Transcription:

Alyne Ellis (Host):  Welcome to Aspirus Health Talk. I'm Alyne Ellis. Today, we're talking about coping with addiction while socially distancing. Joining us is Dr. Kirk Klemme, an Addiction and Pain Management Physician at Aspirus. Welcome Dr. Klemme.

Kirk Klemme, MD (Guest): Thank you very much.

Host: So, with our topic being dealing with addiction, the isolation brought on by COVID is just really ramping everything up. And I'm wondering if you could talk a little bit about how tough it is for people, particularly who are in recovery from some kind of substance abuse disorder.

Dr. Klemme: Right. This has been a stressful period and I don't think anybody really anticipated that it was going to be going on for getting close to a year now. So, it's been a very difficult thing for a lot of people in so many different ways. Because the lack of social connectedness, the ability to connect with other people in recovery is a very important part of what we do and peer support and mutual support. And, not only that, but just even the counselors themselves. There are kind of three pieces to what we do with people with addiction. One is peer support, such as 12-step programs and connecting with other recovering people. And the second part is counseling and the professional, psychosocial, you could say interventions.

And the third part is some medications that we use. Two of those three things are really quite compromised in this situation because a lot of the AA meetings are not functioning live and in person right now. And there are Zoom alternatives. There are just internet alternatives. If you want to go to a meeting just on the internet, you know, somewhere, a non-local meeting, there are some Zoom meetings where you would see some people that, you know, locally. And so those are some options, but, they're different. They create some barriers for people to connect with them, and it's just not quite the same, also not being in person.

And then, just, even in the last few months, it's more and more, it's been striking to me that we have some excellent counseling professionals that we work with but, over the phone, it's just not the same. You don't have that personal connection. You don't have that eye contact. You don't have that body language. You don't have those, some of those nuances that you get. So, it's just really not quite the same. So, there's all of that. And that's a big part of it.

And then some of the other factors that come into play here are we have a lot of people who are in pretty difficult situations to begin with. They may have transportation issues. They may have job issues. They may have housing issues. They may have childcare issues. They may have food issues in some cases. And so, the economic stresses of this, of people being laid off and maybe not being able to work and not having access to some income and their normal situation certainly adds another whole level of stress to the situation. And then you throw in on top of that, that I drive to work and I come right past the high school and middle school in our area. And so I'll come through and say, oh, I better get going early so I miss the traffic, you know, around the school. And then of course the next day, then there will be no traffic because the school will be open for a couple of days and then it will be closed.

And just that uncertainty certainly adds another level of anxiety and stress and uncertainty plus the fact that people want their children to get an education. And some kids are at higher risk of even falling farther behind when these things happen and their situation is disrupted and their routines are disrupted and their contact with the teacher and maybe their contact with extra help that they get are all disrupted.

Host: I'm assuming that this is not only difficult for people who are recovering from some kind of addiction, but it's also adding to the numbers, as people try to calm down with alcohol, or, you know, can't stop playing video games or whatever their particular issue is. I mean, do you have a sense the numbers are going up and that people aren't necessarily reaching out for help?

Dr. Klemme: Well, it's hard to quantitate that, but I mean, there's just no question that it's all about coping mechanism. It's all about resiliency. It's all about what people do to get through difficult periods. I will say, I have had a number of people just in the last few months who kind of were pushed over the edge. In fact, just the other day, I saw a fellow who due to some situations with the COVID, it put him under some financial stress and some different things and it caused him to reach out for help because he knew his life was not going in a direction that he would've wanted it to go and very directly related to the pandemic. There's just no question. And, and that type of factor comes into play to a greater or lesser extent with just about everybody. But there's no question that there are some situations that I've seen that definitely you can look at it and you can say unquestionably the pandemic situation has put this person in a more difficult spot and caused them to make some choices they might not have otherwise made.

Host: You've given us some tips on ways to start the process or to try to continue the process of dealing with a problem like this. And the first one, is calling your healthcare provider's office for a Telemedicine appointment. Can you talk just a little bit about how that might work and ways that people can feel comfortable when they're online as opposed to in person?

Dr. Klemme: It's pretty ironic because we are what's called a rural health clinic, RHC is a designation of a certain type of clinic that through the third-party payers and such. And we have generally not been doing very much Telemedicine. However, under this situation is as I'm sure, you know, a lot of the rules have been relaxed. So, we do fair number of it now. For about a month, for the month of March and chunk of April of last year now that is already I did strictly Telemedicine, but then we began seeing patients live again. But we still do a certain amount of Telemedicine and people talk about few silver lining things like this that are, that have happened.

And one of the things has been is that now that we are capable of doing more Televisits, I actually use some of those opportunities if I have patient that I think really needs some extra attention and needs an extra contact point before when we might see them again on a normal, I will make it a point to set up a Televisit and we will, at least touch bases and have a conversation in between times. So, it has allowed me actually, in some situations to see people more frequently.  

Host: Well, and even perhaps to talk longer or under less stressful situations when they're in the office, worrying that they're gonna get COVID somehow, even though doctor's offices are usually pretty safe. Let's say that, you have a conversation with the provider, your doctor, and then maybe it's on Skype or FaceTime or whatever you use. I'm sure one of the things you discuss is medications and sort of doing a check on what meds people are taking and how it's working for them?

Dr. Klemme: I spend a lot of time talking to people. I'm kind of chronically running behind in the office because my sessions with patients, there's sort of two different parts to them. One is the different medications and you know, and sometimes it can be kind of complicated, and people are on a number of different things and so forth. But then there's also the counseling aspect of it. I tell people I'm not a counselor, but I play one on TV and I have 33 years of recovery myself.

So, that's kind of actually why I got interested in the addiction field. And so I have a lot of my own life experiences and recovery experiences that I kind of bring to the table. And it's hard to, I spend a lot of time talking to people about those things and it's valuable, but boy, it's time consuming. So yeah. I mean, you mentioned something about being able to talk in a little more relaxed fashion. And what I ended up doing is a lot of those things end up being on weekends for me. I'll tell people let's set them up for a Telemedicine over the weekend. And I ended up doing that a lot too, then I don't feel like I'm watching the schedule and waiting for the next person to come in.

You know, I, I don't like that. I like to be able to kind of just relax and spend some time and people respond to that and people appreciate that, but it doesn't always work. It's not always available depending on, the schedule is for the day. Usually it's pretty full  

Host: But it sounds like you're available and that's important. Let me ask you, if you don't mind my asking, when you think back on your own recovery experience given that there are times, I think that people feel extremely isolated, even though it's not because of all the stuff going on right now. In your isolated times, what helped you?

Dr. Klemme: Yeah, going to meetings. I still go to meetings and I've gone to a lot of meetings and in all these years, I've never once said, well, I'm done with meetings, I know there's no cure, there's no graduation program from recovery and you just have to keep connected with people and I guess I always think of mental, physical, spiritual, and emotional. Those are the four kind of components of our lives. And so, I get a lot of exercise. I work out pretty consistently and I have a meditation practice and all those kinds of things that I try to live a lot of the things that I recommend to people.

I mean, because all I know is that it's just kind of it's, what's kept me from, going off the rails, I guess you could say. And it's been a long, long time, it's not always just chemicals. I mean, there are things, you know, anybody who's prone to a chemical addiction can certainly get into other behaviors as well. And a very big common one of course is eating, you know, and the eating disorders and substance use disorders certainly go hand in hand. So, it was very easy for people to get less active, to eat more to, as you mentioned about video games or watch television. You have to try and focus on the mental, physical, spiritual, and emotional parts of everything that you do and keeps you moving forward.

Host: Well, and you've mentioned a couple of specifics about meditation and then a sponsor. Tell me about getting a sponsor. How would you set somebody up to get that if they need it?

Dr. Klemme: One way to get a sponsor is when you go to a meeting, you try to identify someone who you could "relate to." And someone who seems to have some openness and some willingness to work with people. It's really hard, but you know, people just have to kind of approach that person. You can kind of soften it a little bit by asking people, can you be my temporary sponsor?

So, that's always kind of a good way to break the ice a little bit without having it to be quite so scary. And then in our area, we also have what are called peer support coaches. They are actually employed by a local treatment center that we have, and this is getting to be quite a valuable aspect of recovery out in the community. It's called the Phoenix House is the recovery facility in our area. And they employ a few of these peer recovery coaches, two men and one women. I think they're trying to hire another woman who I can refer to when I see people in the office who I know need some help and need some support.

I can give them a phone number and say, you know, call this person. They are more than willing to help you and to help you find meetings and to help you go to meetings and give you rides to meetings and all of those things. And that's a very, very valuable thing. Now, again, it kind of comes down to that same thing of oh my gosh, that's kind of scary to call that person and, and I'll, I'll reach out to the coach and give them the patient's number as well.

Host: Well, but then of course the sponsor in this point of time where we're so isolated can make a phone call and say, here's the meeting hookup, I'll call you afterward and see how it went. If you have any technical problems, let me know, that kind of thing. Another thing on your list is writing down things that you're grateful for and journaling. I'm wondering if you could talk about that?

Dr. Klemme: Yeah, there's, there's a few different writing exercises that you can do. I talk to patients about that a lot. A few different ways you can approach it, the infamous a gratitude list where you write down things that you are grateful for on a daily basis. And it just allows you to look at them more positive aspects of things and try to focus on some things that are going okay in your life. Cause I think it's very easy for us to be negative and to kind of worry about this and fear and anxiety and stress and worry and all of those things are definitely place us at greater risk of using.

So, you know, a gratitude list is certainly one thing that's really important. There's another kind of method of writing that I started to do about a year or so ago. Some people refer to it as expressive writing where I actually use it for a pre bedtime routine because sleep, you know, we didn't talk about sleep yet, but that is a hugely important aspect to have any type of recovery, whether it be from addiction or from pain and chronic pain or any of that. And, you know, sleep is really important. So, I've actually gotten into a routine of some people call it free writing, where I just, I have just some plain paper and write. And then afterwards you just tear it up and throw it away and some people think of it as a form of meditation. One of the concepts with meditation is you just sit quietly and when thoughts come, you kind of allow them to be there, but you don't grab onto them. You don't start perseverating and say, oh yeah, I really wish I'd said that.

Or I should've done this. You know, you don't do that. You just try to kind of let it go. And this is kind of a written format for doing that, where you just kind of write a couple things down or a few thoughts down. And then I tell people, you know, I don't have to worry about it. You don't have to worry that somebody is going to see it. You don't have to worry that your wife's going to see it. You don't have to worry that you're going to look at it later and say, oh, that looks ridiculous. It's just kind of a freeing type of thing to do. I tell people it's very important to stay connected to people and the most important person that you need to be connected with is yourself.

To me, what video games, television, all that stuff is, is just we've become so disconnected from ourselves. And that we need to kind of just spend quiet time. I have this one yoga a little page with a number of pictures of people doing some very gentle yoga positions on it. And on the very first one, the woman is just sitting there in a chair, it's actually chair yoga. And I say, see that picture. Can you do that? Well, yeah, she's just sitting in a chair, right? I said, that's the most important one is just sitting quietly, turn off the TV, turn off the music, find yourself a quiet spot and be able to sit and be present with yourself for a little while.

And I think in our society these days, even under normal circumstances, there's so much stuff out there and there's so many things we can get caught up in that we kind of lose that ability to do that. It's a very important skill.

Host: And I know one thing that has helped me personally, we have an older neighbor across the street and I've tried to call her every day to see how she's doing, even if it's five minutes. And then the other thing is occasionally I'll cook something and take it over there. And I don't see her, I just leave it on the porch. But do you suggest those kinds of activities that kind of gets you up, gets you moving and try to keep you out of yourself too.

Dr. Klemme: Yeah. And not only that, but yeah, you feel like you're giving something, you're contributing to somebody else. And that's, that's one of the things that I tell people, you know, you need to find a way to participate. You need to find a way to participate in life and to do something for someone else. Something that you're going to make their life better. I always tell people that when you reach out to others, when you give something back, when you do something that's positive and valuable for other people, you're helping yourself as well.

And you put yourself in a better position. When we work on our, if you want to say demons or our own things, you know, we're going to put ourselves in a better position to help others. And so it kind of works both ways and it's kinda the same concept as the gratitude list, you know, of just finding things that are going to be a benefit to yourself or to other people.

Host: And then finally, if you do say you've had a few good days and then you have a really bad one or you can't get back up again. I guess it's time to call someone and revise your treatment program.

Dr. Klemme: The core principles of the program are HOW honesty, open-mindedness and willingness. The H is that you just we can't hide. There's an expression, we are as sick as our secrets. And you have to be out there and you have to acknowledge when you've done some things that weren't ideal. When you fallen short and you have to admit it to yourself, first of all, and then the fifth step in AA is admit to God, to ourselves and to another human being, the exact nature of our wrongs. So it's, it's really important that cause you can't move forward if there's stuff back there, if you're hiding things and you just can't move on. And then honesty, open-mindedness and willingness. You know, the willingness is the one I really focus on too. There's an expression in recovery that we need to work as hard at our recovery, as we did at our addiction. The term going to any length, you know, we need to go to any length to do what we need to do, to get to a meeting, to, to make that phone call, to call a sponsor.

And it's hard. And it's really hard. And I really got to say, it's sometimes I'm a little disappointed that there’s not more effort put in sometimes, but it's just, what it is. Everybody is where they are, and I really make a real effort not to judge it. I just say, okay, well, what are we going to do? Where are we going to go from there? And I've been fortunate, that I've not ever had to go out there and do any more research and development and to prove to myself that I can get into trouble. But not everybody is that fortunate, and everybody's in different places and everybody's had different paths and everybody's had different opportunities and everybody's had different traumas if you want to look at it that way.

Host: But you've given us some good strategies today about being socially isolated at this point, or worried to death about the world in general. And I thank you very much for your tips on ways that we can try one more thing, like the journaling, for example.

Dr. Kirk Klemme is an Addiction and Pain Management Physician with Aspirus. Thank you so much for listening to this episode of Aspirus Health Talk. Head on over to our This email address is being protected from spambots. You need JavaScript enabled to view it. for more information, and to get connected to one of our providers. Please remember to subscribe, rate and review this podcast and all the other Aspirus shows. And for more health tips and updates, follow us on your social channels. I'm Alyne Ellis. Thank you for listening.