Taking a Closer Look at the Opioid Crisis

Recovery Unscripted banner image for episode 27

Episode #27 | July 5, 2017

Featured Guest: Holly Fletcher

My guest today is Holly Fletcher, healthcare reporter for Nashville’s daily newspaper, The Tennessean. She joins me for an in-depth conversation about the origin of the current opioid crisis and the actions being taken by everyone from the federal government to local health agencies as they try to get a grasp on the situation. She also shares some of the first-hand knowledge she’s gained by listening to a wide array of people who have been affected by this epidemic’s medical, economic and social repercussions.

Podcast Transcript

David Condos: Hello and welcome to this episode of Recovery Unscripted, a podcast powered by foundations recovery network, I’m David Condos and my guest today is Holly Fletcher, healthcare reporter for Nashville’s daily newspaper, The Tennessean. She joins me for an in-depth conversation about the origin of the current opioid crisis, the actions being taken by everyone from the federal government to local health agencies, as they try to get a grasp on the situation. She also shares some of the firsthand knowledge she’s gained by listening to a wide array of people, who have been affected by this epidemic some medical economic and social repercussions. Alright, here’s Holly.

I’m here with Holly Fletcher. Thank you for being with us today.

Holly Fletcher: Thanks for having me, it’s great to be here.

David: First let’s start out by having you tell us a little bit about your personal story, and how you got started in the world of journalism?

Holly: I wanted to be a journalist since I was a small kid, I made a newsletter called the Dixie Holly Express on I guess what was a very early Mac, with a really bad clip arts and it was my first real job and that’s pretty much all have ever been paid to do.

David: What was your first job?

Holly: My first job I covered local sports for the Robertson County Times. Yes, I was terrible, I’m not a sports person.

David: You got to start somewhere.

Holly: Yes, start somewhere.

David: Now you’re at The Tennessean, how did you end up there?

Holly: I started at The Tennessean about two and a half years ago, after they called me up and wondered if I was interested in covering the healthcare industry here in the Nashville area, I at that time was covering mergers and acquisitions and the power and utility space in New York, I’ve been doing that about five and a half years. I am super nerd, I love infrastructure and all things power, I was looking for a change and health care seemed to me at that time to be as complicated as power, I thought that I would not be bored, I have come to realize it is 10 times more challenging and complex and I am never bored.

David: I guess was healthcare something that you were drawn to for a specific reason, or was it more that the opportunity opened up in it and you jumped at?

Holly: It was more the opportunity, I see Nashville as the Houston of healthcare and if you’re going to work for a daily doing an industry type coverage, there’s no better place to be than in what is a corporate at personal, my background as a corporate finance reporter, I was really drawn to being able to cover the trends and the come to the end that companies that move an industry.

David: I’m glad you touched on that that’s something that listeners who aren’t from this area or aren’t familiar with Nashville, or might not know but this is really a big deal here in Nashville, is the healthcare industry.

Holly: Yes. It’s pretty much all started with HCA many decades ago and from there it has really grown into an industry that contributes about $40 billion in annual economic impact to the region, the companies combined to have I believe it’s around $80 billion in revenue.

David: Then what does your current job entail, on a day to day basis?

Holly: On a day to day basis my job is highly dependent on the news cycle, a lot of times I feel I am reacting to whatever is out there, I don’t particularly enjoy the reaction part I would like to be on the front end of something but I cover the industry and Nashville, I cover its economic impact. If a company were to file for bankruptcy or do side to do big layoffs, we would cover that. That is not the bread and butter of what we do but that is something that readers in the area they want to know about, it impacts their livelihood but also I do a lot of coverage of all possible form. Right now I’m spending a lot of time on the efforts to repeal the ACA, talking about the AHCA and how that would impact and Medicaid, the health insurance —

David: I’m going to jump in here with a quick update, since we recorded this interview, the Senate has released their own ACA replacement bill called the Better Care Reconciliation Act. While there are some differences between the AHCA that Holly mentions, this new version. The senate’s bill would still have some major impacts on Medicaid and individual’s health insurance coverage, in a lot of those effects would be similar to what they AHCA proposed, here is Holly with more. —

Holly: It also look at impacts that rural hospital closures has on people around the state, whether it is the economic or their access to care and what it looks like for people to lose their local hospital, that raises all sorts of questions about timely access to care, if you’re having an emergency or if you’re just trying to get preventative services like a mammogram. Towns are finding people are less likely to drive 35 miles to get a mammogram when they were using a popping over on their lunch break.

David: You touched a little bit on how you hope to educate people, what do you think journalism’s role is in today’s world, in general, and then specifically with healthcare and addiction related topics?

Holly: I’ve always seen it as a literacy process, that you need and I think people need information for their day, you need it to make a town a community a society run smoothly, you can’t have decisions being made in the shadows when it affects everyone around. I think that people are just innately curious about what’s happening with the people who make decisions, whether it’s law makers or executives but the key is that they want to know it in a way that they find interesting, no one wants to sit down and read a 10 Q.

David: I don’t know what that is [laughs].

Holly: It’s a financial file, it is an annual financial filing that companies have to file, no one wants to read that except maybe me and lots of equity analysts and journalists out there, it’s my job to take the information that people need to know, present it in a way that they want to read it.

David: Related to that, in your opinion how much is knowledge or lack of knowledge, a factor of drug misuse and the surge of addiction that we’re seeing now?

Holly: I think that there is a fair amount of naivety about the danger that comes with medicine, from the interviews I’ve done from the studies I’ve read people trust what physicians prescribe, it comes from a doctor the doctor went to school for a lot of years, you trust that relationship and you don’t think that what you’re given, that’s supposed to help you feel better could ultimately make you feel worse and potentially ruin your life for some period. People want to quick fix for their problem, popping a pill is a really quick fix, it takes time to put one in your mouth and take a gulp of water and they would rather do that, then do the work to get at the root of the problem.

I hear from readers who e-mail me and say, well I was in a car accident and I had to have pain medication, I’m not a physician and I’m not saying you don’t or you do because that’s not for I mean to say that’s between you and your physician but physicians say, that when they try to wean them off of pain pills, and get them into rehab or movement exercises. Whether it’s some easy stretching or dare I say yoga, which is still deemed to be hippie dippy by some people, there’s a real resistance to putting in what is work why does a commitment to movement, to maybe get out and alleviate some of the problem rather than taking a pill which is just masking the symptom.

David: The big news item related to substance use right now as you mentioned is opioids. Before we dive in to talk more about that, could you give us a brief history of how that epidemic has developed I guess over the last 10 15 years or so here in Tennessee?

Holly: I was just listening to a state health official talk in the last few days at an event, he reminded people that this is not the nation’s first opioids epidemic, and there was one at the turn of the last century as well —

David: This is true and here’s a little more info, in the late 1800s many Civil War veterans developed opioid addictions after being treated with morphine for injuries that they sustained in battle, this earlier epidemic spread even more widely because of help from the pharmaceutical industry, in fact in 1898 the Bayer Company now famous for aspirin, began commercial production of a new wonder drug, that was touted as an effective pain reliever in cough suppressant. That wonder drug was heroin. —

Holly: But the current problem really has roots, a change to the way pain was measured by providers, I think it was the mid-90s. Pain was added as an extra vital sign that doctors and providers were measuring and also graded on, not graded but scored. So doctors wanting to make sure their patients felt good or they didn’t hurt because I think if you’re a doctor, or if you’re any sort of provider you want to help people. You don’t want to see them suffer.

David: Yes, I mean you feel like you haven’t done your job.

Holly: And they’re coming to you and it’s just being an empathetic person. You want to do what you can and somewhere along the way, pills became a really cheap answer. It became cheaper than rehab, it became cheaper than physical therapy. It was easier than going to the gym and being active. Insurers talk a big game right now about what they’re doing to monitor the doctors writing prescriptions but by the same token, I hear from pain specialists who are trying to get people off the pain pills but there aren’t enough rehab sessions under the benefit plan to really see through an enough of a treatment plan.

David: Because it takes time.

Holly: It takes time and if you’ve had pain in multiple areas that originated from some issue 20 years ago, hypothetically 15 treatments or sessions is not going to work through that. It’s not a simple issue. It’s got tentacles in how people think about their health, their life, and the accountability they want to take for how they feel and treat it. Plus you have to factor in the socioeconomic issues that a lot of the places particular Appalachia which was hit hardest and first. You have lower incomes. I interviewed the former secretary at the USDA last year and he was talking about the relationship between an economically depressed area and the depression that goes along with that and how opioids are an antidote in some way.

In some people’s mind, not only can they be a pick me up there’s a source of income. If you’re getting a prescription and you’re selling it. I’ve heard estimates in some areas in Tennessee you can make $30,000 a year by selling on the black market. That’s not a bad income. So when you’re thinking about this, you can’t go out from one angle because there’s economic. There’s health care, there’s personal accountability, there’s access to care, there’s access to rehab or PT and then there’s also as any scientists will tell you right now the emerging research on what makes a person prone to addiction. I am in awe of people who try to come up with strategies to tackle even one part of it. Because to me, it’s even worse than herding cats. Eventually, they will all take a nap and maybe you can grab them, but-

David: -Where do you start?

Holly: -but where do you start?

David: So on the local level, what are some things that the state government has done to try to strengthen prevention efforts and also access to information and treatment here in Tennessee?

Holly: The state has tried a variety of measures in recent years through, not only legislation passed by law makers but also some regulations that condone from Governor Haslem through the health department. They’ve really tried to clamp down on the number of prescriptions that get written. The control substance monitoring database. If a provider’s writing a prescription, they or representatives are supposed to be checking this CSMD to see if that person has other prescriptions that are controlled. So through that, the state has been able to track the number of pills and the morphine milligram a pill one. Which is a unit that compares the strength of opioids in the potency of morphine?

David: So it brings them all to this even playing field, so you can–

Holly: Yes, because hydrocodone is not the same as oxycodone and how do you track those besides the number of pills floating out in the ether when the potency is not the same. But there was a study last year —

David: Let’s take a second to explain this a bit further. As Holly said, morphine milligram equivalent or MME units are used to accurately compare between opioids of differing strengths. So let’s look at some examples. The Center for Disease Control, recommend using caution with opioid dosages that are at or above 50 MME per day. So to help people figure out how their pills measure up, the CDC created a conversion chart.

For example, hydrocodone has a conversion factor of one. So 50 MME of hydrocodone would just be 50 milligrams, but oxycodone has a stronger conversion factor of 1.5. Which means that you only need 33 mg of oxycodone to hit that 50 MME threshold. It’s like this, if you’re using regular strength laundry detergent, you might use a full cap of soap, but if you’re using some concentrated detergent, you may only need to fill half of the cap to receive the same results. So, when talking about the potency of these two opioids, 50 mg of hydrocodone and 33 mg oxycodone would be equal. Hope that helps. All right, back to Holly. —

Holly: The MMEs out there and Tennessee have been coming down in recent years as physicians have written fewer prescriptions or they are writing fewer pills per script which is one thing that the state has wanted to do so–

David: -So that they end up with less leftover pills maybe?

Holly: Yes, it’s more of a right size prescription and then if you need more you have to come back because you can’t refill that on the phone.

David: So did those seem to be working? I mean it might not be in an opinion that you have.

Holly: If you look at the data and the state just had the data done this week, the last five years of reported data, the number of prescriptions and the MMEs are going down but the number of overdose death continues to rise. So if you’re thinking about chart, you’ve got one hill that is sloping downward, but then you’ve got as a relaying and it continues to be a very steep climb. Law enforcement and state health official say that as fewer pills are on the street, people are moving to illicit drugs. Fentanyl and heroin are showing up in places where they weren’t previously. From 2014 to 2015 for example, the number of confirmed, overdosed deaths in Davidson County with heroin in the system went from 25 to 40. That’s in one year in one county and —

David: Here’s a little context, Davidson County is the second most populated county in Tennessee and contains the state’s largest city, Nashville. So it’s a big metro area. —

Holly: So what you’re seeing according to the TBI and the Mental Health Agency is people are turning to other places. I got a call from a reader, probably nine months ago after an article I’d written and she wasn’t angry at me. Some people are very angry at me. They think I’m personally trying to stop them from having prescriptions, but she was saying that she really needed her pills and if she couldn’t get it from her doctor and four doctors had refused to prescribe her something.

She was just going to go by heroin like she used to on the street. I was thinking, okay that’s a big step, that’s a big jump there. I mean you do see that and the number of heroin arrests according to TBI data in the years that overlap with the health department, the data was just released they are surging across the state.

David: So that’s where people are not necessarily using their prescription as much which is good but then they’re still using something and that can be heroin.

Holly: Or Fentanyl. The overdose deaths that have Fentanyl and heroin confirmed in their system have grown in recent years according to health department data. Now, not all people who abuse prescription painkillers are going to escalate into an illicit drug that is evident from all sort of conversations I had from law enforcement. From people who have abused, but for those people who do feel the physical urge, who need that next high, who constantly need that next level of potency, it is a switch that some people are willing to make.

I interviewed someone about a year and a half ago who said that he didn’t see himself as an addict because he wasn’t taking heroin. He didn’t see himself as an addict because of this or that. Then one day, heroin was cheaper than the pain killer he was buying on the street and they didn’t have enough cash. So I thought just for the day, a deal with heroin but I’m not an addict and all I’m going to do it once. Well, that’s not happened didn’t took him a few years before he got clean but he says he looks back and he kept using the illicit drugs as a benchmark for why he wasn’t an addict. Then at some point, he was telling himself, ‘I’m only doing this because it’s cheaper. So I’m still not an addict or an addict because I don’t look what you see addicts on TV.

But indeed he was and now he’s clean and he’s living a good life and all that but looking back, he walked me through the progression and for some people that won’t happen, they’ll monitor how much oxycodone they take or whatever their pillows and hope they don’t take too much but for some people their urges there, their urges there to steal, their urges there to just take more and that’s what science is really grappling with right now.

I spoke to some people recently while I interviewed them who said that, a better understanding of the genome could tailor how pain specialist or providers treat pain in the future by saying, okay you’re at risk of becoming a substance abuser so we’re not going to prescribe you that.

David: Yes, and so at the same time that government agencies are trying to fight opioid misuse in local communities, there’s also a sweeping health care reform that’s being worked on in Congress at the national level, so how do you think that potential changes in federal healthcare laws might affect the future of coverage and treatment options for people who have addiction issues?

Holly: Under the previous administration, these surgeon generals and a lot of the policies and regulations that were coming down to treat substance abusers, were designed to treat the abuse and addiction as a disease, not a crime, which is a distinct departure from the war on drugs and it will be interesting to see if that mindset carries through, we’re probably too early in the current administration to really get a feel for what their drug policy is going to be, if the American Health Care Act is successful in the way it’s currently written which could change if the Senate takes —

David: In fact, it already has changed a little as I said earlier, the Senate has developed a new health care bill with some minor differences from the AHCA that the house of representatives created but what Holly is about to say about individual states having the ability to redefine which conditions qualify as essential health benefits for their state residents still applies to the Senate’s current bill, here’s Holly again. —

Holly: And right now, mental health and substance abuse our treatment is one of the essential health benefits under the ACA, states would then be able to apply for a waiver to define their own health that benefits. You could see a discrepancy among the ones that choose to cover it and some may not choose to cover it and in Tennessee, it’s particularly interesting. It will be interesting to watch it’s an expensive treatment much like the argument from some quarters is as though is that, not everyone needs maternal care so why should it be recent in the central health benefit?

Well, not everyone needs substance abuse so you can see the argument made but it’s going to be really interesting to see how that would play out in Tennessee its own public health officials have called opioid abuse and misuse an epidemic.

David: Coming up, how the opioid crisis is redefining our cultural stereotypes about addiction and presenting heart surgeons with a complicated moral dilemma. First, we’re going to take a quick break to introduce another trivia question from our recurring segment called This Week in Recovery History. Today’s question highlights the National Mental Health Act, the first legislation that made Americans mental health a federal priority and it was signed into law on this very week in which of the following years: 1926, 1936 and 1946? Find out after the rest of the interview.

Now, back to my conversation with Holly.

Let’s dive a little bit deeper into some opioid data now, you mentioned the data dump earlier that the state of Tennessee recently put out and you recently released a story on that, focusing on opioid overdoses. From reading the story, one of the big things that it seemed like the data revealed was, demographic info related to race gender etcetera. What do these statistics tell us about the reality of opioid addiction today and how that reality might be changing some of the old stereotypes that people might have about drug users?

Holly: A colleague of mine in Memphis, did an article in March that really is a must read about the demographics of the current opioid epidemic, state leaders have said that, it was a problem that cut across all parts of the state. The data from the different places from the state have highlighted that overdose deaths at least you are 86% more likely to be white and more than 50% of people who died in 2015 were male and then if you’d look at data from TennCare in which they track babies who have NAS more than 90% of the babies are born to moms who are white and part of this —

David: Two quick notes here, TennCare is the name of the state program that provides health insurance to Tennessee residents who are also eligible for Medicaid and the acronym NAS, refers to Neonatal Abstinence Syndrome, which is a set of withdrawal symptoms that babies experience when they’ve been exposed to opioid before birth. —

Holly: The east part of the state has been struggling with painkiller abuse longer than other parts of the state and so my colleague Kevin Mackenzie, he really got to the heart of the issue in his piece a couple months ago that looks at that tension and their frustration in black communities that have really been the target of the war on drugs in many ways for years. There’s some anger and some outrage about when we were using illicit drugs, it was treated as criminals but now that the tide has turned and the users are more likely to be white and male, it’s being viewed as an illness rather than a crime.

In an article this week, that I reported with a couple of my colleagues a judge from Davidson County said that, I’m paraphrasing but it was quite funny that “he had white people in his court who said they wouldn’t touch cocaine, it would kill you, he had black people in his court who said they wouldn’t touch opioids, that it would kill you.”

David: In that same report, the data was broken down also by counties we can see specifically what’s affecting rural areas, suburban areas, big metro areas, what are some of the differences you’re seeing in that data between each of those settings when it comes to either type of drugs or overdose rates things like that?

Holly: One of the things that’s interesting, is the growing prevalence of a variety of drugs across the state, urban areas have a long been affiliated with more of the illicit drugs but you can see from some of the data that each — that heroin is popping up in places that it wasn’t previously. This is the first time that you’re really able to understand the impact that the drug problem is having and has had over a range of years, it’s really interesting to dig into and look at the per capita amount.

In Campbell County in East Tennessee for example, that county had 21 overdose deaths in 2015, that was more than four times the number that was reported in 2012 and in small worse populous counties like that, that has a real impact. Everybody knows somebody or knows of somebody at that point. In some of the metro areas, you can still go through your day and not know somebody. In wider areas, it still can be a very removed thing and you can feel like it can’t happen to you or someone you know but when you’re moving out to more rural parts of the state, everybody knows everybody and the same goes for the overdose deaths.

David: Another article you published recently reported on a recent grant that has allowed Naloxone kits to be distributed to a number of state agencies here including the highway patrol where every trooper will now have a kit for the first time and just to clarify Naloxone is a short-term antidote for opioid overdose, so this would seem like a victory in the fight against overdose deaths but then there’s another side where people say that Naloxone might just lead to more overdoses. Could you take a minute to unpack both sides of that debate for us?

Holly: What I thought was really interesting about the grant to the state agencies is that, I learned from the highway patrol that advantage of having a kit per trooper, is not just for people who overdose but troopers and their canine companions can come into contact with very potent illicit drugs and so sometimes, the naloxone is an antidote for them when

they unknowingly or unwillingly come across a very potent batch of Fentanyl, if you are out there and you are stopping somebody on the road you don’t know what you might encounter. Having it for the troopers is really just an added protection but it is also so if they come across someone who has overdosed they can administer that before the EMTs arrive.

David: That’s amazing the drugs are so strong that even just stumbling upon them as an officer might be during a search is that dangerous?

Holly: It blew my mind.

David: Another debate that I saw that you’ve written about recently is related to treatment for endocarditis which is a heart infection that is common among IV drug users. Surgery seems like an effective solution but that solution won’t last if the patient just goes back to injecting drugs. With something like that how are hospitals and other agencies hoping to find a balance between providing needed short term fixes such as that surgery and then providing longer term more comprehensive care for the addiction that led to that emergency situation?

Holly: Endocarditis is a heart infection that if caught early enough can be treated with an antibiotic. If not caught early enough the patient may need to have a heart valve replaced. This surgery according to cardiac surgeons is not high mortality. My colleague and I, we spoke to several heart surgeons and state officials from around the state.

One physician called it demoralizing as a very demoralizing place for him as cardiac surgeon to be in even though he makes life and death decisions all the time, it’s part of his job to decide whether someone is going to recover or they are not and they are going to back to using is outside the scope of his specialty. He’s trying at Vanderbilt University their medical center they are trying to pull together into inter disciplinary teams to bring on an addiction specialist so you treat both diagnoses at the same time.

That’s one way you solve the bigger problem. Just treating the endocarditis without having the resources available to treat the addiction you aren’t treating the patient’s full problems and they are likely to come back and be in your office but it also —

David: And it’s hard to overstate how common of a problem this is among this particular patient group. In the story she wrote for The Tennessean on this topic, Holly reported data from East Tennessee that said only 7% of endocarditis surgery patients who had been IV drug users were alive and sober just five years after receiving the surgery. The dilemma these surgeons are grappling with is very much rooted in the reality they see in their communities. Here’s Holly with more. —

Holly: It’s an interesting debate among the healthcare professionals. I heard from someone that they don’t think it’s another core question at all. You treat the person who’s in front of you and you do your best to help them whereas you have other sides of the argument saying I have seen repeat patients come back and at what point is this not — I’m not fixing their heart issue it’s something of something greater and if the greater problem isn’t resolved, they are just going to keep coming back.

David: And that sounds demoralizing as well.

Holly: Right. In East Tennessee, they were thinking about ways that they could move patients from surgery recovery into like a rehab type place to try to pair up to get better outcomes but they are both very costly. Surgery is expensive, rehab is not cheap, then it becomes a question of how do you orchestrate that? Is the infrastructure in place? Lots of people would argue it’s not. How do you pay for that and then do people want that help?

One of the physicians talked about how some patients didn’t want to sign up for the surgery if they were going to have to commit to rehab. The physician from Vanderbilt he pointed out that whoever solves this problem isn’t going to be famous, you are not going to win a Nobel Prize and I think that’s one of the overhangs of the opioid epidemic is that it’s still seen as an undercurrent to society and that there’s no glory in fixing it and you see that with people who are in recovery or trying to get acceptance for having an addiction they are still a deep stigma about that and the resources haven’t followed.

David: We’ll just wrap up with this last question. As you process all the statistics that come out and all the conversations you have with people who are on the front lines of this epidemic, what is the feeling that you are left with about what’s next for this issue and what you’ll be covering in the future?

Holly: I expect that covering the opioid epidemic will continue to be a focus for me and my colleagues. There are an endless number of angles from the availability of treatment facilities to how you treat mothers and the appropriate protocol and that healthcare and community groups are going to be tackling this issue for years to come because as people point out to me, recovery in point it’s an ongoing struggle. I think what’s next is looking for ways to make sure that people who have gone through treatment successfully fit back into the world.

The state has a long way to go into tackling the problem. I don’t think there’s a law maker or a state official who will say that they have a hand on what’s next because I think it’s very clear they don’t. That’s not their fault, they are having to be in a reactionary position on this and then again recently there was a physician who was saying that the health care industry has a duty to help fix this because they help create it. I think that’s a really interesting step in a conversation that hasn’t really been had on a broad scale yet.

There are still a lot of questions remaining about whether this is going to be treated as a crime, as a disease there are drug courts just for substance abusers, how these are going to work. People don’t see themselves reflected in coverage. They don’t see their stories being told.

The problem is being talked about in very broad strokes right now and at some point, there’s going to be a better understanding of the root of the problem and who’s being talked about when you say an abuser or a misuser. I think that the people who are trying to tackle this from law enforcement from health care from state agencies and federal agencies are a long way off from understanding how to get out a problem that has roots in economic issues that has roots in medical training that has roots in a cultural desire for a fast fix and for the fact that some people are just predisposed to that direction.

This is not a simple problem and I don’t know that even a couple of effective strategies are going to make a dent because as you’ve seen in the state as a number of prescriptions have come down or the MMEs have fallen people look for other avenues.

David: All right thank you for your time today Holly.

Holly: Thank you for having me.

David: Thanks again to Holly for taking the time to share all of that with us. Thank you for sticking around until the end of this special extended episode. For another installment of our trivia segment, This Week in Recovery History. Today’s question focuses on the National Mental Health Act signed into law by President Harry S. Truman on this week in 1946. In the wake of World War II, many returning veterans faced mental health issues that were either brought on by or exasperated by the high-pressure situations they endured.

In this new spotlight on the poor state of the mental health care field prompted wide spread alarm as the US government realize the gravity of this problem, Congress responded by crafting a bill to provide for a host of new research on mental health issues through the creation of the National Institute of Mental Health. This research quickly inspired advances in prevention, diagnosis, and treatment and also led to a pretty major shift in the overall approach of mental health care. The discovery that patients benefited more from evaluation and treatment than they did from simply being institutionalized.

Now the world’s largest mental health research organization the NIMH has an annual budget of one-and-a-half billion dollars with which it continues to transform the understanding and treatment of mental illnesses. So that’s The National Mental Health Act and acted on this week in the year 1946. Stay tuned for more trivia from recovery history in future episodes.

This has been the Recovery Unscripted podcast. Today, we’ve heard from Holly Fletcher, healthcare reporter for The Tennessean newspaper. To read more of her work, visit Tennessean.com. And thank you for listening today. If you like what you’ve heard, please check out some of our previous episodes and subscribe so you won’t miss out on what’s coming up next. See you next time.

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Can LGBT-Affirmative Therapy Help Re-Write Internalized Messages?

Episode #101 | July 17, 2019

In a heteronormative culture, how can providers use affirmative therapy to help LGBT individuals re-write the false messages they’ve internalized?

We’ll answer this with psychologist, author and activist Dr. Lauren Costine on this episode of Recovery Unscripted.

For more about Dr. Lauren’s work, visit drlaurencostine.com.