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Scott Webb: There are many unique challenges that licensed professionals face personally and professionally, when these individuals struggle with substance use disorders or mental health issues, their treatment plan must not only address their individual needs, but those of their licensing board.

And joining me today to help us understand how Sierra Tucson can help licensed professionals is Juan Velez. He's the director of the licensed professionals program at Sierra Tucson.

This is Let's Talk: Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one best addiction treatment centers 2020 in Arizona by Newsweek. I'm Scott Webb.

Juan, thanks so much for your time today. Can you address the unique challenges faced by licensed professionals and is treatment mandatory or voluntary?

Juan Velez: In terms of licensed professional, let me go back and let's have a couple of statistics that is important to mention before we start. So at this point, we have an alarming fact that 44% of the physicians right now experience symptoms of burnout, 8% of the medical residents suffer from depression, approximately 400 physicians in America commit suicide each year.

We also know that 10% to 12% of physicians have substance use disorder. And we also know that 40% of the physicians are reluctant to seek care for mental health. With that being said, there are many challenges that we experience with licensed professionals.

In most of the cases actually, the treatment is voluntary and they come to the treatment because they feel like something is going on. Just in a few cases, when they've been reported to the boards and at different boards in the country, they're mandated to seek help. But most of the cases are voluntary these days.

Scott Webb: Interesting. And those are some, I would say, alarming statistics. And can you comment on the different licenses and the requirements?

Juan Velez: In Sierra Tucson, we treat a very large range of professionals. We deal with medical doctors, nurse practitioners, nurses, pilots, lawyers, therapists. We basically cover every single aspect of people that has been certified, that they have a license that report to boards.

In the requirements, actually, at this point, it depends on each state. Many states have peer reviews or directors or the board members that taylor the requirement treatment for each individual. So it's very individualized, depends on the state. And I believe in a couple of years, there's a draft that is going to be unified in the whole United States. The rules and procedures are going to be unified.

Scott Webb: That does seem like it would be beneficial to have that a unification, as you say. So how or when do the licensing boards become involved?

Juan Velez: It depends on the level of reporting. So we have two different scenarios. The first one is when the professional has been reported to the board and they come with a treatment plan. Usually, they follow up in terms of drug testing, if it's for drugs or alcohol. Also, they need to prove that they follow up in some type of mental health setting. Those are the cases that have been reported.

But again, Scott, most of the cases that we see these days are either results of interventions or, in some point, the patient himself realize that this is not sustainable and this is placing in jeopardy their professions. So most of the cases, they come and they seek treatment voluntarily or as a result of intervention without the board being involved.

Scott Webb: Yeah. And good to know that many are seeking help when they need it. But you mentioned the board there. What is their role? How is the peer review board or when did they become involved?

Juan Velez: Again, the peer reviews are a state specific. Their case has been exposed to the board and then they have these procedures. Many cases, they go like in trial-like situation when they said, "Okay, this is what we saw. This is the behavior that you're presenting. This is the substance that you've been using. And our recommendation is this." This is kind of in the mild cases.

So when the case has been reported either by a client or has been reported by a colleague or a different member of the team, in those cases, they're very strict in terms of the requirements that they need to fulfill. In many cases, they're required at least 30 days of residential facility, a very extensive psychological and psychiatric evaluations. We want to rule out any mental condition like bipolar, depression. And then, that's when the board recommends any type of treatment.

As a generalization, the treatment can be either from three months up to a year. Of course, this is a 12-step groups support, psychological support, psychiatric support, even medication management also is required in many cases.

Scott Webb: Yeah. And it makes me wonder if Sierra Tucson and other treatment centers answer to the peer review boards or the patients?

Juan Velez: We don't report directly to the board in most of the cases, but there are specific cases that the board has very specific requirements and also depends on the state. So in some states, we are mandated to report back psychological test results, psychiatric evaluations, that type of thing, and also the plan. The plan means either if the patient requires to go to partial hospitalization program with a sober living facility, something that we call PHP or intensive outpatient programs.

For most of the residents or for most of the patients, this is the kind of the sequence. They come, they do 30 days of inpatient or residential facility. And after that, they continue to work in an outpatient program. So the answer is yes and no. Most of the cases, when the board is involved, we report. But also that I want to mention Sierra Tucson has this multidisciplinary team that supports the clients having self-reporting and also reaching into the community resources and connecting them to the community resources that they want to be able to be more successful in terms of recovery.

Scott Webb: That's so great to know, you know, the Sierra Tucson model, mind, body, spirit. Good to know that you have this multidisciplinary team, you know, that's treating the entire patient on all levels, both inpatient and after treatment. It's really amazing. What are some of the challenges when treating licensed professionals? And maybe you can share some examples.

Juan Velez: So in the challenges we have pretty much, we identified two different factors. The first one is the external factors and that's when that consideration of the expert, being on call 24 hours in case of many professions that need to continue being the role model or the mentor in the community, but also the internal factors of my own biases in terms of how recovery looks like in my mind, my inability to make mistakes.

In our professions, we also know that their identity has been high achievers and high rewards. All these factors, external or internal factors, prevent people actually, not only the professionals, but in the general population to seek help. These days actually with COVID, we see that people is more open to accept that, "Yes, I do need support from mental health professionals."

One of the cases that resonate in my mind is this physician from the Northeast. Extremely successful, beautiful family and he's pressured, he was coping with substances and he was hiding it until the point that he needed to be escorted out of the surgery suite, the OR, because he was so intoxicated that he couldn't perform. In this case, he was not reported to the board. But he came voluntarily and now he's super happy, family's doing really well, and he's doing magnificent. That's one of the highlights of our program.

As you mentioned before, our approach, having this multidisciplinary team allow us to meet the patient where they're at, so not only the physicality, but also the mind and the spirit. We 've been able to have this team that supports every single component of our humanity.

Scott Webb: Yeah, it's great stuff. And really interesting as you say, you know, anybody seeking treatment can maybe have difficulty, you know, getting there, accepting that, reaching out for help. But you talk about these licensed professionals are high achievers and very difficult for them because I'm sure on some level they know that so many people are counting on them and difficult for them to accept that place that they've gotten to in their lives and having to remove themselves from that. I'm sure that's part of the challenge for them, right?

Juan Velez: Correct. And Scott, we also need to know that these people, they are the providers at home. So that fear of, "If I go to treatment, who's going to support my family? Who's going to support, in terms of money, but also emotionally?" They feel like leaving the family and the kids behind, and also the people that work with them.

Again, these days, we are still seeing that moving to the right direction in terms of seeking help. In other words, we just finally start realizing that it's okay not to be okay.

Scott Webb: That's so well said. What do you want to tell licensed professionals who are struggling with addiction and at risk of losing their license and, as we're discussing here, their families and perhaps their livelihoods? What do you want to say to those licensed professionals?

Juan Velez: As I mentioned before, we need to realize that we are humans. And as humans, we need to rescue that individuality, that need for feeling okay, feeling productive and also feeling successful in terms of what success looks like for you. This is a very individualized process. So for me, being okay, something that we need to realize, as a high achiever, we don't have to perform constantly in that 90, 100 percent. I'm going to steal a comment from a friend of mine that is "See to continue."

So keep in mind that sometimes it's okay to perform in that 65%, 70%. Lowering that bar of success, that nothing less than a hundred percent will be a very good piece of advice. Second, getting moving, actually and isolating those different components between my humanity, my human side, and my professional side. As a human, we all struggle in some point and don't be afraid to reach out for help.

When we perform at high levels constantly as a license professional, we are afraid to come back to the basics and missing those sunsets, those sunrises, that dinner with family, those moments that make us more human and more connected with people that we love and love us. When we have that social support established, it's less likely to fall into these dark moments of addictions and not only addictions, but also to be in depression and anxiety.

When we establish those coping skills, using the people and the situations, we will be better off in terms of happiness and more successful and a better life actually. Just keep it in mind that not because I'm continuing working means that I'm okay. Because at the end, multiple studies show that the last thing that you lose is your work. That work life, that it's supporting all the behavior that you are. Involved in the last six, eight months, a year or two years. So that's kind of the secret place we protect at work. And that doesn't mean that because I'm continuing working, I'm being productive, that I'm in a good place.

That's a good piece of advice that we need to realize, "Hey, let's just start going backwards." "Yes, I'm working. But how is my personal life? How is my family? How are the people that I love and people that love me doing? And how are they seeing me lately? Any radical changes in my behavior? That type of thing.

Scott Webb: That is really beautiful advice and so great to know for licensed professionals and all of us that Sierra Tucson is there to help us and interesting that most licensed professionals do seek out help voluntarily. I mean, maybe that's not surprising because they are licensed professionals and they know what it means to have so many people counting on them, as you say, high achievers. So a really interesting conversation today, Juan. Thank you so much for your time and you stay well.

Juan Velez: Scott, thank you very much. Stay safe.

Scott Webb: For more information, visit sierratucson.com or call (800) 842-4487. Sierra Tucson, we work with most insurance.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.

This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.