Join @RichardTaiteOfficial and special guests Dr. Kenneth Spielvogel and lair Steel Psy D for an eye-opening and informative conversation about helping expectant mothers who are suffering from substance abuse issues. Dr. Kenneth Spielvogel is a Senior Medical Officer with a Special Interest in Addiction Medicine and Blair Steel Psy D. is a Licensed Psychologist. For all things Richard Taite, the We're Out Of Time podcast, and Carrara Treatment Wellness & Spa: https://linktr.ee/richardtaite Key moments from this conversation with Blair Steel Psy D, Dr. Kenneth Spielvogel & Richard Taite. Intro 00:00 What has Dr. Spielvogel seen firsthand during the last 5 years of the addiction epidemic? 02:02 What are some of the primary issues that Dr. Steel sees facing women today and how is substance use playing a negative role? 03:11 Are women not receiving the medical attention they need concerning substance abuse especially due to stigma? 06:20 What is M.A.T., medication-assisted treatment? 18:11 What psychological factors does Dr. Steel see with her patients regarding early recovery? 24:36 Why is trust a primary factor in helping those in need of addiction & substance use disorder? 27:06 How is AI technology becoming a part of treating patients in recovery more effectively? 32:50 #advocate #losangeles #substanceabuseawareness
Chapter 1: What are the challenges pregnant women face in seeking substance abuse treatment?
There's nothing more tragic than seeing an overdosed mom in the ER who's potentially unrevivable. Her unborn child suffers the consequences as well.
As you guys know, my name is Richard Tate. I'm the founder of Carrera Treatment Facility. And I call this podcast, We're Out of Time. And the reason I do that is because we actually are with this fentanyl crisis that we're having. I mean, the opioid epidemic has been going on for a while, okay? But now it's killing everybody with fentanyl. And
you know, when you were back in the day, when you were scoring cocaine or heroin or pills off the street, it wasn't, you, you thought you were getting it, you know, you were getting the Percocet, you were getting the heroin, you were getting all these drugs today. That's not what you're bargaining for. Okay. It's being laced with fentanyl. It's killing about, um, 112,000 people a year, right?
And it's increased 30-fold over the last 10 years. And most of it has been in the last five since I've been gone. And one of the reasons I came back was because of this. This is Dr. Blair. She's a psychologist. Fantastic. She's been doing this for about 20 years. This is Dr. Kenneth Spielvogel, one of the finest women's physicians in the city. And let's start with Dr. Spielvogel. Good morning.
Chapter 2: How does stigma affect women's access to medical care for substance use?
Thank you for having me. It's my pleasure. Thanks for being here. Yeah, I mean, this is an epidemic and it's in the realm of pregnancy and delivery. It is a unique problem because in my job, it's a unique area of medicine because we treat at least two patients at once. We'll have a mom and unborn child.
If it's a singleton, if it's twins, triplets, obviously that brings more individuals that are affected into the picture. So, you know, this problem I've definitely seen, you know, the pandemic weirdly kind of brought a certain quiet to it and definitely started to rear its head up again. And there's nothing more tragic than seeing an overdosed mom in the ER who's potentially unrevivable
And, you know, her unborn child suffers the consequences as well, too. So, you know, I wanted to be involved. I wanted to have a voice that extends well beyond the hospital. So I really appreciate you having me here. It's my pleasure. Thanks for adding to the conversation, Blair.
Yeah, you know, so much has changed with time and women's issues. And one of them is the prevalence of substance abuse in women. And women, as we know, are mothers. And there is a lot of stigma attached that can really prevent someone from seeking treatment and asking for help. And some of it can come from extremely well-meaning practitioners.
Especially when they show up to treatment pregnant showing. Yes. Because there's so much judgment around it.
There is. And you have to be aware of that and work through it. And to be honest and vulnerable, I've had to work through this myself. And it's very important that I get to the place that this person needs and deserves as much love and care and attention as anyone else.
Yeah. Someone asked me last week, they said, what's one of the biggest barriers to treatment when it comes to opioid addicted moms? I said, judgment.
Honestly, judgment is probably the biggest one because I can walk in a room, introduce myself to every family member, to patient, really get on a level to where they feel safe and cared for and in a judgment-free environment to do so, which honestly, to get a patient... who's addicted to trust their healthcare provider is an incredible challenge.
And especially when you mix in race and we look at the outcomes, especially for African-American women these days, and that they clearly have a disparity when it comes to healthcare, being able to bridge those gaps and get to a place, have them feel safe and cared for and trust you, and then you leave at the end of your shift and someone else comes in and that trust is eroded instantaneously with the person walking in the room.
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Chapter 3: What is medication-assisted treatment (M.A.T.)?
So heart disease, for example, is the leading cause of death in women. And to this day, a man and a woman can enter an ER with the same symptoms, chest pain, et cetera, and he will be screened for a heart attack and she will be screened for a panic attack. So if we can have, right? It happens.
So if we can have AI just read symptoms by symptoms, not with race and gender and socioeconomic and everything else. Mm-hmm. I feel like that gives some hope to people receiving the treatment that they need.
Yeah, it's ridiculous how women, it's funny, I had somebody bring in my dry cleaning, right? A woman bring in my dry cleaning and it cost three times more for her than it cost for me, right? And they do that in mechanics too. Like women get the short end of the stick. Hairstylists. Everything. Yeah, women get the short end of the stick everywhere.
How do we go ahead and erase the stigma around women who are pregnant coming into treatment?
Well, it's vital. I mean, it's because the majority of women who are using will not come in for prenatal care. They'll essentially show up for delivery or if they're having an acute episode, vaginal bleeding, contractions, whatever it may be. that's the biggest stigma. I mean, it really is. It's getting women to a place where they, uh, you know, are being treated for recovery.
Um, if they're, you know, on buprenorphine, um, that they feel like they can come in if they're requiring additional dose, um, you know, that that's done without kind of any judgment. And that's around to me, it's around education, um, And, you know, an awareness of the pathophysiology of addiction. I mean, it really is. And I can tell you, if you asked...
What's the amount of hours that I receive training in specific to addiction during a four-year residency? One hour. Well, my answer would be we do a internal medicine rotation as an intern, your first year of training. And essentially, you know, somebody drunk comes in the ER. You admit them for, you know, treatment of withdrawal. Very patient-specific. Probably totals about four hours.
In four years. In four years of when I train 90 hour work weeks. Right. So there's no understanding.
Well, you know, I hear often working with clients who have to go to the hospital and when addiction is the primary diagnosis, right? Substance use disorder. They feel like they're treated like second class citizens. Mm hmm. kind of thrown in the hallway, not given the attention. And I truly believe that healthcare professionals are well-meaning, but we're still human.
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Chapter 4: Why is establishing trust crucial in addiction treatment?
So to answer your question, I feel like talking about it and injecting it with compassion is essential to getting people aware of where their biases are, not if, but where, right? And bringing it to surface, bringing it to light.
I find if you relate it to a disease that people are already well-versed in, that's a good way to do it. So what's a good example of that? Diabetes. Somebody's diabetic. They take insulin for their diabetes. Nobody looks at a person who's diabetic and on insulin and says, why are you on so much insulin? Like, why are you on 120 units a day? Let's put you down. That's not true. Let's put you down.
People are getting fat shamed all the time.
They may be getting fat shamed, but point being is there's a recognition of a chronic illness. This is the treatment.
In the medical community.
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Chapter 5: How can AI technology improve treatment outcomes for pregnant women?
Right.
Okay.
So now you take somebody who's pregnant. Maybe they're already having, you know, medically assisted recovery and they're on buprenorphine. They're on eight milligrams a day. And they walk into an uneducated provider in the first trimester. He says, oh, my God, you got to taper down. We got to get you tapered down. Can't be on that during pregnancy. What do they do?
They start tapering the patient down. They start to experience withdrawal symptoms, uncomfortable. Then the trust erodes and that patient disappears. And they show up at the hospital in labor, no prenatal care and all the associated complications thereof. So understanding there are some people that will be on it for life. That's their affectation. That's the medication that they take to treat it.
Just like we treat high blood pressure. Just like we treat diabetes.
You know what it is? They come in. I think you get pregnant if you're going to carry it to term, right? You... There's a part of the mama bear inside of you, right? And it's protective and right. And so then what happens is they feel such shame, right? That they're not coming to you in the first place.
And so really what we got to do is we've just got to, it's got to be the same exact thing that we did to erode substance use disorder in the first place, which is you're not bad. You're just sick, right? right? And now, like you said at the beginning, it's affecting more than just you. And what scares me the most, why you're here, is because I'm a father.
And when you're as old as I was when I had kids, you don't just love your kids, you love all kids. And I'm passionate about this opioid epidemic and specifically the fentanyl thing. It's causing more homeless, which I'm also passionate about. And if I see another child on the street in an encampment, I'm going to snap, right? I see that all the time.
But this is so bad because they're being born with birth defects, right?
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