 I'm glad you're all here. I'm Ann Gilbert with Central Command New Directions. We're a substance use prevention coalition here in Montpelier, but we work with community partners and serve all of Washington County. And I'm really happy and thankful that the Kella Covered Library could co-sponsor this event with us tonight and provide this space so that we can have this community conversation on alcohol. New Directions works with the Vermont Department of Health on a number of substance use issues, really prevention of tobacco use, underage drinking, marijuana and prescription drugs, primarily of youth ages 12 to 25. And so working with the community, getting out to schools and parents and other treatment providers is really valuable to our work. And we'd like to be able to bring this message out to the community. So we have a fabulous panel here tonight. And I'd like to quickly introduce them. And everybody's going to talk about what their role is in the community, what they're seeing in terms of alcohol. We're really here to talk about the impact that alcohol has in our community and the harms of substance use disorder and alcohol use disorder. But there is hope. There are treatment options. And we're going to hear about that. And talk also about underage drinking and what's going on in the community and how we could make any kinds of changes. But mostly it's about community awareness, raising an awareness about the harms and the problems that alcohol causes sometimes. Even though it's a big economic help in our community. We have so many craft breweries. We're building this distillery downtown. It's part of so many social interactions. But not for everybody. So we're going to talk a little bit about that. So I think we'll start with Dr. Joggingmash Curry and let you know what his role is in the community. We do have feedback and evaluation forms that are on the table in the back. It'd be really helpful for us with our grant reporting and community observations if you jot it down some notes and put them on the table when you do leave. So thanks for being here. Thanks, Anne. As Anne said, my name's Joggingmash Curry. I'm the medical director at the Central Mountain Medical Center Emergency Department. I tried to emergency services. That's my job. And then I'm also a parent. I have four children in the community, two are college age, two are in middle school or high school. So I think what I want to do is focus comments today on the two extremes of age about alcohol. And I want to preface it a little bit with where we are, maybe with some statistics too. When you look at the newspaper and NPR and the news and the nightly news, all you hear about are opioids. That's because they have had a huge precipitous increase in death, mostly young people. So it gets our attention. But what people forget is that alcohol is a drug. And in 2017, there were 70,000 drug overdoses. Two thirds, though, about 47,000 were related to opioids. In the same period of time, almost 90,000 people died from alcohol. So almost two to one. But it's sort of the forgotten drug. And it's precariously placed, certainly in our community, like you pointed out. We live in a state where we don't experience growth anymore. We see industry leave. So we have these niche economies. And one of them is craft brewing spirits. And they're really important because they don't only provide people with pleasure if you drink responsibly, but they also drive the economy and give jobs, keep people in our state. So it's this kind of struggle. How do you balance an economic force versus its potential for destruction? And unfortunately, where I work, I'm on the receiving end of a lot of the bad effects of alcohol. So I see a couple of things. I see acute toxic effects of alcohol. I see people that drink too much, that come in very impaired or uptended or almost comatose at times. Some need to put on life support because they're so uptended or overdosed on alcohol. And then I see trauma involved with that. Car accidents, 10,000, 12,000 people a year die from alcohol-related fatalities from alcohol abuse. You're driving a weapon at that point, and you see this. People are intoxicated and they're driving a car. Can do a lot of damage. And then you also see the sort of accumulated toxic effects of alcohol. So someone that drinks for a long time that has an alcohol use disorder. So they're drinking too frequently too much or a lot at one time. And then you start to see the health issues that accumulate. So liver problems, balance problems, heart problems, lung problems, a lot of people smoke too. And then a lot of people that struggle with substances, not just alcohol, also have issues with their mental health. And you put those together and you see people that are leaving the earth way through a road. If you look at people that die from the complications from alcohol abuse, they die on the average 30 years earlier than their peers would. So if someone's living to almost 80 now, people die at 50. But what worries me now, though, is what I see at the two extremes of age. Because we know that teenage children in Vermont have the highest per capita use of alcohol. And these are high school age children. Now you say, well, you know, there's nothing to do, they're out in the woods, whatever. But what happens is the effect of that is you're exposing children to alcohol at a young age. And we know that kids that drink before the age of 15 are four times more likely to develop an alcohol use disorder. And the scariest part now is what we're seeing is the highest group that are now suffering and developing cirrhosis from alcohol use. And remember, it takes 10 to 15 years of hard use to develop liver disease. Our people that are in the 25 to 35 year range. So do the math. I think when they're starting early, they're drinking often and navigating really sick. And they're the ones, alcohol induced cirrhosis is the number one indication for liver transplant. In my own practice, I've seen two patients in the last two weeks. One is in her 30s who has horrible end stage liver disease and will probably not live to see 40. I just saw a young man who was early 20s who already has abnormalities of his liver functions in his blood. So again, we're used to seeing patients that drink for a long time. And they get in their late 40s, early 50s. We start to see them turning yellow and retaining fluid and having trouble. Now it's shifting. And you're seeing a young group of people do this, which is devastating. I mean, these are people that are just it. It's the reason you see all the attention of opioids, because opioids tend to kill young people. So people really focus it at such a tragic loss than it is. But alcohol is always classified as sort of a slow burn. It took a long time to get sick and die. So to see that curve shift over is upsetting. And it really forces us to look at what's going on. And we can't get away from it. It's a big part of our society. We celebrate family events, graduations, all these things without all. But the question is, how can you do it safely in a way that makes sense? And more importantly, to your point is, how do we educate kids? I mean, the best way to treat this disease is to prevent it, right? So how do we do that? It's not easy, because it's not an illegal thing that's hidden out of sight. It's splashed all over the media. It's splashed all over the stores. We run a race. You get up here when you're done, right? There's all kinds of things. And there's all kinds of pressures. Especially young people. The other group is elderly folks. So we tend to not diagnose alcohol-use disorder in older folks. It's kind of cryptic. We may not know what's going on. A lot of people are living solitary and alone. They don't socialize. So people don't visit them, maybe, so we don't know what's going on there. Then they come in. They're falling. We don't know why. And then someone goes, hey, I think I smell alcohol. And lo and behold, you check an alcohol level. It's 300 in an 80-year-old. And again, why is this dangerous? Well, even if they've started as a late adult, which is happening more and more now, it affects their balance, their vision, their sure-footedness, right? So we see falls. Falls are killing elderly people. It's estimated in the last seven or eight years we've seen a 30% increase in people falling. People that fall are on medications like blood thinners. They bleed into their head and their brains. They break their hips. Or if they get hospitalized, we know if you use a certain level of alcohol, you're going to stay in the hospital three to seven days more than someone who doesn't have an alcohol use disorder. You have a much chance or a higher rate of having heart arrhythmias, breathing issues, all kinds of things. So we have these, everyone thinks about people in the middle of 40 to 50 years old. But if you really look at either side of that, there are some real problems. And these are the harder problems to take care of. But what we do now, the emergency department is always the catch-all. People would come in when everything would go wrong. And they'd crash in the car, they'd fall. But we've started now screening everybody for their patterns of use. So we don't, we used to be, do you drink yes or no, right? Now it's, do you drink yes? How often do you drink number? How many drinks do you have when you drink drink? Do you ever drink more than a certain amount? So we're looking at occurrence, frequency, binge drinking. And with that, we can generate a score. And we can predict, because these are tested tools, that if you score a certain number, I can say, you know, right now you're fine. You're OK. And the great thing is, over three quarters of people are totally fine when they screen for alcohol use. But if people are in a sort of middle area where they're leading towards more risk, you say, look, these are what's going to happen to you. You're going to get pulled over. You're going to get in front of the court. You're going to stay in the hospital longer. You're not going to take the medication you're supposed to take. So we can predict these things. So when we know this up front, we can talk to people like these nice folks to my right and say, I've got somebody in room three who's, you know, using alcohol at a risky, in a risky matter. And we can offer help. We can offer education counseling treatment if we need it. So we're using the emergency department not only as the receiving area for injuries and toxicities, but we're actually using it, I think, for a better reason, is to make it not happen in the first place, to kind of cut it off at the pass. I'd be much happier if people wouldn't come in with those issues and could come in and just say, I need help. But we still have issues of getting them help, right? We've all worked together for years now. You can say that, which is kind of cool. But we're still, even in our own community, you know, getting people into alcohol detox is a big deal still. It's a big struggle. We struggle with it every day. So my last thought is that, you know, substance use, it's not, it's a disease. We have to treat it just like we treat diabetes, high blood pressure, anything else. It's not a character flaw. It's not a sign of weakness. There are neurochemical changes that occur in the brain that change the way you perceive pleasure and reward. So we have to treat it medically, but it's not just up to people that work in prevention and treatment. It's not just the emergency department. It's up to the community because we need support. You know, none of these entities themselves can come up with a substance use treatment center, but as a community with business leaders and civic people, if we say it's an important community problem, which I would guess it is, then maybe we can do something, but we need help. And you can see, you know, we get beat by the sunshine there, right? It's not a popular thing for people to come and talk about this because it's troubling, but it's there. It's not gonna go away. And we need to do things like this. We need to get more people out and just inform people. I think the more they hear about it, the less scared or intimidated they are, and we can do more about it. That's all I'm gonna say. I think we're done. I think we're done. We're just done. I'm Angela Shea, and I am a social worker and drug alcohol counselor embedded at the Women's Health Clinic at CVMC. So I have the great privilege of sitting with both OB and GYN patients, who are oftentimes in delicate moments, and I'm able to sit with them and bear witness to that and talk a little bit about what's happening for them, and inevitably the common thread that runs through that often is alcohol use. And it's not about necessarily that patient, but it could be about a partner or a loved one or a parent or even a child that might be using. And so alcohol for me, I feel like it's important to be here today to just talk about the fact that it's not going anywhere. And I think with the discovery down the street, it forces us to just ask that question, well, what are we gonna do now? And so I'm really curious about the treatment edge. What gets people to understand their use and understand the loved one's use? I think alcohol, a lot of people know that it's a depressed, and so they think, I'm gonna have a streak, and I'm gonna feel better, and my problems may go away, and they may for a little bit, and it works, but it only works until it doesn't anymore. And if you're already struggling with depression and or anxiety, it just makes that much more worse. And so I'm also curious about the prevention edge too, as we walk through strategies to be able to get through some of the challenges that people have with use. Prevention for families that I work with that are wondering, hey, what can I do? How can we make this better for the next time of the next generation? Thinking about meals, right? Thinking about sitting in a circle, right? Oftentimes sitting in a circle just having eye contact with people can really be a meaningful, powerful experience, and we get it that sometimes you can't get a full meal in at the dinner table, and we've got to run and get to the next one, but even if it's just a quick check-in with the family, right? There was a study that three meals a week could be to prevention, and that's a great concept, right? And I get that sometimes we can't all be at those meals together, but wondering what would that be like to just to get some eye contact with children and your children, and what does that conversation look like? So, mental health, alcohol use, right? It's rare when you just have alcohol use. It is a rare day when someone's saying, I just have substance use, right? Nine out of 10 times, there is a mental health component to that, and I think that you can't talk about one without talking about the other. So, my name is Barb Grimoia, and I work with Dr. Mash Curry in the Emergency Department at CVMC, and part of my role there is to sit with patients as Angela does at Women's Health, but people who come in with urgent matters that may or may not be related to alcohol, and I would echo a lot of what these two have already said. Definitely, I can't think of a patient that I've worked with who doesn't have some sort of mental health issue going on, and I actually like to think of mental health as kind of a spectrum thing. We're all somewhere on that spectrum. We don't have mental health, like perfect mental health, nobody does. We go up and down that spectrum throughout our lives, and when things get really difficult for people, and especially, I see a lot of folks who have struggled with alcohol. All their lives, they had really tough childhoods and started drinking at maybe age 12. I saw a patient today who described that very situation, starting drinking at age 12, and now, not yet 40, wanting to be a better parent, realizing that if this individual doesn't change what they're doing, they're going to be going right down the path that they grew up with and found so intolerable. So, yeah, it is tricky to talk about prevention. I think that there's a lot that we as society can do, and because there are these other benefits, and it's so ingrained in our culture, and when somebody is trying to quit, they're dealing with all these influences that their friends think that they're fun anymore or whatever. It can be really tough to know exactly what to do, but there are things that we can do, and I'm really glad to have the opportunity to talk about that. My name is John Casaris. I am the marketing director at Valley Vista. We are a 97-fed inpatient substance use disorder facility. They're pretty much served as the entire state. We have two locations, one in Bradford and another in Virginia. It's that we opened up just a little over two years ago. It's interesting what Dr. McCurry said about alcohol and the opioid crisis that's going on, as we see the effect of that a lot. Interestingly enough, from our perspective, the opioid crisis is overshadowed so much because it's so much in the news and heightened awareness around it that I've actually gone to provide our meetings where people seemingly forgot that we actually do detox from alcohol, and sort of mind-boggling to me because that frankly was kind of where we started and where most facilities like ours have started. And also statistically, the numbers are still a lot higher on the alcohol side versus opioids. Whereas we don't necessarily see that, and I think that's largely in part because of people not thinking that we are able to do detox and it's something that's more medically necessary at a hospital or an environment like that, but we have the staff that can work with that. There's been the discussion about the mental health piece, which is huge. Oftentimes, the correlation between mental health and substance use disorder in this particular case, alcohol, it's huge. Oftentimes, most people that are suffering from substance use disorder or alcohol use disorder have long history of some kind of behavioral health issue that they're ultimately trying to self-medicate. And as we said, it's something that might, for a moment or two or a period of time, go away, but it ultimately just exacerbates whatever that condition is. So we, as Dr. McChurries sees the sort of front end of the sort of disintegration of someone's life, we hopefully are on the receiving end of those folks where I'd like to think that we're not the last resource, but in many cases we are. We work with the ERs around the state and we'll be peopled into the facility and really try to work with them on the mental health piece. The thing that we're challenged by or really any facility like ours is challenged by is the length of stay. At one point we were over six months, then ultimately we kind of got driven down to 90 days and right now, depending upon clinical need, we're anywhere from 14 to 20, 26 days. So do you think about the amount of time? Yes. Can you say that the time is going down? Is that because of health care coverage or people's time that they're kind of spent there? No, it's a direct result of health care coverage. Just as a quick aside, I was at a civil reform in Manchester a couple of years ago and there were over 400 people in the library during winter, so it wasn't so great. So, but there was a gentleman who started talking about insurance and then another person that was there started talking about how treatment centers like ours had really cut down the length of stay and that's where the confusion really lies. We are really at the whim, if you will, of the insurance companies that have really driven it down. The coverage has gotten less and less. So if you think about the amount of time that it takes for somebody to detox, it could be seven days and maybe they start getting a little less foggy, it's almost time for them to be discharged based upon their insurance and we're continually fighting or our clinicians are continually fighting. The insurance companies try to get more time for that particular individual based on clinical need and research has shown that effective treatment, and Dr. Mishchery talks about the effects of assosins on the brain, but to have any kind of change, what is being said is that 90 days at a minimum is the most effective time for a length of stay. And so when you see that and you're a room full of people like the Governor's Openwood Coordination Council, people that are actually in a position to make change, yet we keep on doing what we're doing, not really getting anywhere back then. The likelihood of us ever getting back to that type of length of stay in our lifetime is pretty slim. It becomes a comment upon this, this type of forum, where communities play a greater role, where we work together better so that at some level, how can we, for all intents and purposes, create this notion of an effective 90 days treatment? So maybe we jumpstart the individual treatment for two, three, maybe four weeks, then we are able to work with a sort of living facility, IOP, or attention to the outpatient treatment program, any number of outpatient services that will hopefully continue what we've begun. And hopefully that individual, if they buy into a 12 step program or something along those lines, where they have some kind of contact at every level, every day, or some level every day, with their recovery, they can hopefully effect change with our support, because the one thing that we know for a fact is that, particularly as the way they sell the whole peer support is one of the, has the single greatest impact on someone's recovery. And I think one of the things that Central Vermont Medical Center is doing really well with is, first of all, there's this rapid access to treatment. And there's also, at least it's more opioid centered, but we're also having certified recovery coaches in the ERs, having people like Barbara in the ER as well, that are screening the individuals and ultimately making referral to treatment, whether it's inpatient or outpatient, or some other type of treatment to get them on their way, depending upon whether they're clinically. So again, these types of things which we always love to participate in is really trying to pull resources. I think if we kick back and wait for our legislators and the government to take it on for us, it's just not gonna happen. And the more and more these types of things happen, the better that we're all able to collaborate, breaking down the silos that perhaps have existed for some time, the better off we're gonna be able to serve the communities and the populations that are suffering from these afflictions. Thanks. Were there any other questions? Kim, yes? I have a statement. Yes. I put together today, I have a firsthand decades of knowledge about this, about alcoholism in specific drug predictions. I agree it's sort of the gateway to drugs alcoholism can be. And based on my experience, I have recognized firsthand that the attempts that you're all talking about, for the most part, have failed. For all good intentions, but unintended consequences. They're driven by insurance, money. I think you all may have professional income and depending on those types of services, I don't, I'm just a janky citizen and I've written a book about it, I've helped research and I've been involved in it for over 55 years. And not just involve flight layup for my time and money and effort with both legislation and other areas. My statement is, and you probably've heard much of this before, alcoholism and drug addictions are neurological medical conditions. The treatments with medical science and aversion therapy do bring healing. A program from a hospital named Schick Schadel, S-C-H-I-C-K-S-H-A-D-E-L, founded by Mr. Schadel in 1934, for these specific issues, also has had positive impact. Insurance is accepted and there's a lot of valuable information that we could glean from this and kind of coordination effect. I'm not associated with hospital, I just have seen the response. Also, I believe strongly and have advocated for seizing the serving of wine at churches. Under the veil of, it's the blood of Christ, for communion, et cetera. These types of rituals promote alcohol combined with spirituality. Young children are conductive adults and my advocacy to stop including alcohol at churches has been chuckled at. Why include alcohol at churches? Tax exempt organizations when so many people are affected by it. I agree with writing real clear specific pamphlets with scientific findings. They do not talk down, but they give an illustration of clear results, consequences, impacts. People can understand that, they're very, many are very little and not able. Write these pamphlets with these scientific findings and provide proven solutions. AA meetings, solar houses and anti-abuse efforts are endless cycles that do not work long term any more than these addiction treatment places. They're a little tiny fix for a couple of weeks or maybe a few months. Alcohol and drugs will always be marketed and by providing people information and solid solutions, these diseases can effectively be harnessed, but they will not be harnessed with the ideas that I've heard repeatedly and seeing effects of for decades. Well, thank you for sharing that and I like that you called them diseases because it really is a public health concern and it is a disorder. It's not just a moral failing or you just can't stop drinking. It's really a physical addiction and it is a problem and that there are so many places in the community or in our society where alcohol is readily available. And that will never stop. Well, but we do have a lot going for us in a lot of ways. There are environmental strategies that can be used to really help with prevention. It's great that we have all these resources because different things work for different people. One, I think the education, and we've all spoken to this about really helping families and communities understand it, but especially youth. I mean, I just don't think you get enough health education in elementary school and middle school and high school or enough time spent on prevention education. There needs to be a whole lot more funding so that we're not just putting out fires and treating people later on. I believe it could be done without a whole lot of funding. I think one possibility and I've advocated for this is to get all the bishops and clergy and different community churches and community action people involved and step up to the plate without money being exchanged. And for instance, not advocating for not serving more in your church. So that's a possibility or having an option, that the faith-based community is certainly a place to have at the table in terms of discussions on prevention. So are the rotaries. Yeah. The Vermont Department of Liquor Control does a really great job in the state of Vermont of really educating all retailers and servers at restaurants and in stores. Everybody has to go through this certification before they can serve alcohol. And they have to learn how to check IDs and that's really, really valuable and in Washington County we actually rate really high in compliance. Well that's nothing new, I own a small mom and pop store, that's nothing new, that's my favorite. Yeah. And we're meeting with curriculum directors at some of the schools to find out exactly what's in place at a lot of different levels. We have a lot of youth groups in some of the high schools that are really learning a lot about this and willing to go and teach or talk to some of the younger kids because when people can learn about the effects on the body it makes a really big difference. And at these key transition times, when kids are going into middle school or kids are going into high school or kids are going into college. So often they hear this message, drink responsibly but they're still all underage. So it's illegal, what does that mean? What does that mean? And especially for the brain that's not fully developed until they're 25 or 26. It really can be very harmful. And sometimes people say, well, it's just this once. We've all seen sometimes that one time of too much alcohol can be poisoning or an auto crash or drowning. And a lot of kids, well all of us, really need to be aware of our family history. What is our family history? Do we have parents or relatives who have alcohol as a problem in their life? We're much more susceptible to having problems as well or mental health issues. If there are mental health issues either with ourselves or in the family that it's so much more difficult when there is a substance. Well, Peter White attended some of these group efforts which some people were aware of in different parts of the state but one hand doesn't know what the other's doing. It's all fragmented, it's all these paid services that are after the fact but nothing like preventative. Well, I will speak to that. Congressman Peter Welch has been doing roundtables in all the communities and we did have our turn and we all met at Down Street in Barrie and we're able to have lots of different organizations who are all community partners. We're working in the substance use prevention and treatment and recovery fields. Really talk to him about what our concerns are and what's being done. So he just met with people in LaMoyle in Morrisville and New Directions is an organization. There used to be six coalitions in Washington County that really covered prevention and everyone's lost funding and we're the only one left. That's good because that's one of the problems Peter is faced with because once they have these meetings the feedback from the general public is what do you want more money? It's like we're getting nowhere with anything forever. What do we want? Community effort, we want activities. So we're having a community conversation and these are happening? Well, more people have to take panel providing information than there is in the audience. That's true. And so that's why we have work immediate here so people can watch this at home. Yeah, it is unfortunate tonight and sometimes there's a bigger crowd. People are being paid to progress something that isn't working. Excuse me one second. I'm gonna take a question over here. Yes, Officer Matthews. We see in our line of work when people begin to get into alcohol abuse or when they're midst of it it starts as a coping tool. And I think a big push for children not to get into alcohol abuse is to find better coping mechanisms. Not necessarily to check out by having a drink, you're wasted. You've checked out for this in an amount of time. Then they become sober, you have to deal with that problem. No one's shown them how to cope or maybe their parents were all checked out on our phones. 50 years ago we weren't and we had those discussions around the dinner table. I'm having trouble with this. I can't cope with this. Trying to help people cope with that. In our transient community those people in particular have no coping skills and that is a huge part of their mental health issue and their substance abuse issue. Right, alcohol is not a good long-term solution for those kinds of things. You probably have to speak about coping in your work. Yes, that is. And I think when you speak about intergenerational substance use I didn't learn that. You think about everyone pick a coping skill, right? Where did you learn that from, right? Where you didn't get that from before and makes it really hard to know what to do and to learn it at age 30. I also think the other thing about substance use and alcohol use in particular is those, you know, you mature a little bit later, right? So you're delayed around your critical thinking, around your impairment, you know, around how you believe or feel things or how you may cope with things, right? Because you never really kind of had to deal with that necessarily. And so alcohol sort of did that for you. So now you rip that band-aid off and you need to deal with all these unaddressed other issues. And if they don't have coping tools now it just got even worse. So that's real. And I think it's a huge point that you brought up. In fact, you brought up the family component as well. You know, if our parents didn't have coping skills and our coping skills were to have, you know, a couple of whiskeys when they got home or something like that, we learned that ourselves and we don't have any other skills of value. You know, one of the things that's been discussed and I think some of my colleagues have heard of it is this Icelandic model, which was actually discussed at a couple of meetings up in Waterbury. And really the crux of it, this is really geared towards the younger population, was that sort of that time zone between three and like six o'clock when kids don't necessarily have anything to deal with. What do they do? I mean, boredom is not like a great thing if they're not engaged in sports or anything like that. And I'm gonna probably mangle this, but the numbers of views, and they had a real problem there with alcohol and substitutes in general, went from something I wanna say like maybe 60% of that particular population were abusing something to something like seven or 8%. And that was just by engaging more and really whether it's school level, at the family level, having more interaction, more support and perhaps talking and teaching mindfulness and some kind of a program skillset. Right, that's from really beating up protective factors. And so really helping kids with build up their assets. So like in Iceland, every student was required to have a hobby or an activity. And there was time right after school and there was funding for that. But they got involved in something. And when Vermont administers the Youth Risk Behavior Survey every year, there's a number of questions that really address the protective factors and the risk factors. So are you involved in activities or sports or music? Do you eat dinner with your family several times a week? Do you think that your parents would disapprove if you were drinking alcohol or using other substances at an early age? Do you think that it's harmful for someone your age to be drinking or binge drinking? And so I think we ask the parents to be aware of these things. Kids need to learn to be involved in things and hang around with kids who also have goals for themselves. It's so, so important. And so for parents to model healthy behavior like not, oh, I'm so stressed I need to have a glass of wine but enjoying that wine or if they're going out to dinner or at a party being vocal about how much they're gonna drink or not drink because they're driving or because they hadn't eaten very much. They need a lot of information about that too. So the protective factors are really important for us to build up and be aware of. And even as a community, appreciating all the youth that are in our downtown or wherever we see them. And I ask business owners or people on the street to look someone in the eye, a young person and say hello, acknowledge them, address them so that kids feel like they matter. Yeah. Marie? Well, I just wanted to speak with like, and there's this, but I'm doing a research project on prevention of substance abuse here in Washington County and over my 90 hours of contact with community experts and leaders over this, I'm finding some really fascinating information. I'm an RN at CVMC and I also work as a school nurse at Calis Elementary. Washington Central Supervisor Union has zero prevention efforts that occur. Berry City and Berry Town have a huge amount of effort at both the elementary, middle and high school level, but it's crazy to me to have make this assumption that somehow Washington Central is immune to any of this. I interviewed a state representative who's sheltering Nameless because there seemed to be a huge disconnect between what I had learned from people at the community level in these interdisciplinary coalitions and what the legislature really thinks is happening in the state of Vermont. He said to me, how can that be possible? Every school got $25,000 for prevention and I said, well, when? You know, my principal's funneling some stuff right into her purse, how's that happening? But that's not what happened with any of that funding, right? But the legislature is not aware that that's what is occurring. And most of the research, I looked a lot into that Icelandic model because Vermont has so many challenges in being as rural as it is. And I have to say, I'm super impressed with Wixar and all of the other, the coalitions here in Washington County, they're working so hard to try to keep the net intact and not let anybody out because that seems like a really formidable task here in as rural a state as we live in. But I definitely have a huge concern about, I mean, here I am dragging my child around to these types of meetings here. So, but I have a huge concern that the youth is not being reached early enough. The conversations are not being had in the timeframe of children when they're still scared to death about their health. You can't talk to a 14-year-old about their health. They can care less. But if you talk to a 10-year-old about their health, they will internalize that and then say things like, mommy, you eat your vegetables, right? Like, we need those sorts of conversations where they're still concerned about their health and they haven't yet gotten to the uninvincible and I know everything stage of life. But I would be very interested in seeing a lot more emphasis be put in the elementary to middle school level, especially. My elementary school goes to the end of sixth grade. Those kids are already cursing and smoking and spitting and probably drinking, you know? Those conversations need to be had and we're not having them. And I can tell you that the parents are making huge assumptions that the school is having those conversations and the schools are not equipped, funded, or educated for that situation, right? And I guess I would just say like, the prevention piece seems so amorphous because there's very little measurable outcomes that you can apply to grants and funding that come from prevention. But I really encourage trying to focus more into those, utilize your schools, right? As a school nurse, I can tell you I'm underutilized for the educational level I have in the school setting. And I don't know any of us that wouldn't love to dig in and make that a bit more of a robust position and feel like we're offering our students a little bit more. So, but I guess one of the things that I really wanted to say was that I am hugely impressed. All these meetings that I sit in, everybody's level of commitment is huge and really impressive. And the fact that with three people here and I think most of us are related to someone on the panel or has a, like I do a total ulterior motive of trying to get my contact errors in so I can finish this degree program. You guys are still 100% committed in having this conversation and I'm impressed. Thanks. Thank you. That's great advice too about getting into the schools among that as a twist. I think that's great. And I would ask, are there, I know there's substance abuse professionals like the SAP counselors that are funded but you're saying they're not in the elementary and the middle school. So they're not in Washington Central at all. So they're in the Bay Area City and Bay Area Count. I know that you guys just worked with doing some training in terms of the school nurses at the middle and high school at the E32 level but none of the elementary schools have a program and in fact, Doty Elementary only has a school nurse one day a week which is woefully underserved for that small of a community. So we do have a meeting set up with the curriculum director to really figure out what's in place and what's missing, great, but I will say that WCSU does have a social worker who's got more and more information, has been gaining a lot more knowledge in prevention because there is substance use and there are kids who get into trouble but she started several youth groups at the middle school and high school level and that's really important to have that youth leadership. Absolutely. Okay, just one thing. One of the things I was really challenged by and I think what you said was awesome. I just wish there were like a U in every school. When I've tried to reach out to do that some kind of education, prevention, you know, both as a representative of the treatment community but also someone who's in long-term recovery, what I was often met by, principles and also other people within the school system that they were reluctant to have people come in and talk about substance use because, well, maybe we might create awareness about it so they're gonna get curious and wanna check it out. Right, so yeah, so you don't understand the reality that having a discussion that doesn't mean, I can talk about Cheeseburgers all day, it's not gonna necessarily make you eat at Cheeseburg. Precisely, and so it's trying to say, well, that's really not what it's about and if they don't know then they don't know how, if kids don't have any kind of base knowledge on how to respond to an encounter or temptation or peer pressure, that's the prevention piece. And hopefully, I've heard a lot of talk at the legislative level, the OCC is gone. It had its last meeting in, and in May. The opioid coordination council, well, obviously this is about alcohol but the importance of that, it's evolved. There was a bill that was passed, our legislative, legislatively approved, about in the middle of May, towards the end of May, it's called S146 and I'm probably gonna manual this again, but it's the substance misuse, oversight and prevention, I think, something along that lines but the whole idea is that the opioid coordination council realize it, but this is a lot more than opioids, it's recognizing that alcohol is still number one in terms of deaths, that most visits to the ER are primary alcohol, so it's really going to be not just about opioids anymore, but just about everything and there's a big piece of it, my understanding, is that it's geared towards the prevention because as you find out, and as we pointed out at it elsewhere, is that the prevention piece is really, really, really underutilized and really not tapped into enough, so there's gonna be an effort that, again, hopefully will come to fruition at the elementary end of the schools, whether it's through social work, whatever, and that's something that's gonna be, hopefully sort of netted out as the new entity that was created moves forward. So it's, you know, I travel a lot to New York State because we provide, we work with insurance plans over there, so I meet a lot of providers over there and take a step back, I mean, as a state, we're so far ahead of so many other states that in bigger states with more resources, like in New York, I mean, they live in bureaucratic hell, but the reality of it is that what we're doing here, I mean, this again happens more frequently than it does over there, frankly, there's not a ton of people here, but at the same time, after it's happening, it's getting traction, and as you pointed out, it exists beyond just this, so, you know, they're solid. So, I'm sorry, I didn't catch up. As a parent, it's interesting how not all schools do the same thing, and you run into that over and over again with tons of different things, but as being, I have a child in one of the schools that she mentioned that does have that, their health classes are now geared toward, my kid just finished this thing and it's following, about coping skills, role playing, they've set little role plays about sex and drugs and alcohol and how you cope. It's interesting to me that not every school does that and at different levels, she hadn't all the way back since elementary school, and it is that whole difference of where you go to school, what's available and what isn't. They send out to them and say, here's what we're gonna be talking about, you need to sign this to say it's okay, so the parents are aware of the conversations that are happening, and I think it just connects with Karen at home to say, hey, what's your talk about today, what's this project from PowerPoints and all that? So, it's just sad, but it's not every school every time. I agree, 100 ways to Sunday, coping skills are also a huge issue. I mean, there's so many tendrils that go out from substance abuse, it's connection, it's genetics, it's isolation, I mean, that's a huge issue here. We don't have anything in Calis. If your kid wants to do something after school, they're up a creek. There's no after school activities at our school. There's no after school activities in the community. We all live on dirt roads on this, you know, weird mooring of a pretend town. It's really hard, and I just had this conversation with her driving over here today saying, how do you feel about that? I don't think I've ever asked you that question. I would live, find myself in the woods for the rest of my life. I absolutely enjoy enforced isolation. I've never asked you how you feel about that, and that thing worries me, you know, what if you consider it isolation, what if I predisposed you to, you know, a problem with substance and alcohol abuse, and without knowing it in any way, shape, or form, simply because she's never fought to say, I'd really like to do a bunch of stuff after school, because it hasn't been available in her life, it's not the experience that she has. So we had a conversation, she moved him up here, just so you can walk to the library after school if you wanted to meet your friends, or something like that. I mean, it's really kind of fascinating, and, you know, we're very fortunate privileged humans, because we can have a conversation about whether or not we want to move. The majority of the people who live in Washington County don't have that level of privilege, and wouldn't consider it even if they did. They live next door to their parents, you know, they live on family property, they never would even consider moving. Their life is as it is, and I feel like in a state this small, there ought to be some way to counteract that level of isolation. It can almost be like the perfect experiment, because it's, our population is less than Boston, and we're a whole state. Like, we really ought to be a butt again with a tax base that, as far as we don't have the funding. It's such a, I understand how nothing has ever been solved, because I go around in my head and I think it weighs a Sunday about. It's certainly difficult in our rural communities, and feeling isolated sometimes. And it really demands that families and parents, you know, really kind of have to step it up to either provide or find those activities for kids, or to really kind of get back to knowing neighbors and knowing the families of who your kids are hanging out with and having a lot of conversations about that. And, you know, we're working closely with the Vermont Department of Health, who has a campaign called Parent Up. And it's really about having conversations with your kids and, you know, primarily around substance use, but it can also be just having those conversations. So you do have that connectedness. And a lot of people find it difficult to talk to their kids, either if they're, you know, certainly like you said, middle or high school, they don't want to hear it, but if you start early and you talk often, you have a bunch better results. And this is not 160, you know, minute conversation. It should be 61 minute conversations. You really gotta, you know, say these things over and over or when you're driving in the car or you're watching a movie or you read something in the paper and say, my goodness, look at this. Or, you know, something alcohol related. You know, New Directions started 20 years ago in response to, you know, communities coming together because of the alcohol related car crash and two Montpelier High School students died. And parents said, we can't let this happen again. And so, you know, alcohol's still a big part in our community. We've got prevention efforts in place. We've got treatment available. We've got recovery coaches. And, you know, we've got the, you know, emergency department saying it's still a big problem. So just wanting to get this information out to the community to keep having conversations about this to raise awareness. And this is not the last conversation we'll have about this because, you know, I do think at a different time of year, you know, this is busy at the end of school right now, but more parents do want to have this discussion and more students do too. And we need to reach more of our elderly, right? I think I'm one of the schools that I've been aware of through different areas in Vermont. They're hiring assistants, people that assist the teachers. And many times those people are not that. And unfortunately, sometimes those people are distributing drugs to the children for money. And there are people on the school grounds that get there or are close to, and most young people at schools know how to get drugs right in their own school or near by. There is access to all kinds of substances among you. I would not say they're coming from teachers as much as it would be from peers or older siblings, probably something like that. Unfortunately, I had a first-hand situation and I was aware that came from two different assistant teachers in a elementary school to say. Well, we're almost out of time. I just wanted to give a ratio again. I have one question. Do you have material that suggests language to use in talking with families or friends, you know, whether it's a child or an adult? You know, if an adult is concerned about a friend who seems to be learning a lot, is there material that suggests more to use? Yeah, that's a good question. Yeah, I could not put my finger on anything particular myself. I mean, lots of great material about treatment and access, et cetera, but about what to say or the language, that's great. I almost feel like too, your parent-up campaigns really remind me of like motivational interviewing, which is sort of a lot of foundation of the work that we do and those motivational interviewing questions that are very open-ended. How many of you feel about that? How do you think you're dealing? Right, and I love your parent-up. I think that that translates to so many parts of our lives that we can use with our family or kids, our partners or spouses, and those who were concerned about expressing concern, giving out potential examples, and then asking them, how do you think this pattern is more, right? So, sometimes you can use some of that language onto someone who you're concerned about. Yeah, these folks here are the masters at that. When they came to our department, we had to learn how to ask people in this sort of non-confrontational, non-judgment way about their, and the first thing they taught us was they had to ask their permission. May I talk to you about this? And some people said, absolutely not. Then you just back off, because you know maybe the next time they will. But the thing we found is most people do want to talk about that, right? I mean, that's what we learned. But there are very good techniques about how you motivate someone to talk about it and really ask an open-ended question to allow them to fill in the blanks. You want them to be the participant. And the second thing you taught us was, yes, how do you think this is working out for you? And that was kind of a loaded question for me, because they're laying there broken in half or something, but sometimes they would say, just fine. Then what do you do? So, but it's a skill. And it's like, I don't see how to practice it. But I think we're learning slowly the truth. Yeah, and I think the idea of asking permission, I mean, at least then the person knows that you are aware of something and that if they decide they want to talk about it, that you'd be there to talk with. Yeah, I think the non-judgment. Yeah, because that happened often. I mean, we would talk with patients and they would come back weeks or months later wanting to talk more. Now they were ready. So, maybe nobody asked them anymore. No, that's the point of screening, right? If you're not asking about it, it's not there. And it depends on who it is and what the relationship is, but even saying, I noticed that I'm worried or I'm concerned about you or I just saw a presentation or I just heard the doc at the ER. I just heard some people talking about alcohol and it made me think that there's so many different ways to get help out there. Would you ever consider something like that? And we, I mean, we, we, you know, we'll use anything. So, we've evolved. At first it was just us, which we probably didn't do very well at all. And then we had folks that were, you know, experienced with life, you know, licensed alcohol and drug counselors. And now we have recovery coaches that you're people with that are in recovery themselves with lived experience. And that's sort of like the, to the end of the group, you know, the, you can see the change in the dynamic when someone walks in that's had that same struggle talking to somebody about it. Because it does do, they just want to disarm the patient. They feel they can trust someone, they have an ally. And they also can see what's possible, what success looks like, right? This is someone that was sitting in that same place, you know, at some point in the past. And now they're there to help the same, you know, someone who suffered from the same disease. So it's a pretty powerful, pretty powerful relationship. And we're really happy to have that. I'm lucky, yeah. I've seen a change in just sporting events, like triathlons and, you know, local runs, you know, at the end of the race, you'll get a beer. And there's this, you know, kind of, connection now with health and drinking and so it would be interesting to be able to see, you know, the beer tent set up at the end of these races with some of these questions that are marketed with the alcohol, you know what I mean? Yeah, yeah. So you can kind of question it before you take that beer after you run or whatever the social event is, but. Well, to mix that in with the alcohol is what it is. Well, that's a whole nother awareness that I think our communities and our families need to be more aware now with so many people struggling with alcohol use disorder that when you're hosting Thanksgiving or Christmas or a graduation party, you know, you're providing this environment and really do you always have something non-alcoholic or can you be really sensitive to other people who, you know, are showing, I mean, we've had to learn to be, you know, to offer gluten free or, you know, be aware of the peanut allergies kind of thing. And so to really be more sensitive to people who are sober and how much of a struggle that can be sometimes and that we have alcohol in so many social events, which is difficult. And so from a prevention standpoint, you know, I guess I would advocate for family-friendly events that don't necessarily have to have alcohol all the time, even if it's in a roped off area, even if they're checking IDs. It's that familiarity and, you know, kids seeing that it's the norm or it's the common thing to always have alcohol. And so that's where, you know, where there's just a lot of conflict going on. But there have been articles recently about sober curious, about millennials who are so curious about how they can be more healthy. They're eating all the right foods, you know, they're exercising, they're taking care of themselves, they're doing mindfulness in yoga. And why, and they're starting to question why are we going out in every social situation, has to involve being at a bar or having alcohol, you know, even in the middle of the week or whatever. And so I think we'll see, you know, coming up soon, especially, I hope in this area, more places where there are mocktails or alcohol-free events where people are feeling like, I don't need to have that, you know, what is it doing to my body after I've just run this 10K or, you know, I've just gone for this great height or I'm socializing with my friends. Or I'm painting a picture. Yeah. Right. I can't do art without, I mean. Right. I can't express it. Yeah. Yeah. Just getting back to your question about how to talk to people, there is, and you may have heard about the seven challenges, particularly for the more youthful audience. And I think the real key of it that was already mentioned here was that you can't be confrontational. You know, demonstrating genuine care, which is clearly happening at the ER level. You know, as soon as you start getting confrontational, you start doing this with anybody, it automatically, the wall goes up and that never works. And also, you know, you can sort of help lead them down a path, you know, using, and that's really the question of the seven challenges is help people towards being a part of healthy decisions that they make for themselves, or they're a part of ultimately. Thank you. Well, I want to thank Jalvian and Angela and Barb and John and Rachel from Tele-Covered Library and Adam from ORCA. And thank you, all of you, for coming to be here tonight. See you at the next one. Thank you. Thank you. Thank you.