 I'm James Milan, and this is Talk of the Town. Welcome. Today, we are going to be talking about a subject that is very serious here in Massachusetts and nationwide, very familiar, I think, to all of our audience as well, and that is substance use disorder. It's current manifestations and what can be done about it, including myths about addiction, et cetera. And to do that with me, I have. He doesn't see himself as an expert, but I do. Will Lakatur is joining me. Hi, Will. James, nice to see you. Thanks. Thanks for being here. Will is the Director of Community Outreach for Brightview, Massachusetts. And Brightview runs in a number of states, outpatient addiction treatment centers. And so Will spends his professional life in this space. And we want to tap into his knowledge and talk extensively and in some depth about what the current situation is. So again, I thank you for being here. Well, thank you for having me. Can you start us off by just actually at the most basic level? Why not start there? I think most of our audience is already going to be able to supply an answer of their own to this. But what is addiction? It's a disease. And it's something that people can't control. It's like having heart disease. You don't choose to have heart disease. You don't choose to be an addict. And it's something that can be treated with medication. And I actually want to start before we start talking about the services that Brightview and other such companies provide and also what the general issues are here in Massachusetts. I'd actually would like to start with the things that people think that aren't accurate and that aren't true about addiction and treatment for addiction, et cetera. So what are some myths that you're probably very familiar with that you can share with us? It's a great question, James. Some of the factors in the society is people can cut cold turkey on it. And that's not the case. If people don't get the proper treatment on it, it can be deadly. And people that have addiction, we need to treat these people that have addiction like they have normal disease, heart disease, diabetes. You treat them with passion and empathy. And given the resources to help, because if they're not getting those type of resources, they may not want to go to treatment and they may start using more drugs more because they're not feeling ostracized, they're feeling excluded from society. If we educate society on helping people in the community and the resources that are available to people that need to get addiction recovery, that's the big thing right there is just helping them. Yeah, I mean I think what you're speaking to there is like this stigma, which we're all very familiar with, right, which makes us think collectively about such people who are in need of treatment for substance use disorder, we may think of them as, oh, they got themselves into that situation, they should get themselves out, or, oh, that poor person too bad for him or her, again, not really seeing people in those situations with compassion and the sense that, oh, you know, there but for the grace of God, blah, blah, blah, but instead it's really, we are excluding them in a sense as a society, it's part of what I think you are both combating against and trying to educate around. Yeah, if we educate the community, you know, like we're working with a lot of local police departments and providing resources to them as far as some of our partners so that we're able to help people get help at our centers and also our competitors because, as you and I were talking earlier, this is an area where we're not competing in, so we're here to help people and we want to utilize, if we can't help someone here, we want to get them help right away because a day could go by and they're not getting help, that could be deadly and we can't just put someone on a waiting list for three weeks, we need to help them right away and that's where Brightview offers patients to come in, walk in during the week and that's something that we take great pride in trying to find and help them and find the resources right then and there and we customize and a lot of other people do it too as far as our patient services is we try to customize what we're doing for the patient to help them as far as what's going on in their life. Right, because every patient, as we know, is different and I do want to just kind of follow up on something you were just saying again, kind of delineate the many ways in which the work that you're doing and the space in which you're doing it is just fundamentally different from what we think about as businesses competing against each other. This is not somebody walking into your car dealership and you want to make sure they buy that car from you and not from the guy down the street because you've just said it yourself. This problem is too big, it's a societal problem. You are now putting yourselves on the front lines of something that we all have an interest in but you guys can and are actually doing something about. So in order for that to happen, you need to, I assume, work in conjunction with other people providing or other businesses providing similar services and also with other kind of, I was almost tempted to start saying kind of social welfare services which most people don't see a police department as but here in Arlington we have a recent history going back at least 10 years if not more of a police really seeing themselves as tackling this problem especially the problem of opioid addiction in a way that does not stigmatize, that does not try and criminalize behavior that as you said is more around health and around disease and around treatment of disease and not again incarceration or some other form of isolating those people who are suffering instead seeing themselves as being among the providers of recovery services in a sense. Do you guys work actually with the Arlington police department? Yes, we have. We work and we just actually had some representatives over to our center over in Mass Ave a week or so ago actually last week on the 15th and we've met with the chief of police as well too and they're awesome to work with. They really want to help within the community and also set an example here in Massachusetts as far as some of the things that they're doing as far as addiction and recovery towards getting for the addiction and we provide services back to them as well too. We're not just here to help their patients get outpatient services for recovery for their addiction but we also want to help them as far as transportation to the facility whether they need a job, food, some of the essentials for everyday life and we have a resource or referral network that we utilize a lot of services that we want to actually expand and give to our partners that we work with as well. Whether it's the police department or if it's a hospital it could be you know the parole officer. We're trying to make people's lives better and one step is starting with treating the addiction. And again you see yourselves as part of a network of different services to again address this issue which has so many different facets to it not simply the physical addiction component that you guys really deal with you know very directly. Let's take a step back for a second if you don't mind and talk about like what the overall situation is like at the moment here in Massachusetts which I assume you as the director for community outreach for the state in general you're probably aware of like what are the things that are most troubling most concerning for us as a population in this space of just substance abuse let's say. What are the drugs that are most worrisome at the moment? What are the kinds of things that what are what are we seeing here? Great question there's you know there's obviously the opioids is a major major problem and there's also the fentanyl and then it's now also now the trunk that is actually now found in the fentanyl as far as a horse tranquilizer and that's a major concern because the Narcan can't really can't help on that and it's really alarming in many ways. Obviously there's alcohol there's cocaine there's all these other drugs that are out there that is major problems here in massachusetts and throughout the country but at the same point there's other drugs as well too that can cause addiction sleeping pills depression you know attention deficit type of medication these are what we're seeing out there and it's the issue is not going away anytime soon we're here just to try to help people recover and live a better life and deal with a lot of the the issues that they're dealing with as far as their addiction and it's it's concerning and it's growing and I know the government and the state has done an awful lot as far as putting resources back into helping people we work a lot with a lot of hospitals state of massachusetts has set up these community behavioral health centers that we're working with to help patients instead of going to emergency room for addiction in overdoses they're going now they're trying to push them towards the community behavioral health centers and we're working with a lot of these centers to help people get off of their addiction. You know you were in what you were just saying you mentioned tranq and this is horse tranquilizer I guess that must be being cut into you know fentanyl which itself is also cut into other substances and then you mentioned that that a big problem with that is that it is resistant or Narcan is not effective in that situation let's just remind folks what Narcan is well not if someone overdoses on on an opioid Narcan is administrated and helps save their life that's the big thing we're trying to teach more and more people to how to be able to have to administrate a Narcan and at the same point have them available police departments need to have these hospitals have them as well too so it's it saves a lot of people lives when they're overdosed you know I as I was preparing for this interview and doing some reading to do so I was surprised because I don't see it on display or something like that to hear that Narcan is available in most pharmacies and at CVS etc did you know that I didn't yeah I really I assume that that is true I have not yet done the you know the the personal investigation of walking into our local Walgreens or whatever but if that's the case then I assume that one of the things that you guys are trying to to make sure that people understand and educate and encourage people to do is carrying Narcan with them right you know again just because they may know somebody who might need it or they may not know somebody who turns out to need it right and they happen to be in the area I assume it Narcan does work that well right yes yeah and it's and it's the only game in town I think in that way is that right right but it doesn't it doesn't help on the tranquilizer right and that's a concern yeah that sounds it yeah that's a that's a big concern right so one of the things I was wondering is you were mentioning before and we should make it clear I made the analogy to a car dealership and to the fact that this is a societal problem and that's a very big difference but the other thing that we should talk about and you did allude to the fact that Bright View allows for walk-ins is the fact that when somebody needs your services when somebody is in crisis in this particular way they need help right right then correct right we can't afford as a society or a community for them to have to wait for a week two weeks three weeks which is so often the case so how does it work when somebody you know walks in your door had just kind of walk us through what happens at that point great question is if a person walks in before three o'clock five days a week Monday through Friday they will go through an intake process they'll go through some clinical and medical and then they'll be seen by a provider there's a little some paperwork that has to be done and then the next day they do some follow-up as far as setting up appointments other services that they may need to have and they they actually we actually set up a treatment plan customized towards that particular person so that it's no one plan is the same because everyone's life has got different demands and you know having an outpatient service like this a lot of people don't have time to go away for a month for their addiction it's you know this gives them an opportunity to continue their life with their family their job and also on their way to recovery so we feel very proud of what we're doing over Brightview as far as having people come in because if someone is that day they want to get service and they can't see someone the next day they may change their mind we feel that that day they show up we're going to walk them with open arms give them resources to help them not just on our patient services for for their recovery but other areas that we can help them case managers group therapy and a lot of other resources that we have as far as working with our patients one of the things that that I wonder about is whether you know I I tend to think of people in need of these services and in crisis and how easy or hard it is for them to recognize that for themselves how often when you get somebody walking in like we were just talking about is that person has that person made that decision for him or herself and how often is it that somebody else is escorting them there you know to again to in recognition that this is what needs to happen you're gonna see both both sides of it there's obviously there's some patients coming in because they're court ordered and when they have to do that we're trying to help that person because they've been in and out of the court system quite a bit so obviously they're coming in with court order a lot of other people come in based on just they've had enough they just want to they want to get help and when we move forward other people coming in just because they've gotten out of the emergency room and they've been given a bridge script now they need to they need to take the next step to helping them get recovery and do you find that it's just it's different to work with people depending let me put it this way how important is is the the patient's attitude towards his or her recovery in the in the chances for success of that recovery in other words if you've got somebody kind of dragged in there either by court order or by a concerned family member or friend or something like that is that already automatically starting with a with a with a heavier lift for you and for the patient yes and no i think what it comes down to is how we how we go about us we're going to treat that person as a person and treat the addiction as a disease and by doing that we might make them feel welcome and that we're here to support them and here to help them they may have relapses as you go along but we're not going to turn them away we're going to continue to work with them so if we show empathy and compassion to them they don't feel like they're just pushed off to the side like sometimes society can do with this particular disease you know we just got to battle through that and work with them and and that's one of the big things about what we're doing here at Brightview as far as helping people you're going to have some people push back but when they're ready they know that hey we were there for them and you know i feel very comfortable going back and and trying it again because sometimes their mindset may not be right then right that at that particular time maybe if they go home maybe they think a little bit more hey that person was really trying to help me out i mean it was a little too hot in that person you know what i want to go back how do you do you guys have any opportunity to know what happens when somebody's course of treatment is done with you so in other words like you said you're part of a network of different service providers to help uh and and you are yourselves trying to facilitate uh other services for your for a patient so that he or she again is not left a ground with just you know just having gone through this recovery process and then they're thrown back in without the same supports that they didn't have uh earlier so how much are you able to see what happens or know what happens after a patient leaves well like i said the the treatment program for a patient is customized towards their needs and what they're dealing with and the provider that works with the patient sets that plan and there's a course of how we go about it you know the m at the medication is for the for addiction treatment is a program that helps the patient wean off of their addiction and that's an area that really helps the patient because it does prove results 90 days does make a difference and we've seen major results as far as reduction is as far as a lot of different things and one of the areas that it's right here is you know we've seen a decrease in substance abuse uh 70 percent with by doing that so you mean in the in the patients that have come through your doors 70 percent reduction in substance abuse when they when they stand when they stay on the m at program that's a big that's a big thing the other area is a 50 percent decrease in alcohol consumption 77 70 percent decrease in time spent in jail 50 percent decrease in unemployment 60 decrease in an arrest so the by working getting on the program with the m at and working with the provider it's a step there may be some of the abscess you can't control that but we're we're continually trying to get them and the patient to move forward in and how they go about it is is a process so as they move continually get better and better and better they're weaned off of the medication treatment and then all of a sudden they're able to go back and so patient stops coming in we get worried we're going to we're going to follow up with that patient we're not going to just let them go away so and we work with our partners as far as that as well too yeah and uh the I I know that you you have uh reminded us a couple of times for sure so I don't want you to think that I wasn't listening I know that you that each patient's course through your particular you know your particular facilities is a customized course but is there like a an amount of time that you know is necessary for you know most people to to be able to commit to coming to those sessions over a course of time in order to in order to ensure the best chances for success um can somebody so in other words do you have a again customized as it is is it like a three week program is it anything from three weeks to you know long time or is it just really different for every single person different for everyone like I said the 90 days that's a real big part right there the night first 90 days makes a major difference some patients have longer periods because it depends on the the the addiction they have towards a particular one could be an opioid which is going to take longer there's a whole process that we go through on that so it's just not one particular customized you know one day a week or or three months and you're done it could take longer and I and I think one thing is it's it's always there you're always recovering from your addiction and you always have to have that support and then it goes into other facets of the support you have whether it's working with group sessions working with other people a lot of people that you know are in the industry that are actually helping a lot of people with recovery are former addicts themselves and that's so they know the language they they know what they're dealt with and because they've been there and that's that also helps the person that's trying to get recovery I wonder if you could share any wisdom you have about the I assume that part of the the treatment that people are receiving in these in these situations is around giving them tools to be able to go back out either after the course of treatment in general or whenever they're not in the facility and they're at home and in their lives etc tools and supports that they can carry around with them I I wondered if if that is the case if you could give us examples of of you know some of that kind of thing are you talking like for a job specific or no but more like just like so when the person is in your facility I assume that they're meeting with I don't know their like well maybe I should reframe it and just ask you when somebody is on it is in the course of treatment what would visit to the facility look like you know standard okay I've got a I'm I'm going there today what what what what would that look like who are they talking to what are they what are they talking about what I understand now what it comes down to is after they do their first initial intake going through the medical and the clinical and they meet with the physician the next day they come in they set their plan so an everyday situation coming in they'll be greeted at the front door by our our staff at there and then they may have to wait in the waiting room for a little bit but then they will meet with the provider whether it's a therapist or a doctor or whatever is going on that particular session they have closed closed doors it's all privacy sometimes you could be telehealth too because right now with the the the shortage of of medical professionals and therapists and so forth it's just not here in massachusetts it's nationwide so we'll utilize our other providers that could be down in hyenas or or lol and even though the appointments in in Arlington so they're not going to not have an appointment they'll always have that opportunity to see someone whether it's face to face or through telehealth and that's in that basically you were saying could be a therapist it could be a physician it just kind of depends on what is going on with that particular patient what clear clearly what their needs are and how to address those and is these are outpatient treatment clinics does that mean that that really it might be just as a visit it's it's not necessarily a daily visit that's required for any length of time or anything like that it really just works with you work with every patient's individual schedules correct so it could be coming in most of the time it's once a week depends on what how often the provider wants to see that particular patient but again we have we have 12 centers throughout the state in 80 throughout the country and we only utilize the telehealth for the professional the providers here in massachusetts so we're lucky on that aspect so if we're someone's out particular day but we usually have the patients always seeing the same person all the time so this continuity and consistency yeah i would assume that's really important right piece of things you were talking about how there is a shortage as i think most people are aware of that there's a real shortage and on the healthcare professional side and that you guys then need to make use of telehealth in order to make up for that among other things which makes sense the but that makes me wonder what are the challenges that's clearly a big challenge right just having enough providers and being able to access enough providers any other challenges that are really glaring or that you could that you'd want our audience to know about in in tackling this really difficult therapist is a big one right now we can't find enough therapists there's a shortage there's a lot a lot of people that are dealing with a lot of issues right now for a lot of different things it could be addiction it could be depression it could be a lot of different things for that have happened over the last million years with the covid it's affected a lot of people adults and young children and the therapist is an area that is the shortest here in massachusetts and throughout like you said the country so that's probably there could be a little bit of a wait time in some areas uh depends on the center that we have but by and large we're trying to see our patients right away because they need to they need to be seen not not tomorrow today and i know that Brightview itself has been in business for about eight years now and i'm wondering whether you see you know whether that's long enough for you to get a sense of things are getting better things are getting worse what what lies in front of us it's not going it's not going away time soon it's going to be unfortunately it's going to be here for a long time and we're continually educating people about the addiction the disease you know and we if we treat the disease like any other disease we can help people recover and obviously you know the opioids is the situation there is a major issue and we help you know people get off of the opioids it's going to help a lot of other things too okay you know our time has already you know come you know it's coming to a conclusion it goes very fast all the time when we're talking here but i wanted to ask you if there's anything else that you just you want to make sure that people in that our audience understands that we hadn't haven't yet mentioned or that we didn't cover sufficiently like i said at Brightview we treat people as people we treat the addiction as a disease and we're here with open arms to help them all out walk in we're going to get them seen and we're going to help them live a better life great and you know we want to remind people that Brightview is of course one of a number of different providers of this sort and we've asked you here to to speak to the general situation we really appreciate you doing such appreciate it james i have been speaking to Will Lakutur who is as we mentioned before the director for community outreach for Brightview, Massachusetts all 12 facilities 12 right and we really do appreciate Will taking the time to come and join us and educate us we appreciate your time as well this has been talk of the town i'm james melanne we'll see you next time