Yes, yeah. Cleveland State, one of the top PTs in the country, believe it or not, back in the day. I won a scholarship, it’s called the Mary McMillan Scholarship, and I’ll never forget my mom, it’s part of my four-step, I guess, ode and omens to my mom, they flew us out to Vegas and I was one of six to win an award and it was more important for me to go out drinking and partying in Vegas than to hang out with my mother.
Shlomo Hoffman [00:08:56]: Who had come in for your…
Dr. Julius [00:08:57]: Who flew in with me for the…yeah. So, you know, the selfishness of the disease, when I look back at it, it just permeated my life, but it’s hard to see it at the time, you know? And I didn’t drug a lot then; I used schooling and excelling in school and getting A’s and studying as my reward. So I worked as a physical therapist and I didn’t really drug then – or just maybe have beer on the weekend with my husband, I got married, but I always felt frustrated when I was working in the hospital system that I just wanted to learn more and know more. I would start reading the charts and I would hang out on the floors with the internal medicine docs. And before I knew it, I said you know what? I’m going to go back to school. So I took a Stanley Kaplan course and I studied for the MCATs and I did okay and I applied to one medical school, it was early acceptance, and I got into Case Western. And this was at the age of 35 and it was 1991 I got into med school. And it was hard; it was not easy. And I was sober all this time.
Shlomo Hoffman [00:10:08]: And you were sober straight through med school?
Dr. Julius [00:10:09]: I went to med school ’91 to ’95 and…
Shlomo Hoffman [00:10:13]: So you were living in Cleveland at that time.
Dr. Julius [00:10:15]: I was living in Cleveland.
Shlomo Hoffman [00:10:16]: Where in Cleveland did you live?
Dr. Julius [00:10:17]: Lakewood. Lakewood, Ohio.
Shlomo Hoffman [00:10:19]: Sure.
Dr. Julius [00:10:20]: The problem came when the stress in my marriage of taking my husband’s – my husband and I had been married before and he had had a daughter and we took her into our family. She would come on weekends, and at one point she was actually kicked out of her house. She was a very sick child: oppositional defiant behavioral disorder. So she basically turned our marriage and turned it upside down, and that with the stress of medical school, you put it all together, my husband took a lover while I was in medical school. And that was heartbreaking. And so the divorce is what spiraled me down and opened the door to drugs. I used to – I thought you know what, he doesn’t want me, he doesn’t love me, I’m going to go out, I’m going to have a good time. And this was the time when I was interviewing for residency matches, so I was flying to Chicago, Florida, Tennessee.
Shlomo Hoffman [00:11:10]: You were getting wined and dined.
Dr. Julius [00:11:11]: Yeah, yeah. Had a great time, partying, staying up late. I partied one night so late in Chicago I missed one of my interviews.
Shlomo Hoffman [00:11:13]: Wow.
Dr. Julius [00:11:14]: Yeah, that’s how crazy it was.
Shlomo Hoffman [00:11:15]: You didn’t get that residency.
Dr. Julius [00:11:16]: No, I didn’t get that residency. Yeah.
Shlomo Hoffman [00:11:18]: Shocking. What were they thinking?
Dr. Julius [00:11:20]: Oh my god. So…
Shlomo Hoffman [00:11:24]: So how did your medical – so you’re doing drugs now while you’re studying for residency, sort of a perfect…
Dr. Julius [00:11:28]: I was smoking some pot, going out to the clubs, snorting a little coke, and drinking on weekends. And I had lost a lot of weight and that identity of looking good, feeling that I’m beautiful again, you know, men are going to want me because my husband didn’t want me. It all – it gets intermixed. And I matched – I thought I wanted to be a surgeon. There was that all-competitive, you know, all-or-nothing: if I’m not a surgeon, I’m nothing, I’m not a doctor. And of course, I picked one of the most crazy most tough militant programs, it’s probably a few steps down from Duke, which was Tulane, and I got accepted. I matched at Tulane General Surgery. Spin the dial – the very first night, so I had to pack up, go through a divorce, drive down from Ohio to New Orleans, I did it in – stayed overnight in Nashville, and of course…
Shlomo Hoffman [00:12:22]: You picked the right city.
Dr. Julius [00:12:23]: I picked the right city, yeah. Packed up, drove from Nashville to New Orleans, and I unpacked my whole U-Haul and put it all away loaded on coke, straight – 18 hours straight, just unpacked. And I went across the street, went to my first daiquiri bar, frozen daiquiris. You never have that up in Ohio. And who is the first person I meet? A guy that does heroin, you know. Luckily, I never did heroin, but this was the people that I bumped into in my life and made friends with, you know? The very next day, I went down to the quarter and I went out partying. I went down by myself. I went out partying – this was 1995. Rolled a couple joints, actually took them down to the quarter, was bold, smoked them right on the street. Went in and out of clubs. And it was late at night and I parked on Royale – Royale Street, and I had a little Toyota MR2, it was like Ohio license plates. It was like, hello, hello, police, you know, and I was walking back to the car with another – a guy I had picked up, I was going to just smoke a joint with him and who knows what was going to happen that night, but the cops were there, and they go, “Don’t get in the car. We want you – you know, you look loaded. You need to take a cab back.” And I’m like – I was loaded, so I was belligerent. That guy, he’s just in cahoots with the cab company. So they said, “Don’t get in the car.” So they got me in a cab with this guy, we dropped the guy off at his hotel, and as they’re getting ready to take me home, I go, “No, no, no, I want you to take me back to my car.” What a dumb mistake. I get in the car, I pull up the street, I pull out on Canal, the light goes on, boom. So I’m picked up for DUI, and in my purse was a little roach wrapped up in foil. So here I am, the night before starting my surgery residency, DUI and possession of marijuana. I saw my whole life gone in front of my eyes. And I had to call the head of – one of the chief doctors in trauma surgery to get me out, Dr. Terry McSwain, he’s very famous, he’s deceased now, but the NOPD knew him and loved him, so he got me out of the clinger. And I got off. They lost the charge for the marijuana, the DUI was dropped down to reckless, but my fate was almost sealed before I even started. I was a problem; you see? I was a problem. And I had to go out of my way to always prove myself that I wasn’t a screw-up, that I wasn’t, you know, a drunkard or trouble.
Shlomo Hoffman [00:15:02]: How did your medical career turn to addiction specialization?
Dr. Julius [00:15:04]: Oh, it’s a long story. Well, two years of surgery residency, they told me, you know what? You’re not good enough. And they canned me. So now my med school loans were called and I didn’t know what I wanted to be. So I actually switched to family medicine at Oschner Residency Program, finished my program, was top of my class, actually, chief resident. There was two co-residents at the time. But again, my addiction kind of got in the way. One night – one morning I didn’t go in for early morning rounds.
Shlomo Hoffman [00:15:34]: Did you ever practice loaded?
Dr. Julius [00:15:35]: I practiced hungover. I practiced high on coke, yes. Yeah, it wasn’t good. Yeah. Finished my residency, started my job, and worked for a couple different companies, and things just didn’t seem to always go well for me somehow, and so I decided I was going to run my own business, and that was really the beginning of a real spiral down because I just kept thinking if I could just have more of me and be awake longer, I could do more. And so of course I had the power of the pen and I found the drug Adderall and Altram.
Shlomo Hoffman [00:16:12]: And you were able to self-prescribe.
Dr. Julius [00:16:13]: Yes. Yes, yeah. And I wrote scripts to myself, which is totally wrong, obtaining amphetamines by deceit. And back then, Ultram, or Tramadol, was sampled in little packages. You could get them – the drug reps would bring them. They would bring samples of Panlor-40, little bottles of hydrocodone cough syrup, I mean, there were just tons of them in the cupboard. It was nothing to…
Shlomo Hoffman [00:16:38]: It wasn’t a big deal for you.
Dr. Julius [00:16:39]: It was not a big deal, yeah. These were the days – this was before, you know, Purdue Pharmaceutical and OxyContin came out. So that hit, Purdue Pharmaceutical, Oxy came out, all these pain management clinics were coming up, I was struggling as a new doctor, as a provider trying to run my own business. So I thought I’d moonlight at a couple pain management clinics. And what I would always meet would be the wrong people. Always the wrong – and I hired a girl that I shouldn’t have hired. She was just as sick as I was. And in opening my medical practice, she would funnel in pain management patients that were basically patients on Oxy and hooked on meds.
Shlomo Hoffman [00:17:20]: I want to go back to something you said a minute ago.
Dr. Julius [00:17:23]: Yes, yeah.
Shlomo Hoffman [00:17:24]: You said, you know, you practiced high on coke. How can – we talk about this all the time, people that are functioning, you know, “functioning,” while they’re professionals, lawyers, doctors. And doctors – all of them, have sort of an obligation to their clients or their patients or whatever and it’s a dangerous place to be.
Dr. Julius [00:17:45]: It’s a terrible – yes, it is.
Shlomo Hoffman [00:17:46]: How common is that? I don’t want to scare anyone that’s going to the doctor, but how common is it to actually be able to perform…you’re obviously not going to be at the top of your game.
Dr. Julius [00:17:58]: The crazy thing is, the whole time that you’re – or that I was sick and active in addiction, I thought I was fine, which is the façade, the actual denial of the disease.
Shlomo Hoffman [00:18:10]: So you seriously didn’t think you were putting anyone at risk.
Dr. Julius [00:18:12]: No.
Shlomo Hoffman [00:18:13]: Because you were on top – you had this.
Dr. Julius [00:18:15]: The endorphin flood in the brain when you’re taking these drugs, opiates, they flood the brain with dopamine and endorphins and you can’t even tell the true from the false. And so I knew I was doing wrong, but I would rationalize it, that I’m trying to help people. If I just see 20 patients in pain management and I drug test them and I see them every month and I only write – I don’t write in any Soma, I don’t write in any Xanax with it, then I’m doing okay. And if I see my family practice patients also, that between these two things I can keep myself afloat because it was not easy as a single provider.
Shlomo Hoffman [00:19:05]: And there’s nobody like bosses or anybody that’s picking up on this?
Dr. Julius [00:19:09]: Well, see, I ran my own business, so I was –
Shlomo Hoffman [00:19:13]: At that point, but originally you were working for different companies.
Dr. Julius [00:19:15]: So it’s interesting that you said it. In residency, I was late for rounds one day, they asked me to give a drug test and I refused. And doctor – when I worked for Dr. Lesser as a brand new doc coming out as an attending, he would see me staying late trying to catch up and keep up with things and he called me in his office and said you know, you can’t work late anymore here. One time when I was a doctor on staff at Turo, one of the head directors of nursing cornered me in a stairwell and asked me – actually said, “I would never say this in a court of law, but I think you should show me your arms. I think you’re shooting dope.” And I just looked at him and I’m like, are you kidding? And I pulled my sleeves up and of course I didn’t have any track marks because I swallowed the Ultram pills and the Adderall, but he was so spot-on that it scared me. But these were flags that…
Shlomo Hoffman [00:20:08]: But you could refuse a drug test and what’s the consequence of that?
Dr. Julius [00:20:12]: Yeah, that’s why I finagled my way into running my own business because I only held myself accountable; I didn’t have to perform for anybody. But that charge nurse, that was at a major hospital. They didn’t fine me, they didn’t suspend me, he just gave me his thoughts and it kind of scared me into realizing I can’t work real late hours when I go there because I’m not supposed to be up at one in the morning; rounds are supposed to be earlier in the day.
Shlomo Hoffman [00:20:37]: How did you look at yourself in the mirror and begin recovery? What was that moment?
Dr. Julius [00:20:41]: I had to get arrested. I had to get arrested.
Shlomo Hoffman [00:20:44]: Again.
Dr. Julius [00:20:45]: Again.
Shlomo Hoffman [00:20:46]: You got arrested first thing.
Dr. Julius [00:20:47]: Yeah, this was the second time and…
Shlomo Hoffman [00:20:49]: The woman who charged into New Orleans and got arrested.
Dr. Julius [00:20:51]: Yeah. It was not good. But it took getting arrested to change my life. And I had to go into rehab. I spent three months’ inpatient. I stayed six-and-a-half months at a sober living house and I worked my four-step and worked my steps, got a sponsor, went to meetings every day. I had to work for a delivery company for food and deliver steak out. It was great, they hired all people in recovery. That and the Golden Corral. They kept us all employed. This was in [unclear 21:31], Alabama.
Shlomo Hoffman [00:21:32]: How was it dealing with the fact that you’re this educated person who is a medical professional, who is a doctor, who is delivering…
Dr. Julius [00:21:40]: It was tough. It was tough. It was tough. I had to humble myself. I think the two hardest deliveries were the one day where I had to deliver to a doctor’s office and another where I had to deliver to an emergency room. It was pretty…
Shlomo Hoffman [00:21:53]: It made you face what you sort of thought that maybe you lost forever.
Dr. Julius [00:21:56]: Yes. But every step that I took was a step in the right direction and by just staying sober and working my program and doing the next right thing, I plowed through everything that I had to go through. I had to stand up in court and plead guilty to obtaining amphetamines by fraud and deceit. I went through two years of probation, paid my monthly fines, I had to learn back my DEA license. They stripped me of my family practice board status; I had to earn that back. 18 years…
Shlomo Hoffman [00:22:31]: What’s the process for that?
Dr. Julius [00:22:32]: Oh my god. 18 years later, I had to re-sit for that exam and pass the family practice boards. At the age of 58 I had to sit for those exams.
Shlomo Hoffman [00:22:42]: So your medical license – you weren’t able to…
Dr. Julius [00:22:45]: I couldn’t practice, almost 17 months I didn’t work, and then when I did work, I had to go back working at a methadone clinic working underneath another doctor. And every time I had to go back in front of the board to get another DEA level. They gave me Schedule 5, which was basically bull crap. You can’t do anything; it’s Imodium. So no insurance company would let you be on their panel. So I went back and I got a license to dispense medicine so I could hand out legend drugs, which are like Augmentin and Hydrochlorothiazide and work at the homeless clinic in New Orleans. I was the Director of New Orleans Homeless Clinic for a year and a half. And then I was given the chance by Dr. Howard Weitzman to come to work for Townsend and I spent the next six years of my life working at almost every Townsend facility, driving all over the state, working one month all weekends at the inpatient facility in Scott, Louisiana. I saw people in Baton Rouge, Lafayette, I opened up the Lake Charles Clinic and when the Townsend Center opened on Reed Boulevard, I went to work there, I believe it was in 2016 they opened, I would work one weekend a month there, and I loved it. I loved my job. And because I had worked so long at the methadone clinic, I was able to sit and study for the ABAM Boards and I became certified in addiction medicine. But ABAM was never recognized by the American Board of Specialty, so at the age of 58, I sat for Family Practice Boards and the next year I sat for the American Board of Preventative Medicine Boards so I’m actually double boarded now in family medicine and addiction. None of this would have happened unless I got arrested. Got help.
Shlomo Hoffman [00:24:23]: Amazing.
Dr. Julius [00:24:24]: It is an amazing story. I’m living proof.
Shlomo Hoffman [00:24:27]: You’ve got to go find that cop that picked you up and thank him.
Dr. Julius [00:24:31]: Yeah. They had a…
Shlomo Hoffman [00:24:32]: Imagine if he would have let you off the hook then.
Dr. Julius [00:24:34]: You know, I’m very sad to say that the office manager who actually turns state’s evidence, she actually died. Methadone and Xanax overdose. And she plead, you know, she turned state’s evidence against me, so she didn’t get in trouble, but it didn’t help her. She went on to keep using. And it was a mother, she left three beautiful children behind. Yeah, yeah. It took what it takes. Sometimes people can hit rock bottom and still not get well, which is terrifying. This disease…
Shlomo Hoffman [00:25:14]: You know, but sometimes you find people that don’t have to hit rock bottom.
Dr. Julius [00:25:16]: That’s right, that’s right.
Shlomo Hoffman [00:25:17]: I don’t think there’s a message here that you have to hit rock bottom. This is your story. But we meet a lot of people that somehow got ahead of it, or there was a family member that got involved, or they just have their own realization. But it’s really interesting how for everybody it’s sort of – what triggers recovery is a little bit different.
Dr. Julius [00:25:36]: The thing that I find most amazing is in that process, I learned that I should be just Susan, and not Susan the Doctor, believe it or not. Because the thing that scared me the most was that I was going to lose my medical license and lose my whole career and my life as a doctor.
Shlomo Hoffman [00:25:53]: Sort of what you were hanging your identity on.
Dr. Julius [00:25:55]: Yes. And when I went to rehab, it was at Bradford Health Services, which took a lot of professionals and I could remember sitting in group one night at aftercare, this pharmacist sitting across from me going, “You only are here because you want to get your medical license back.” And I looked at her, I go, “What about you? You’re a pharmacist,” you know. And that really caught me that night and I had to do a lot of soul-searching and self-reflection, and in that process…
Shlomo Hoffman [00:26:22]: Is that a terrible thing? Is that a terrible motivator?
Dr. Julius [00:26:25]: Well, we learn in the field of addiction and we try to teach our patients that having external motivation can be a problem because when you reach that goal, then what? Now what motivates you? Now what motivates you? And I can remember standing…
Shlomo Hoffman [00:26:42]: But isn’t that – I’m really curious about this, because isn’t that a place to start a lot of times?
Dr. Julius [00:26:46]: It is, it is.
Shlomo Hoffman [00:26:47]: Sometimes people that are in a haze, they need something to get in the door.
Dr. Julius [00:26:50]: Yes, sometimes – I agree with you, I agree with you. But that’s where in the process, it took what it took for me to get my help, but in the process I think is where I learned that I have to live and take care of myself as Susan, and that self-actualization, that’s the step that I think actually is maybe what we call the spiritual awakening; realizing I can’t do this by myself, I need help, I surrendered instead of fighting everything. There’s some doctors who actually will get a lawyer and try to fight the board, the Board of Medical Examiners, which is not easy. I had to go through ten years of drug test monitoring, believe it or not, five years of therapy, every day getting up, calling on the phone and finding out if I had to give a urine drug test. It wasn’t an easy program. But what’s ironic is after I finished the ten years, that’s when I actually got on the medication called Naltrexone, and it was because Naltrexone blocks the opioid receptor, and if I was going to go try to drink or take a pain pill, it would not have been rewarding to me, so it was kind of like a guardian angel sitting on my shoulder. And the reason I got on it then was my mind started spinning – ah, I don’t have to drug test anymore. Nobody’s watching me!
Shlomo Hoffman [00:28:14]: It was the carrot.
Dr. Julius [00:28:15]: The cravings. The cravings. You can have cravings anytime, anyplace, anywhere, and they can come years later, and that’s the part that I teach my patients; the amygdala is the memory center of the brain that stores all those memories and when you actually think those thoughts, there’s a chemical released called glutamate which literally binds in the receptor and sends out surges of the chemical dopamine which then releases endorphins and you get high in your head and you haven’t even drank or drugged yet. It’s pretty crazy.
Shlomo Hoffman [00:28:52]: Let me ask you this. What are we – in the addiction field in general, I don’t mean specifically our organization, what are we doing right and what can we be doing better?
Dr. Julius [00:29:03]: That’s a good question. What we’re doing right is we’re trying to destigmatize the illness and I think we need to carry this message again and again, every day, all the world over, that people that have this illness, they’re not bad people; they’re sick and they need to get better. I think the research is out there and trying to help medications so we can use meds as stepping stones. For some people, they need medicine to help bridge the gap from the depths of despair and being so sick and so physically bound to the substance or the behavior that they’re taking that they need help. And these medicines can be in the form of vitamins, like L-Methyl Folate, they can be in medicines like Suboxone or Zubsolv or Subutex, long-acting medicines like Sublocade, they can be in medications like oral Naltrexone, Vivitrol. I’m not saying that some people need these meds every day of their life forever and ever – methadone is even another drug. Some people do need them as stepping stones. So I would like to see more money placed into research to give us other medication options. Meds that help methamphetamine use disorder, cocaine use disorder. Meds that can help people that have severe cravings for marijuana.
I also would like to see – you know; they talk about you can’t stop drugs. They did this in the prohibition time, they stopped alcohol, and what happened is – Dr. Weitzman taught me this, my mentor – high-fructose corn syrup, you can trace syrup and high-fructose foods, after booze was stopped, then sugar hit the market. So we’re going to constantly cycle from one substance to another. When opium spikes, then there’s always a trend down and then usually an amphetamine or a cocaine substance would go up. So we’ve seen these opioid trends before; they came back with Vietnam and now they’re trending again. So actually trying to stop the drug, believe it or not, we’ll be battling that forever. But maybe helping to use some specific laws to stop bringing in some of these products so they’re not made, staying up on the latest substances, the different fentanyl analogues that are constantly being changed. If we could stay on top of that some, maybe perhaps the access would be a little bit better. And maybe we even need more research in how to block these kinds of drugs because I’m seeing problems in my patients that they can actually use these substances and override some of the blockade by Vivitrol, Suboxone, or Sublocade. So I would like to see more money in research. I think that’s one of the best things that we could do. And families and patients with this illness, not being afraid, like me, right now, today, I’m a little nervous about sitting here and telling you that as a physician, I had 31 felony charges and it’s something that I’m not proud of. But if I can’t sit here and tell you this, how can I ask my patients to do that? To be able to tell you, this is how sick I was and I needed help and I got help and I’m trying every day to live my life to the fullest and to the best and to not pick up for today. Just for today, I’m not going to use. And if I can’t sit here and tell you about my life and how I did that, how can I expect my patients to do that? So constantly spreading the word I think is something that we need to work on.
Shlomo Hoffman [00:32:51]: How hard is it for you as somebody in recovery to deal – first of all, to deal on a daily basis, with that challenge on a daily basis of dealing with people that are in addictive addiction, and you know, just the trauma, the triggers, sometimes the loss that we experience in the addiction field, all of that, is that a very difficult challenge for you in terms of maintaining your own recovery?
Dr. Julius [00:33:12]: It is, it is. You know, one of the things I have to constantly remind myself, and I was taught, I cannot control your disease. I can’t make you stop. I can’t follow you out the door when you leave treatment and watch you constantly and tell you, “No, no, don’t do that. Don’t go to that party tonight. Don’t get on social media. Don’t unblock your dealer.” I can’t do that. I wish I could go out and follow all my patients, but that’s not feasible, and nor is it healthy. So learning where I can help and where I cannot help and setting boundaries for myself helps keep me able to come back to work every day. One of the hardest things is to watch – we call it AMA, against medical advice, and it’s when we have AMAs. We have people leaving treatment. And it can be very demoralizing. You work so hard – the team works hard, the counselors, the nurses, the techs, every single person plays…admissions, every person plays a role in getting that person into treatment and keeping them into treatment, it’s a whole team approach, and when the patient is so sick they can’t hear the message and they leave, that can be tough. That can be tough. And we can’t really hang our hat on every single AMA that leaves, nor measure our success on our AMA rate, but it’s something that’s one of the hardest things to handle in the day-to-day life of someone working in the field of addiction. And to learn how to not take it personally is one important thing, but also to learn how to not be apathetic and say, “You know what, I can’t do this anymore, just let them go. I tried. We tried.”
Shlomo Hoffman [00:35:01]: It’s a balance between being completely cold and being completely taken over.
Dr. Julius [00:35:04]: Yes, yes, yes. And in seeing the patients or the client come back again to treatment, the first thing I always say is, “It’s good to see you again,” because I would rather see you than not see you, you know? I want to see you coming back and doing IHI, hospital institution and giving your story. If you can’t do that, I would rather see you back in my treatment center than to not see you back. I think there was one month a few months back, literally six or seven names came up, almost one a week, of a patient we had lost that had been a prior patient. It’s pretty sad. This disease is a bad disease and we have to remember too that alcohol is very, very deadly. In the world of the opioid epidemic, alcohol gets pushed aside a lot and we forget about alcohol. Alcohol has been around and will always be around and kills a lot of people. A lot of people.
Shlomo Hoffman [00:35:53]: Wow. Do you see firsthand the effects – in terms of overdose – with everything that’s been going on with COVID?
Dr. Julius [00:36:04]: It’s been amazing. COVID has changed so many things in the world for so many people, from should we test to not test, okay? We test all of our patients before they come in the facility. We’ve had to deal with outbreaks in some of our treatment centers and how to take care of patients safely and get them where they need to go. We wear masks every day at work and you know, I’m tired of wearing my mask, I’ve got acne coming out on my face where my mask line is, I can’t breathe, I’ve got asthma, I want to eat. How many times a day I wash my hands or touch my nose and then rub my eyes. You cannot follow all the rules, it’s just impossible, and yet we’re supposed to set good examples for our patients. COVID has brought so much money out of the furniture and into the hands of people who do need it, but I get sad when I see how they’re spending that money. I see people who are not going to work because they’re paid so well to sit at home – and I don’t mean it derogatorily, but I have to call it as it is. I mean, we have such crisis now for shortages in nurses, techs, LPNs, RNs. My garbage people, the collectors, the sanitation department, they’re coming once every two weeks now in New Orleans; it used to be twice a week. So it’s affecting every line of service, you know? People are actually being paid to stay home and making more money than they would if they actually worked. It’s affecting the workforce.
Shlomo Hoffman [00:37:58]: What about your patient flow? Meaning do you see uptick? Do you see more people overdosing? Do you see more people…?
Dr. Julius [00:38:08]: So, with that money being – I’m not saying all money given out by the government is being spent on drugs, but there’s a good section.
Shlomo Hoffman [00:38:15]: And there’s also a loneliness factor. I mean, now, sort of the shut downs.
Dr. Julius [00:38:19]: Yes. They’re isolating, they’re sitting at home, they’re not allowed to leave or they’re sick or their family member is sick, and so they’re drugging more, they’re drinking more, they’re buying drugs. And I want to say one last thing – my nurses are phenomenal. I have tons of nurses that are giving their lives every day on the frontline. People in ICUs, people in COVID units, people every day on the floor that are working long hours and taking the job and the role of the shortages that are out there. I mean, I’ve seen that at my facilities, we’ve had to – everyone has put on a different hat. So I don’t know if this is going to change or when it’s going to change, but I think it’s here for a while. It’s here. It’s strange; I feel like I’m living in a movie. When we were kids, we used to watch this show called The Outer Limits. You remember? You’re too young to know Outer Limits. But it’s a great show; they control your TV and there would be a dial and a line on there and all of this sci-fi stuff, and here I am, we’re almost living it, you know. I can’t watch shows about plagues and viral, yeah, it’s just…
Shlomo Hoffman [00:39:30]: You’ve got to get your mind off of it.
Dr. Julius [00:39:33]: Yeah. People – there’s a lot of politicizing too that causes tension and you don’t want to step on other people’s toes, and at the same time, somewhere in there, I have to feel okay with what I’m doing. And so I was vaccinated and I do recommend the vaccine to my patients and we offer them to get vaccinated, and if they don’t want to get vaccinated, I don’t push it on them. It’s tough. It’s a tough day, you know. But I feel very fulfilled and grateful for every life that I am able to touch. And we have a lot of good progress. We see so many people doing better. And we have an alumni through Townsend, there’s an alumni on Facebook that they get to follow-up on.
Shlomo Hoffman [00:40:24]: You get to follow-up; see how well they’re doing. I feel like that’s also very, very important. We know that it’s really important for alumni to stay connected but not just for the alumni; there’s also an aspect for the people who work in the facilities. It gives you a reason to keep going.
Dr. Julius [00:40:42]: Yes, it does.
Shlomo Hoffman [00:40:43]: You know, you’re able to see – this mother comes in, she’s reunited with her child, that one talks to her dad now, that one has a successful job, that one looks healthy and happy. And I think when you’re really, really able to touch the impact that you’re making every day, it’s not just important for the alumni, it’s really important for the staff.
Dr. Julius [00:41:02]: I agree.
Shlomo Hoffman [00:41:03]: To see that, have the people come in, like look, this is what we’re accomplishing. And then even for current patients, they can see this is possible.
Dr. Julius [00:41:12]: We actually have – you used to take people out to AA meetings almost, not every single night, but three to four nights a week and on weekends. So now, when COVID hit, we had to shut that down, so we have to do Zoom meetings. When things cleared a little bit, we were allowed to bring meetings in. We also had family weekend, family would visit, we had family education day, so a lot of things have changed that way. I teach my patients – I give them a handout on social media. There’s a lot of good websites. There’s a website called In The Rooms, which I really encourage them to use, or their local AA or NA guide source. Reaching out at least through Zoom meetings is better than nothing. And telemedicine, man, it has changed the world of medicine. I think telemedicine is here for good now. You’d be surprised how many docs can see a patient that way. I think it’s a pretty good delivery of medical care. I still like placing my hands on the patient and hearing that heart rate and looking in their eyes and giving them a physical touch; I think physical touch is really important, and by not being able to physically touch in the world today, it’s changed a lot of things. It’s changed how we interact. It’s nuts. I see it different in different cities, just from one city to another, the way people…
Shlomo Hoffman [00:42:44]: The protocols.
Dr. Julius [00:42:45]: For COVID, yeah, it’s kind of crazy. It’s crazy.
Shlomo Hoffman [00:42:47]: What’s your message? Leave us with a message for the people. Not even the people that are involved in addiction treatment. I like to ask this to our guests, everyone sees it, everyone is touched by it to a certain extent with the six degrees of separation. What are we asking people to do even if they’re not working in addiction? What can I do to make a difference?
Dr. Julius [00:43:08]: The message I would love to get across is, number one, this is an illness. People are not bad people making bad choices. Two, this disease is not about choice. It’s driven at the subconscious level and we inherit it and then life stressors come along and access and when you put genetics plus life stressors and trauma and access together, up comes the illness of addiction. One in twenty have addiction. Some of the statistics even say one in ten. But only 10% actually get help. So if we destigmatize the illness, maybe it will be able to bring the people out more so they can get help, and when they do, that they’re not looked at as crazy bad people. And that we need to give them a chance in the world. If I was never given a chance, I wouldn’t be sitting here right now today. So try to look at this as a chronic, progressive disease that if we don’t learn how to manage it, we won’t learn how to recover from it. And to treat it like diabetes or heart failure. Would you tell somebody with diabetes not to take their insulin? No. Why would you tell somebody with addiction not to take their medications that they need? That’s one of the most important things I would do. Please learn that this is not about being a bad person or making bad choices, that it’s an illness. And to spread that word and not be afraid to tell people that you’re in recovery.
Shlomo Hoffman [00:44:50]: There it is. And one of the good choices that we’ve made here at Avenues is obviously having Dr. J on board. Thank you so much for coming out here, thank you for talking to us, thank you for sharing. Everybody, this has been Episode 9 of Rubber Bands, conversations about the push and pull of addiction. Please listen, subscribe, and rate. Once again, we will see you next time. This has been Rubber Bands.
[END OF RECORDED AUDIO]
“Strength of the Titans”
Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0
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