Today we hear a substance abuse counselor’s perspective on healthcare from Richard Capriola. He joins Rob Oliver on the Perspectives on Healthcare Podcast from Texas. A member of the baby boomer generation, he works primarily with adolescents and young people as both a substance abuse and mental health counselor.
Here are 3 things that stood out from Richard Capriola sharing a substance abuse counselor’s perspective on healthcare:
· Quality healthcare has to involve timely care.
· A patient centered team comprised of multidisciplinary practitioners improves the quality of healthcare
· Addiction is a disease, not a character flaw. As such, it should be treated not punished.
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Here is the transcript of Richard Capriola: A Substance Abuse Counselor’s Perspective on Healthcare:
Rob Oliver: Thank you. And I appreciate you being here today. Today’s perspective on health care comes from Richard Capriola. He is a mental health and substance abuse counselor, has been for the last two decades. He is from Katie, Texas. He is a member of the baby Boomer generation. And Richard, thanks for being here.
Richard Capriola: Oh, thank you, Rob. I really appreciate you having me on the program so much. So thank you. Thank you for your time and for the opportunity to be here.
Rob Oliver: You bet. I’m very keen on hearing your perspective. And I think that it’s something that my listeners will benefit from as well. So let’s get right to it. Tell me about yourself and your role in healthcare.
Richard Capriola: Well, I actually started out in education, where I was in school administration at the state level in Illinois for around 30 years and worked in the field of education. And as I transitioned out of that career, after about 30 years, I moved over into the mental health area, and I started out at a regional mental health crisis center in central Illinois, and I noticed that a number of people that were coming to us to the crisis center from the emergency rooms had not only a mental health crisis going on, but also a substance abuse issue. So I went back to the University of Illinois and got a master’s degree in addictions counseling and continued to work at the crisis center for a while until I was offered a position at Mininger Clinic at Houston, Texas. Vinegar is a large psychiatric hospital serving adolescents and adults from around the world, and I worked there for over a decade as an addictions Council for both adolescents and adults. And after I retired from Vinegar a little over a year ago, I set about to write my book, which is The Addicted Child, The Parents Guide for Adolescent Substance Abuse to help parents and families understand a little bit more about this complicated topic of adolescent substance abuse. So actually transitioned from education into mental health and then substance abuse.
Rob Oliver: Okay. So as a substance abuse counselor, we all hear all of the statistics. And I’m assuming what is your front line perspective on how how much of an epidemic? How much of a how much of a crisis are we at right now in the United States with substance abuse?
Richard Capriola: I think that we are seeing it get more and more serious every year in the adult population, there has been a tremendous increase in opioid overdoses. And I think in some areas of the country that’s become almost like an epidemic. I think we’re seeing a lot of prescription drug abuse among the adult population. In the adolescent population, adolescents are still gravitating towards alcohol and marijuana as their primary substances. There is some exposure to other hardcore drugs, but mostly it’s alcohol and marijuana. But what we have seen in the last three years in the adolescent population is an explosion in what’s termed vaping, where they’ll take a substance like nicotine or marijuana. They’re use an instrument, turn it into a vapor, and then inhale it. And in the last three years, the percentage of adolescents who are vaping, nicotine and marijuana has just exploded.
Rob Oliver: Okay, just for my own personal curiosity, do you view alcohol and marijuana? What I was taught when I was a kid as gateway drugs, or are they issues in their own? Or what’s your perspective on the concept of gateways?
Richard Capriola: There are issues in and of themselves. First, a certain percentage of adolescence, for example, they will be the road into using other drugs, more hardcore drugs, whether it’s cocaine or perhaps prescription drug abuse. But certainly not every adolescent or not. Every adult who is smoking marijuana, let’s say, is destined to move on to more hardcore drug. It’s very individualized.
Rob Oliver: Okay. What does quality health care mean to you?
Richard Capriola: Well, first of all, it means patient focused. It means the ability to sit down with a patient and not just listen to their words because we’re all pretty good at listening to each other’s words. But it’s also the ability to hear the feelings behind those words. So when I think of quality health care, the first thing that comes to mind is patient focused and the ability to hear not only a patient’s words but the feelings behind those words. And to really tune into that, I think it also involves timely care, getting patients what they need medically and in the health care field in a timely manner. And that’s particularly important when it comes to addiction. You want to get on top of that as quickly as you can. And then I think it also involves effective treatment, and it involves safe treatment. So basically communication, patient focused, giving healthcare in a timely manner and in an effective manner and also in a safe manner.
Rob Oliver: Excellent. Can you give me an example of quality health care?
Richard Capriola: Yeah, I can. When I worked at Vinegar, that’s an excellent example of quality health care. And by that, I mean, I was one member of a comprehensive treatment team. In addition to me and my role as an addiction counselor, there was also a psychiatrist on the dream. There was a social worker on the team, there was a psychologist on the dream. There was a network of nurses and support staff, and we all function together as a multidisciplinary team to provide that kind of quality treatment to the patient. And that’s one example of what I would consider to be an example of quality health care. It’s a combined approach of several different disciplines, working together in unison to provide quality health care to a patient.
Rob Oliver: And I think it relates back to what you were saying is your definition of quality health care is that it had to be patient focused, and every one of those disciplines is is looking at the patient from a different viewpoint. But all of it has got to be focused on the patient as an entire being, not just as a singular diagnosis or as a singular issue.
Richard Capriola: That’s exactly right. Each one of us was coming from our own discipline, and we would have our own view of what was going on, but as a disciplinary team that would all come together as a cohesive unit. So the patient was getting the benefit of a multidisciplinary approach.
Rob Oliver: Excellent. What do you wish people understood about your role in health care?
Richard Capriola: I wish people understood that first of all, and we are making progress in this regard that addiction is a disease, that it is not a character flaw, that it truly is a disease, that people deserve to have quality treatment when they have it, whether they’re an adolescent or an adult, and that people ought not to be punished for being addicted to to a substance or being addicted to a behavior. But they need quality health care. And I think the other thing is that so many times, along with the substance abuse that a person is struggling with, there’s an underlying mental health issue that needs treatment as well. And what I want people to understand is that in those cases, a person needs help, not just with the substance abuse. They need help with the underlying mental health issues, because in many cases, a person will be using a substance to medicate an underlying issue. A lot of the teenagers, for example, that I worked with told me that when I asked them, help me understand why you’re smoking so much marijuana. The number one answer that came back was it helps me with my anxiety. So in many cases, there’s this underlying mental health issue that also needs treatment as well as the substance abuse.
Rob Oliver: I think it’s so interesting what you say, because what you gave is not an answer that’s about your about you as a practitioner, but it’s an answer that relates to the individuals that you treat and kind of the stigma that goes along with that. Can you just speak a little bit more to that concept of what are some of the road blocks that people are experiencing, some of the input that they’re receiving that’s telling them that it’s about them being a weak individual or it’s fault finding rather than problem addressing. Do you understand what I’m saying?
Richard Capriola: Yeah. And I think a lot of that comes from society. I think what we need to recognize and part of the reason there is this stigma, the stigma towards addiction and to a certain extent, mental health, but certainly much more so for addiction is the behaviors that are associated with addiction are completely different than the behaviors that are associated with any other disease with addiction, as opposed to, say, cancer or diabetes or hypertension with addiction, society sees the behavior is unacceptable. You don’t see somebody, for example, with hypertension or with diabetes going out and committing crimes, but often you see crimes associated with addiction use. And I think that’s sort of skewed the way that society looks at addiction as opposed to other diseases. And the response to addiction is different than what it is for mental health or for other diseases. The response from society because of the behaviors that they associate with addiction is, let’s lock them up, let’s not treat them, let’s lock them up. And that, I think, does a great disservice not only to the entire field of health care, but also to those individuals.
Rob Oliver: Maybe this is just my my perception on it a lot of times. The desire to lock them up is you’re seeing people view addicts as a segment of society, that is them not in us, meaning it’s something that is in the inner city. It’s something that is among people who are different than me. Although I’m assuming that in your work with adolescence, you’re seeing that a lot of the addiction issues are coming out in middle class and upper class America, where you’ve got access to the funds that allow people to explore all of the different substances and options that are out there. What are your thoughts? I am I right in my premise there. And what are your thoughts on that concept of the difference between us and them and where addiction is showing up on the societal scale?
Richard Capriola: I think there isn’t us versus them attitude out there. I think there’s also a very dangerous attitude among parents that this cannot happen to my kid. I live in a very a very good area. I send my kid to a very good school. This can’t possibly happen to my kid. And that’s a very dangerous perception and attitude to have because every child, every child is subject to being captured by substances. It doesn’t matter where you live, urban, rural, suburban. It doesn’t matter how much income you make or don’t make. It doesn’t matter which school you send your child to. Every child is vulnerable to being captured by substances.
Rob Oliver: Yeah. And I think that’s a very important point for all parents to remember that this is this is not just out there. It is very much something that faces my children.
Richard Capriola: And one of the reasons that led me to write my book was I would sit across from families so many times, and I would go through their child’s history of using a substance, and I would give them the diagnosis of a substance use disorder. And when I finished, they would look across at me and they would say I had no idea this was going on or if they did suspect their child was using a substance. They would say, I sort of thought something was going on, but I didn’t know it was this bad. And these are good parents. These are good parents. They missed the warning signs, and then they started to feel bad that they felt like they weren’t good parents. Well, they missed the warning signs because nobody told them what to look for.
Rob Oliver: Right. It makes a lot of sense to end up in a very sad and yet real and practical way. What excites you about the future of healthcare?
Richard Capriola: I think what excites me is we are slowly but gradually moving away from the idea that addiction is a character flaw, and we are beginning to see that these individuals need health care and they need treatment and they need support. Now. We’re not as far along as I wished we would be, but we are a lot further along than we were 2030 and 40 years ago. So that’s sort of exciting to me, seeing a lot of the changes that are taking place in terms of how we are providing health care and how we are providing addiction services to make it more of a wrap around comprehensive way of dealing with people who have substance use disorders.
Rob Oliver: Yeah, and in some ways, I think what you talked about earlier comes in there when you’re looking at it as a comprehensive treatment where you it’s not just dealing with the substance abuse. It’s also looking at the mental health issues just because you can get someone to quit using a substance for a temporary period of time. If you’re not addressing the underlying mental health issues, the recipe for success is not truly that’s true.
Richard Capriola: Oh, that’s right. You’re almost putting the person on a road to relapse. It may be a while, but if you don’t address those underlying issues, the chance of relapse is very high.
Rob Oliver: What is one thing medical professionals can start doing today to improve the quality of healthcare?
Richard Capriola: I think one thing they can do that we can all do is start to reach out more to the people who are uninsured to the people who live in the rural areas that don’t often have access to good quality mental health or physical health, basically to expand our services in the rural communities, to provide good quality medical care to those areas and to help everybody get good quality health insurance so that they can afford to get the type of preventive care that they need and when they need actual care to be able to get that. I think medical professionals can lead the way in terms of keeping that in the forefront of what we need to be doing.
Rob Oliver: Just to follow up on that. Do you think that in this day and age of, you know, virtual everything, that the telehealth market is something that is now being more broadly used to bring treatment to those rural communities?
Richard Capriola: I think the pandemic has expanded the ability of people to communicate with medical providers in a way that before the pandemic may not have been readily available or easily accessible in the rural areas. I think part of the problem is a lack of adequate Internet connections in the rural areas, which, until that issue is addressed, is going to make it very difficult to bring any type of telehealth into those communities. But it does raise the possibility that if we can improve telecommunication services Internet services into the rural areas, we open up that possibility of more telehealth into those rural are excellent.
Rob Oliver: I appreciate your perspective on it and thank you for being willing to answer my my follow ups and kind of a little bit wandering path. So listen, Richard Cariola, I appreciate you being here and I appreciate your perspective on health care.
Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.