Here we are. Here you are. Issue 3.
Let’s keep showing up. For you. For me.
This week, we highlight someone we deeply respect and admire, Amy Olseth MSN, RN. But first, a few notes about this week’s newsletter issue.
We are diving into a sensitive topic. Addiction. Stigma. Shame. These topics may bring deep feelings, triggers, and/or fears. That said, if you or anyone you know is struggling with addiction, Amy offers us some immediate resources: If you or your loved one is in danger to themselves or others, call 911. Do not attempt to negotiate with an intoxicated or mentally unstable individual. Call National Suicide Prevention Lifeline: 1-800-273-8255 or Substance Abuse National Helpline: 1-800-662-4357.
With that important information in mind, let’s dive in. In this issue, we’ll learn about the harrowing realities facing the current state of addiction treatment, the efforts Amy is making to implement change in the field, and the strategies that we may borrow from her approach.
Rock On, Rebels!
In this section of the academic rebels' newsletter, we'll highlight challenges to inspire and spark change across industries. Here, we'll examine expectations, stigmas, or barriers that limit the potential of an individual, organization, or system.
It could be your daughter or son. Your brother or sister. Your friend or family member. It could even be you. Amy Olseth calls him “John” and writes about him routinely under #doyouknowjohn on LinkedIn. John is a fictitious character who represents one of 19.7 million Americans (age 12+) who struggle with a substance use disorder.
How did Amy find herself in a position to share John’s story? To write about the way his struggle with addiction impacted his family and friends?
Amy’s interest in the field of addiction began with her career in nursing and her dissatisfaction with the healthcare industry's response to patients and their families as they worked to overcome addiction. Through her experience in various hospital departments and settings, Amy identified barriers to providing care for individuals who were coping with substance use disorders (SUDs). Some barriers included: stigmas associated with SUDs, a lack of patient advocacy, and a need for enhanced ethical standards throughout the addiction industry.
To better understand these barriers, we reviewed research examining treatment options for those battling opioid use disorder (OUD). Buprenorphine is an effective medication used to reduce the effects of withdrawal and prevent relapse. In a review of over 40,000 insurance claims pertaining to those with OUD, Sarah Wakeman and her colleagues (2020) found those who were treated with buprenorphine or methadone were 76% less likely to experience an overdose at 3-months post-treatment, as compared to those without treatment. No other therapy demonstrated a significant reduction in overdose.
Despite such impressive findings, availability of buprenorphine at treatment centers does not seem to parallel its effectiveness. Tamara Beetham and her colleagues conducted a study where they posed as callers to residential treatment centers across the U.S. Each caller identified him/herself as a 27-year-old who used heroin, was not insured, and was seeking treatment with Suboxone (buprenorphine-naloxone) (Beetham et al., 2020).Of centers contacted:
- 29% offered Suboxone with a continued maintenance option (i.e., standard of care)
- 31% offered Suboxone only for short-term detoxification
- 39% reported they did not offer (or, did not know if they offered) Suboxone
- 21% of centers actually discouraged the caller from using Suboxone for treatment
If buprenorphine is an evidence-based treatment representing standard of care for those with OUDs, why might such variance exist in its availability? And, why might a substantial portion of facilities actually discourage its use?
Dr. Jennifer Velander’s work sheds some light on these questions. She highlights the stigma associated with buprenorphine use, suggesting that some see the medication as being indicative that one is not “truly sober.” Our addiction expert, Amy, does not advocate for buprenorphine, specifically. Rather, she makes personalized recommendations based on individual assessments of a client’s needs. She notes there is no “one-size-fits-all” approach to addiction. However, Amy agrees that research highlighting the discrepancy between buprenorphine effectiveness and availability is just one area where industry practice does not reflect research.
In Amy’s work, she continues to encounter patients with a variety of SUDs. Regardless of substance utilized, she observes common themes that impair effective treatment including stigmatization of those with SUDs and questionable practices employed by treatment facilities pertaining to treatment availability and eligibility -- practices that don’t always align with her own ethical standards. Amy wants to ensure that her patients obtain the best possible care -- care that would help them to achieve their full potential.
But, without an advocate, how can a person in the throes of addiction be expected to navigate this complex system?
In the real rebels portion of our newsletter, we’ll share stories of the innovators, creators, and rebels who are making waves and paving their own way in various industries.
We selected Amy as a fellow #academicrebel because she has discovered and created a way to innovate from outside of the system. Once Amy started to use her “loud and captivating voice” by combining it with her expertise and passion for patient advocacy, she started her own business. She launched Holistic Interventionist LLC to advocate for the rights of those living with substance use disorder, to educate the public, and to help her clients access treatment services that fit their individual needs and circumstances. Now, with Amy’s help, patients, families, and loved ones are supported by a unique and personalized approach to addressing the impact of addiction. Amy bravely treads the difficult path to expose the root cause problems impacting her patients and the addiction industry.
Why did Amy decide to operate in a new way? Her words sum it up beautifully:
Amy earned her #academicrebel pedigree as a young nurse working on an innovative telehealth program. When Amy was promoted to oversee the program, she wondered if she might be perceived, by some, as a compliant young leader who could be easily manipulated. However, she also believed in her own ability to work hard and use her voice for change. Though some in leadership offered doubts and criticisms pertaining to the future of the telehealth program, Amy was a rebel who was -- and continues to be -- up for the task of taking on massive change.
Under Amy’s leadership, the program quickly became known as “The Little Engine that Could” and Amy was dubbed a “phoenix” for bringing a program from the ashes to the attention of system leadership. Amy found creative ways to showcase data demonstrating her patients’ successes and her program’s growing needs. Amy and her team of nurses became trusted liaisons for hospital wide improvement projects and were seen as the go-to leaders for interdepartmental communication. Today, the program is alive and well and contributes to reducing hospital mortality, reducing hospital length of stay, and increasing compliance with evidence based practices.
As Amy worked in traditional healthcare positions, she was gathering and collecting information. Hospitals became her training ground. Based on her observations throughout that time, she uncovered her passion and potential to make change in the addiction and recovery space. Now, her mission - the heartbeat of her work - is to reduce negative stigma associated with addiction. Amy’s content is reflective of this focus.
Recently, Amy launched #doyouknowjohn on LinkedIn. This set of posts chronicles the life of a man named John who is struggling with addiction. Amy created this fictional character based on the traits of many individuals and loved ones she has worked with over the years. She tells his story with empathy, without condemning or judging his behaviors. Amy uses John’s story to build community, providing her audience with insights and tools to assist with addiction.
Using #doyouknowjohn, Amy presents a comprehensive scenario outlining the problems that emerge in John’s life, the denial and desperation that follow, the discovery of a solution, and then, the development of an action plan. Through it all, Amy colors the trauma of addiction with hope. Her content serves as a reminder for all that help and support are available.
After reading John’s story, it is clear addiction is all around us: alcohol, illicit and prescription drugs, pornography, food, social media, etc. It is fair to say that all of us will be directly or indirectly affected by addiction in our lifetime. Yet, society still stigmatizes addiction as a negative, self initiated, character flaw, instead of as an illness that can be managed to improve quality of life. Just like some people choose to not treat their medical conditions or are non-compliant with a medical plan of care, there will be those who refuse to seek treatment. And when that happens, there are things we can do to ensure it doesn’t take an entire family system down with it. We can all learn from John and his family; how to love with boundaries, care for ourselves, and accept things we cannot control.
Amy demonstrates that one person can absolutely make a difference and begin to disrupt industry standards. When asked what she has learned throughout her career, Amy’s insights provoke inspiration and courage for us all:
In order to be effective disruptors, we must accept and embrace our gifts - not temper them. I can't - and I don't try - to fix all the problems in my field and my profession, but I don't avoid difficult conversations. I never walk away from a problem that I have a contributing solution for.
This is a real rebel.
We’ll end each newsletter with a rebel reflection - a place where we can explore the intersection of the academic and rebel in each of us. Through rebel reflections, we’ll identify ways to step, leap, and jump into spaces we have only imagined. We combine the research with our personal experience. And, then? We jump. With support. With each other.
Amy’s story provides lessons to each of us who strive to live an #academicrebel lifestyle. First, Amy’s observations of a discrepancy between research and practice in the addiction industry highlight an important lesson: Rebels refuse to ignore the signs that something is problematic beneath the surface. For Amy, this meant recognizing an issue with stigma and unethical practices, taking responsibility to offer clients a personalized approach to assessment, advocacy, case management, and intervention, and drawing from her skills as a nurse to know how to correctly implement and effectively carry out these practices.
A second lesson gleaned from Amy’s work arises from actions taken as she transitioned between employment in a formal hospital setting and development of Holistic Interventionist LLC: Rebels identify their transferable skills and use them strategically. Within the hospital, Amy had difficult conversations with leadership, encouraging them to support a program. Now, Amy has difficult conversations with clients and their families, encouraging them to find appropriate treatment options. She has difficult conversations with the public, as she seeks to reduce perceptions of stigma surrounding addiction. In the hospital, Amy empowered nurses on her team to believe in a program that others doubted; now, she empowers clients and their families to seek treatment when they may doubt their potential.
A third lesson gleaned from Amy’s work is that real rebels don’t need permission to create. Amy began her journey from employee to entrepreneur and hasn’t looked back since. She launched a website, began creating unique and interesting content, and continues to build brand recognition. Amy uses the power of audience to build and attract potential clients. Her unique voice attracts many and reduces the stigma around addiction both within her community and beyond. By consistently sharing valuable content that is freely available to all, Amy has positioned herself as ‘top of mind’ in the addiction industry. If someone requires services and has been exposed to Amy’s words? She will undoubtedly be their first call.
Ultimately, Amy progressed by relying on her skill as a nurse, her trust in herself, and the support of others who believed in the value of her mission. This allowed her to innovate both inside and outside of traditional healthcare settings. This is the dream of every #academicrebel we know. To be seen for who you are. To know that your words, ideas, and dreams are containers of significant value. Amy knows this fact. She encourages you to find the same.
Do you know an #academicrebel?
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Ashley E. Fico, Ph.D. is co-founder of InnoQuests LLC. InnoQuests LLC enhances tourism by crafting city-based interactive adventures that encourage engagement in problem solving and exploration of local spaces. As the original #academicrebel, Ashley draws from her career in higher education, as well as her entrepreneurial efforts, in order to identify factors necessary to facilitate innovation and organizational change.
Stacey Gonzales, Ed.D. is founder of SG Creative Connections LLC. She is a former K-12 administrator, who is igniting the #academicrebel movement with her in-depth knowledge of technology and instructional design. She excels in helping individuals and organizations uncover their vision, gain clarity, and develop plans to execute on their goals.