“Not in my backyard” is not an option, with Dr. Randall Dwenger

“Not in my backyard” is not an option. It is already in your backyard. Addiction affects every family, school, workplace and every community. We need to embrace and encourage people in recovery and be the sort of community that welcomes the person in recovery. As a part of my series about “Heroes Of The Addiction […]

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“Not in my backyard” is not an option. It is already in your backyard. Addiction affects every family, school, workplace and every community. We need to embrace and encourage people in recovery and be the sort of community that welcomes the person in recovery.

As a part of my series about “Heroes Of The Addiction Crisis” I had the pleasure of interviewing Randall Dwenger, MD. Dr. Dwenger is board-certified in both psychiatry and addiction medicine. Throughout his 30-year career, Dr. Dwenger has built extensive knowledge in addiction treatment and is skilled in psychiatric evaluation, medication management, and individual psychotherapy services. Today, he provides guidance and leadership over Mountainside treatment center’s detoxification program, utilizing safe, medically-monitored treatment delivered with competence and compassion to help people transform their lives in recovery.

Thank you so much for doing this with us! Can you tell us a bit of your backstory?

I was born and raised in Columbus, Indiana. I was a chemistry and psychology double-major at DePauw University. I hated chemistry, but loved psychology. I graduated from Indiana University School of Medicine and then completed my psychiatry residency training at the Institute of Living in Hartford, Connecticut. Like so many of the decision points in my life, I think I backed into the right decision. I liked listening to people more than I liked talking. I wanted to work with young people. I’m a hopeful and positive person and I wanted to instill hope and optimism in others — and I think that’s why I ended up sticking with a career in addiction medicine.

I’ve been working in the addiction treatment field for over 30 years. My career has included positions like running an adolescent rehab facility in New Jersey, developing a detox program in Staten Island, New York, and overseeing a Homeless Veterans treatment program for the VA in Brooklyn, New York. I’ve been with Mountainside treatment center since 2008. I started out as a Consulting Psychiatrist there before transitioning into the role of Medical Director in 2014. That year, I helped to develop the treatment center’s detox program, which I continue to oversee to this day. Currently, I am the treatment center’s Chief Medical Officer. Despite the challenges of the opioid crisis, I love what I do. I have a wonderful and talented and caring team at Mountainside, which is essential if we are to help people heal during the vulnerable early stages of recovery. It’s a great opportunity and honor to be able to make a difference in the lives of people suffering from this disease. And I believe we do make a difference.

Is there a particular story or incident that inspired you to get involved in your work with opioid and drug addiction?

I’ve always been inspired to work with young people and adolescents. At first, I was convinced I wanted to be a pediatrician, but then I did my clinical rotation in psychiatry in medical school and really found a connection with helping people suffering from mental illness. My first job after residency was working as a psychiatrist at the ACCEPT Unit (Adolescent Center for Chemical Education and Treatment) in New Jersey. Addiction treatment has come a long way since then — the late 80’s — but the idea of helping a kid who got off-track get back on a positive path was challenging and exciting and rewarding. It’s cliché, but youth have their whole lives ahead of them and endless potential, so I feel energized in being able to help them progress and grow in their recovery and their lives.

Can you explain what brought us to this place? Where did this epidemic come from?

Obviously, the over-prescribing of opioid painkillers has been a big contributor to where we are in the current crisis. These are powerful drugs, and I think many people with a license to prescribe don’t understand what opioids do to the brain — particularly to the brain of a vulnerable individual. I have heard so many times a young client describe his or her first taste of opioids as “love at first sight.” But when prescribers write prescriptions for 120 Percocet tablets at a time — with refills — for a sports injury, the addiction has already taken hold before the patient comes in to get the cast removed. Tolerance to these drugs develops quickly. Clients need more and stronger drugs to get that same effect they are chasing, and when their doctors finally say, “I’m not prescribing for you anymore,” there is a market on the streets where the clients can find stronger and cheaper opioid pills, or illicit drugs, such as heroin or fentanyl.

One of the big problems with prescription pain medications is: they work. They make people feel better, and then people want more of that “better” feeling. They want to continue to experience that dopamine release at that same level, even when they are no longer in pain. This can lead them to look for that feeling in other places.

If doctors need to prescribe opioids, we need to make sure that it is a very limited prescription that we’re giving people for acute pain. And at the onset, doctors need to have a plan for alternatives for when the prescription runs out. They should never be able to say, “Here’s a 30-day supply and three refills.”

Can you describe how your work is making an impact battling this epidemic?

I’m a big advocate for the use of medication-assisted treatment (MAT) for treating alcoholism and opioid use disorder. I’ve seen firsthand how MAT can save lives. And, sadly, I know of too many cases where not being on medications has cost lives. MAT is evidence-based and the treatment-of-choice in the field. When a person struggles with the disease of addiction, their natural instinct is to deal with their physical and emotional pain, interpersonal distress, or just the stresses of life by doing what they know will work — taking a substance. But if a person knows his opiate receptors are blocked through MAT so that when he uses heroin, Percocet, or Oxycontin, it’s not going to do anything, then he’ll have to use the other tools he has worked so hard to learn in treatment. It’s going to give clients an opportunity to call their sponsor and talk to their therapist or psychiatrist or parent instead of acting on that impulse to take a substance to deal with their stress.

I’m especially proud that we’re one of the first treatment centers in the state of Connecticut to offer Sublocade™, an injectable form of buprenorphine product that clients receive on a monthly basis to stop the cravings and block the opiate receptors. Embracing and promoting products like this help us battle this epidemic, and decreases the risk of overdose deaths, giving people the time they need to develop and utilize recovery tools and get back on a satisfying, positive, thriving trajectory.

Wow! Without sharing real names, can you tell us a story about a particular individual who was impacted by your initiative?

There are so many people that I’ve been lucky enough to work with throughout my career. You make powerful connections with people when you are involved with them at such a critical juncture in their lives. I get texts and calls from clients every week updating me on their progress, whether it’s a sober anniversary date, a wedding, a graduation, or baby pictures. But the ones that stand out most in my mind are the clients that make real progress and then, sadly, pass away from this disease. When I was working in my adolescent program, I used to give a lecture where I referred to addiction as a “primary, progressive, relapsing, terminal illness,” but the reality that it was a terminal illness never sank in until the recent epidemic of overdose deaths. I am so motivated to do what I can to help curb this epidemic, and prevent the loss of life and the devastation for families torn apart by this disease.

Can you share something about your work makes you most proud? Is there a particular story or incident that you found most uplifting?

I’ve been lucky enough to have assisted thousands on their journey to sobriety, so it’s difficult for me to choose a favorite story. I’m always thrilled when young clients are able to get back to school, graduate college, and start their lives in pursuit of their dreams. I recently had a client graduate from Berkeley School of Music and he sent me the link to some of his music on Spotify. He would never have gotten back to school. The universe would never have encountered these songs if it weren’t for the tools and connections he made in his recovery — which included medication-assisted treatment.

Can you share three things that the community and society can do to help you address the root of this problem? Can you give some examples?

  1. We need to educate the community in order to raise awareness of addiction and treatments that are available. “Not in my backyard” is not an option. It is already in your backyard. Addiction affects every family, school, workplace and every community. We need to embrace and encourage people in recovery and be the sort of community that welcomes the person in recovery. The community can be a system of support for our friends and neighbors who want to live a sober lifestyle.
  2. Stigma is one of the biggest hurdles to people seeking treatment for addiction. We all need to remember that addiction is a disease and not a choice. Even within the recovery community there are those that stigmatize certain treatments, especially medication-assisted treatment. These attitudes cause people to avoid getting life-saving treatment. And in the case of opioid addiction, it is truly a matter of life and death.
  3. The other thing everyone in the community can do is to get a prescription for naloxone (aka Narcan) and take a course to learn how to use it. Narcan is the medication used to reverse an opioid overdose. Narcan should be available in every school, business, and home — but it obviously is not. You literally could save a life by carrying around a cartridge half the size of your cell phone.

If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?

We’ll need more than legislation to eliminate this problem altogether, but the following measures could help save more lives:

  • Providing true mental health and addiction treatment parity in insurance plans. Just as physical conditions are considered diseases, behavioral health illnesses need the same consideration. If insurance plans provide unlimited doctor visits for conditions such as diabetes, the same should be offered for mental health and addiction treatment.
  • There needs to be mandatory education about addiction and addiction treatment in medical schools. I know it was a long time ago, but I (literally) had a one-hour lecture on addiction during my medical training. We need to make sure we are teaching young doctors that addiction is a disease of the brain and not a moral weakness. We need more new doctors to understand that there is a human being behind the addiction when he or she comes into their emergency room or primary care office.
  • Along those lines, I think all new healthcare prescribers should receive buprenorphine training as part of their schooling. Only a small fraction of doctors and nurse practitioners across the nation have the federal waiver required to prescribe buprenorphine. And, of course, those with the waiver are limited in the number of patients they can treat with buprenorphine. The government can find a way to make it easier for doctors to prescribe this medication for addiction — a medication that has been proven to save lives.

I know that this is not easy work. What keeps you going?

The things I love, I pour my heart and soul into. I love to be on my bike, I love my golden retriever, I love my husband, I love to cook. I love the Zen feeling of being in my garden. And fortunately, I also love my work, my work colleagues, and the patients I get to care for. It takes a lot of my time. But I really care about my clients and helping them — and that truly drives me.

Do you have hope that one day this leading cause of death can be defeated?

Of course! It’s why we do what we do. When I was in medical school in the 80’s, young men were dying from something we called GRID (gay-related infectious disease). Today, AIDS is something you live with, not something you die from. In the same way, we are going to win this latest war. We are making positive strides in treating people who struggle with opioid addiction. If we can keep them in treatment and maintain that connection with people and communities who care about them, keep their opioid receptors blocked, and keep their cravings down, then opioid use disorder will be much more of a disease you live with rather than one you die from.

How do you define “Leadership”? Can you explain what you mean or give an example?

A good leader empowers other people to think and make decisions. I have the greatest team of nurses and clinicians that I get to work with at Mountainside. I count on them to come up with the right treatment plan for each individual client we get to serve. In some ways, I think I have taught them to make my job easier. This way we all share in the satisfaction of this challenging job we get to do. I’m also proud that I have the chance to nurture young medical and clinical professionals and watch them become leaders in their own right.

What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.

  1. Psychiatrists treat real diseases and deal with life and death situations. Indeed, there is a difference between the way physical health and mental health are regarded by society. When I told my mother I was going to be a psychiatrist, she said, “I thought you were going to be a real doctor.” But over the years, especially in light of the opioid epidemic, I realize that the practice of psychiatry is real medicine, and that I am a real doctor.
  2. Doctors aren’t always good and ethical across the board. I thought they were when I was first starting out in the field, but — sadly — not all doctors are. Doctors don’t belong on pedestals. Once I had that realization, I felt reinvigorated to be one of the doctors who truly make a positive difference in the world.
  3. No one told me how little sleep I would need. I seriously get up at 4:30 in the morning, make my coffee, walk my dog, and start working. My work and the challenges of it energize me. I’m able to find deep satisfaction in the small moments thanks to my clients and my coworkers
  4. Another thing I have learned is that I’ll never get caught up. There is always some project or client or evaluation or problem that needs my attention. I used to have that fantasy that everything would stop for a week and I would have a whole seven days without interruptions, and I would get everything done. But I understand now that my job is really about prioritizing tasks, and doing what I can do. Accepting that I won’t ever get it all done helps me achieve some balance in my life and maintain my own mental health (even though I will still get up at 4:30 in the morning).
  5. You can’t always believe what drug companies tell you. I honestly don’t think pharmaceutical companies are the enemy. Not at all. I am grateful for all the options I have in my toolkit thanks to their contributions. But doctors need to remember our oath to Do No Harm. I was practicing when Xanax was first released and it was touted as a non-addictive anti-depressant. But we now know it is not an anti-depressant, and it is highly addictive. I was at the VA hospital when doctors were encouraged to treat pain as the “fifth vital sign” — and this contributed to the over-prescribing of opioid medications like Oxycontin. Sometimes the most therapeutic option is to put your prescription pad to the side, and just listen to your patient.

You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I’d love to find a way to reduce the stigma around addiction. Society often deems a person to be “bad” or morally corrupt or weak if they have a substance use disorder, when they actually have a disease. People who are struggling with addiction may internalize this message, which only further intensifies their feelings of shame. They start to feel things are hopeless for them, when that couldn’t be further from the truth. The stigma around medication-assisted treatment is especially prominent, even among those in recovery. I’ve heard some clients say, “Well, if I have buprenorphine in my system, that means I’m not really in recovery.” Addiction is the most stigmatized disease in the world. We don’t need people who are taking steps to get well being told — or telling themselves — that they are bad.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Choose your battles.” My staff will tell you I say this all the time. Life can be complicated as it is; don’t create problems where none exist. Let’s see if we can decrease barriers in each other’s lives. We don’t need to be so rigid. I see many parents who are worried about every aspect of their teenagers’ lives, and while it’s natural for them to feel concerned, sometimes we all need a reminder not to sweat the small stuff and keep an eye on the bigger picture.

Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. 🙂

Honestly, I would like to have lunch with one of the young people that I lost. It’s a fantasy, but I’d love another chance. I’d want to know: What could I have done differently… what could I have done better for that individual? Addiction is cunning, baffling, and powerful. The other day, a young man told me that his addiction was like he was trying to swim with chains around his feet — that’s how his disease felt to him. His drug was like kryptonite, but if, together, we could find the key to keeping him away from it, he could be superman. The sky is the limit.

How can our readers follow you on social media?

They can follow Mountainside on Facebook or LinkedIn!

Thank you for all of these great insights!

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