We at MindPath Care Centers are always looking for new ways to work towards destigmatizing mental health in our world, whether that be through blogs, videos, or social media. Keeping that in mind, we decided to venture into podcasts, to bring you the voices of our providers and to talk about important mindcare topics.
September is Addiction Recovery Awareness month. No one chooses to suffer from the disease of addiction. There is hope though. When patient effort is combined with professional guidance, addiction treatment is effective. At our Addiction Recovery Center, you will be treated with respect, dignity, and compassion. As you navigate the path to recovery, we will support you every step of the way.
If you or a loved one believe you may be suffering from substance use disorder – we have a free and anonymous online screening you can take to get a better understanding of how you’re feeling.
Below you’ll find the fourth episode of our new podcast, “Let’s Talk Mindcare” with provider Dr. Dean Drosnes, MD. We hope you enjoy!
Read the Transcript:
Introduction: Hello, and welcome to Let’s Talk Mindcare, a podcast brought to you by MindPath Care Centers. MindPath is one of the largest outpatient mental health organizations in the Southeast US with over 25 locations and more than 180 providers. For the past 25 years, we have helped tens of thousands of patients across North America and now we’ve created this podcast to further commit ourselves to ending the stigma and continuing the conversation around mental health, through discussions with real mental health professionals. Please note, that while the podcast will include accurate information with professional input, it is not intended as a replacement for medical advice from licensed providers to receive such advice, please contact MindPath Care Centers at mindpathcare.com or call us at (877) 876-3783 and we will connect you with a professional who can further assist you. We hope you enjoy the episode.
Ciara Pagels (Host): Hello and welcome back to Let’s Talk Mindcare, a podcast dedicated to ending the stigma and continuing the conversation around mental health, through discussions with real mental health professionals. I’m your host Ciara Pagels, and if you don’t know, September is Addiction Recovery Awareness month. So joining me today is Dr. Drosnes. Dr. Drosnes is an Addiction Medicine Physician at our Raleigh location here in North Carolina. Dr. Drosnes, thank you so much for joining me today and why don’t you go ahead and tell us just a little bit about yourself.
Dean Drosnes, MD: Hi Ciara, it’s a pleasure to be here. Thank you so much. I’m a physician and interestingly enough, I did not start off my career as an addiction specialist, but as a head and neck surgeon, and one of the things that quite rapidly in that field was that many of the patients who came to see me for problems in head and neck, whether it was nasal problems, sinus infections or even something so severe as head and neck cancer, where abusers of many substances, including tobacco, alcohol, and cocaine. And after many years of doing that, I started to think, you know, maybe I’m putting the cart before the horse here addressing the consequences of these behaviors rather than the behaviors themselves. And in addition, I found out not as a child, but as an adult, that there was a good bit of addiction in my family and I was exposed to addiction and through my family before I was exposed to it in medical school. So I had some reasons to make a career change, later in my career and I’ve done a lot of different things in the addiction treatment world. I’m now in North Carolina, I came to the Raleigh area to be closer to my children and grandchildren, and I’m just very happy with my life and with the practice and how things are going. So I’m really glad to be here today and hopefully, we can educate some people on addiction today.
Ciara Pagels (Host): Yeah! That sounds like a great little backstory. Like I feel like everything kind of worked out the way it was supposed to, which is really nice. I guess just to start off the first question I have is just, what is substance use disorder?
Dean Drosnes, MD: Substance use disorder is very simply it’s a newfangled term. It’s the updated term. We used to replace addiction specifically addiction to using substances such as alcohol or tobacco or cocaine or heroin, et cetera, et cetera. And we use that updated term because it’s a more accurate description of what actually goes on for the person who has a substance use disorder.
The term addiction and you mentioned this word in your introduction about stigma, the term addiction has a stigma attached to it, and we’re trying to break away from that. So using substance use disorder simply means that the use of the substance, in question, whether it’s something you chose to use or whether it was something that you were prescribed and caused more problems than help. That’s a substance use disorder addiction has a, an assumption that you chose to use something for the specific purpose of getting high or feeling the effect, but that’s not always the case.
Ciara Pagels (Host): In like movies and shows and things that I’ve watched, It kind of gives the idea that if you’re addicted to one thing, you will be addicted to everything. Is that true? Or?
Dean Drosnes, MD: So, yes and no. How’s that for a clear answer? But what I’ll say is that addiction or substance use disorder is a combination of individual predisposition to problems with certain substances plus exposure to those substances through life, through behavior. So the way most people identify, whether they are at risk for having an addiction or have a predisposition is by looking at their family. Addiction tends to run in families and if a person comes from a family where there’s a lot of addiction it’s probably in their best interest to be very, very careful when using alcohol or other substances that they may become addicted to.
In many cases that I’ve seen over my career. The people who have a problem with say alcohol, will have a problem if they start taking opioid pain medication and people that have trouble with nicotine will be more likely to have a problem if they experiment with cocaine and there are specific associations that are being found in the addiction science world, as we speak, there it’s fascinating science as we learn about it.
Many people become addicted to nicotine and never become addicted to other substances. There’s a lot more people who smoke and don’t use other substances than there are people and I should say smoke or vape. Then there are people who use, all kinds of other substances. Where this whole question becomes important is if somebody has, is diagnosed with a substance use disorder and it’s in their best interest to stop, it’s really best for them to stop using any substances that may be associated with addiction.
It has to do with how the brain gets better after a long period of using a substance. So I know it’s a kind of roundabout answer to your question and It’s much more likely that somebody with an addiction to one substance will become addicted to another substance than if they’ve never had an addiction previously.
Ciara Pagels (Host): Wow. Oh, okay. That’s really interesting. Is it more common in men or women or is that not a concern at all?
Dean Drosnes, MD: No. There are gender differences when it comes to certain addictions. Alcohol is one that is much cited in that regard. The way human beings, metabolize alcohol once it gets into their body is dependent upon some enzymes that are concentrated differently in men than women.
So in general, men who have a predisposition towards alcohol addiction will develop their addiction on a somewhat linear, progressive schedule or trajectory I should say. With women, oftentimes there’s a very, very slow initiation of their problem with alcohol. And then, it rises rapidly a little bit later on and it has to do with the way the alcohol is metabolized between men and women.
So these kinds of things are studied very heavily in the university academic world when it comes to looking at people who have an addiction and it’s not clear, cut. It differs from one substance to another. Women often times have a stimulant medication, whether it’s medications for ADHD, weight loss, medications, or cocaine.
If that is believed, I won’t say it’s true, but it is believed that it has to do with a decreased appetite as a side effect of these drugs. And for women who are conscientious about their weight, it seems to be an extra benefit of using some of these drugs. So that’s another piece of the of the gender difference puzzle.
There are certainly racial differences between how certain drugs are metabolized and therefore the likelihood of developing an addiction that starts off as casual use. So it’s a very complex scientific question about race and gender difference.
Ciara Pagels (Host): Wow. I would never have guessed that. That’s actually really interesting. So I’m going to throw like a two-parter at you. How would I know if I have an addiction? Like, what are the signs versus what are the signs to look for? If a friend or a family member has an addiction?
Dean Drosnes, MD: Hmm, those are really, really important questions and I’ll take the second one first, if that’s okay with you, if you know if you’re looking to see, cause I, I could probably bet you that our listeners, if there are people listening to this episode, They’re thinking, “I wonder if my, and you can fill in the blank there, you know, partner or child or parent or spouse or sister or brother, or what have you, have a problem with there and they can fill the other blank, in cannabis or alcohol or painkillers or what have you.
So generally what you look for with people that, you know, when you’re most of the time that it’s identified by confrontation. In other words, a loved one expresses some concern by saying, don’t you think you may be drinking too much? Or does it ever occur to you that maybe you’re drinking too much? Do you think it would be better for you if you stop drinking so much? Can I ask you to not drink as much during the week cause I’m worried about you? And then gaging their response to a question like that.
People who don’t have a problem are usually able to modify their behavior. They can say sure. You know, I won’t drink Monday through Thursday or Sunday through Thursday nights and I’ll drink on the weekends if that’s okay, where they’ll be able to say, okay, instead of having three drinks, I’ll have one drink.
When people are having a problem, there’s oftentimes pushback.They say things to defend their drinking or their cannabis use. It’s very common with cannabis these days, because cannabis is, you know, in the, almost in the realm of medicine that is prescribed because there is, you know, legalization in many states for medical use of cannabis.
So, so it gets tricky. But just addressing it, you know, and expressing concern, I think is probably the most common way that people talk about addiction with their family members. The second partner, the first part of your question, the second part of my answer is how would I, how would I identify this in myself?
And that’s a trickier situation because as we say in our field, one of the signs of addiction is that you tell yourself you don’t have it. Well, how do you figure that out? So if the question arises to you and you say to yourself, you know, I didn’t use to drink this much. I didn’t use to smoke cannabis this much, and maybe at first, you’re going to say, well, you know, it’s that, it’s really all about this COVID-19 pandemic and I’m stressed out and you know, I’m just, I’m sitting indoors and I don’t have the relationships that I used to have the opportunities to go out and enjoy myself.
And for some people, that’s going to be true, a true answer, but for other people, it’s not.
And so the challenge then becomes, you know what, let me, let me cut down a little bit. Let me just, you know, let me just cut down or even stop my drinking or substance use. And what people often find is that. They may want to do that once or twice and they do it and it’s okay. And then after the third or fourth time, they decide, gee, I went right back to the level of use that I was before.
And I really didn’t mean to let me try cutting down or stopping again, and then that’s, that’s almost a very red, very bright red flags signed that addiction is developing. Also, if you’re on the opposite end of the conversation I talked about earlier where your family members or loved ones are saying to you, Do you think maybe you’re drinking a little bit, too much? I’m a little concerned about you. You know, you’re looking not looking as healthy. You used to do more exercise.
People start to give up things they used to do that didn’t involve alcohol in favor of things that do involve out. So those are some of the really common signs. I mean, there’s a whole list, you know, it’s a very popular questionnaire called 20 questions to determine if you have a problem with alcohol and it’s on the internet, you can Google it and I’m certain it will come up and you can apply that to any substance that you want to, but it’s very useful. It’s been around for decades.
Ciara Pagels (Host): Interesting. So say I go out every single night with my friend, get drinks, do whatever and she gets a problem and I don’t. Why is it that some people get addicted and others don’t? Does it just go back to genetics and race and all that? Or is there more?
Dean Drosnes, MD: No, that’s a very important question. I could probably spend a couple of hours and give you a detailed answer about that, but I won’t do that.
So your, your first part of the question where you said, is it a matter of genetics? And the answer to that is it certainly is. There’s no question that the predisposition to developing a substance problem is genetic and It’s oftentimes very easy to see, you know, somebody will say, well, you know, I had a lot of alcoholism in my parents and their siblings or my grandparents and their siblings or cousins, or what have you.
And such was the case with me and my family and other people will say, no, really nobody has a problem. Now that second person is not immune from developing an addiction, but their likelihood is less than the first person with a strong family history. So the genetic component is about 50% of the risk of developing an addiction.
The other 50% is the environment, and a lot of that has to do with challenges faced in childhood. There is a scale called the adverse childhood experience scale. It’s very common. I’m sure that everybody in our organization knows about that. I mean, who’s a clinician knows about the adverse childhood experience studies and not only do adverse childhood experiences, predispose people to have psychological and psychiatric and relationship problems later on in life but it also directly predicts the development of alcoholism and drug abuse later on in life. So circumstances that were you know, traumatic in childhood, oftentimes results in somebody with a higher predisposition to develop alcoholism. Also, the environment that they grew up in, did the individual grow up in an environment where alcohol was part of regular social life among their parents and their family members and their friends growing up, you know, did they live in a, a liberal environment where, you know, kids use cannabis and alcohol in high school and it’s kind of, parents turned a blind eye and, you know, they’re responsible kids, et cetera, et cetera, or are they brought up in a more conservative, social or religious, society, or environment where those things are frowned upon and they’re not exposed.
So. There’s a, there’s a huge, so first of all, there’s the genetic component and then on top of that, the genetic component is what’s the individual’s environment and their upbringing has what’s that been like? So you can take two people, one of whom both of them have the same genetic predisposition, but one had a very, very supportive, strong relationships, very loving childhood. Another had a, not so stable, childhood. The person with the not-so-stable childhood probably is at higher risk of developing a substance use disorder with regular use of this.
The key to all of this is if nobody puts the substance in their body, they’ll never develop a disorder with it. So, you know, a lot of people choose people who come from high-risk, families where there’s been a lot of problems will choose. They’ll just say, you know what, I’m not going to drink or ever, I’m never going to do it. And that’s kind of counter to what usually happens in adolescents, but nevertheless, some people who have had a traumatic childhood because of substance use problems will choose not to ever use substances.
Ciara Pagels (Host): Yeah. Yeah, that makes a lot of sense. One of the questions that were sent to me to ask you, which is I’m interested to learn as well. Cause I didn’t even know this myself. What is the difference between a process addiction and a chemical dependence?
Dean Drosnes, MD: Oh, okay. So, yeah, no, that’s a good one because process addictions are being spoken about more and more in 2021. Part of the reason for that is because the COVID-19 pandemic and quarantine and stuff were associated. Not only with people having trouble with alcohol, whatever they could get, but people having trouble with gaming and the internet – what they call internet addiction. So a chemical dependence, substance use disorder is really what it, what it says it’s use of the substance from outside of us. As I mentioned before, nicotine alcohol, cocaine, opioids, sedatives, et cetera, et cetera – use of a substance to the point where it’s causing us detriment rather than help. A lot of people start off using alcohol or cannabis because it helps relax, and sleeping pills because they help us get a good night’s sleep. But over a period of time because of the chemistry. Breaking down these drugs and what they’re doing to the brain. The individual develops a dependence. They cannot function normally without them, after a period of time.
That’s based on chemical reactions in the brain that I’m going to very much oversimplify, but there’s a chemical called dopamine. It’s a neurotransmitter in the brain and it’s getting a lot of popularity now. There’s a lot of medicines that work on dopamine and that dopamine is really a feel-good chemical. It’s a pleasure chemical and people like dopamine. They just like that feeling when we get a flood of dopamine.
Process addictions, whether it’s video gaming or being on the internet and going through websites that, you know, have that are designed in a certain way or social media. Where somebody – you post something and you sit there in sit there waiting to see how many likes you get out of that. Right? That’s a, that’s a dopamine hit to the brain. So the brain likes dopamine, especially when it’s not feeling real good and the brain will do, you know, things just to get dopamine.
Dopamine is, is a natural a chemical in our brains, and what we usually associate with a surge of dopamine in our brain is eating and drinking, you know, food and fluids. We need to do that to survive. And when we do those things, we feel good. And the reason that we feel good is dopamine. Also people, you know, intimacy and affection and bonding, social bonding, whether it’s in a partner relationship or whether it’s an, a family relationship or whether it’s in a close friendship relationship, is all about dopamine as well. That helps release dopamine. When we feel close to someone, when we feel safe and secure, that also releases dopamine. Mating in every species, you know, causes, I mean, in every man mammalian species, that has dopamine in the brain causes dopamine release and – dopamine is essentially a survival chemical. And you know, it, its purpose, its physiologic purpose is to help us survive.
But with substances in people who have the predisposition. And with behaviors in people who have the predisposition, gambling is one I didn’t talk about – a process addiction. Inordinately high levels of dopamine are shot into the part of the brain that likes that. And so what ends up happening to really put it in a, in a very, very, tight nutshell is to say, You know, the more dopamine you get you more, you’re going to like it. And if you get more dopamine from playing a video game than you do from interacting with your family, well, you might be a, you know, you might be a common teenager. Right, but for some people, it’s actually even more so than that, they get so much dopamine and they can’t break that cycle without help.
So that’s why some people with process addictions, gambling, Internet, social media, things like that need treatment, just as much as the person who has a substance use disorder.
Ciara Pagels (Host): So if anyone listening is relating to everything that you’re saying, what would you suggest is the first step for either themselves or a loved one to get.
Dean Drosnes, MD: Yeah, probably the most important question of the session. Psychiatrists, addiction medicine specialists, many, many counselors in the substance use disorder field are good people to turn to. If there’s somebody just saying, Hmm, I wonder what I should do. I can tell you that there are great resources on SAMSA, that’s a substance abuse and mental health service administration, part of the government, a website, they have an addiction treatment finder. It’s very easy to use. It’s intuitive. It will point you to local regional resources where you might want to look to get that individual help.
SAMSA is probably my first go-to. My other go-to’s include, Psychology Today Magazine. They have a huge database of practitioners. The issue I find with psychology today magazine is that people are not necessarily vetted. Like they would be with SAMSA. SAMSA kind of looks to see whether they’re legitimate practitioners and they have a ton of information on the website that may answer many questions.
The other organization, a nonprofit called Shatterproof. Shatterproof is a private, non-for-profit organization that specifically looks at addiction treatment providers and their institutions and kind of vets them based on their perceived quality. And they oftentimes have recommendations or suggestions for people. So those like those resources or are for everybody.
It’s interesting. I just recently moved to this area from Pennsylvania. And when I Google, when I do a Google search for addiction treatment in Raleigh, North Carolina, I find, first and foremost, a bunch of advertisements for individual treatment centers or practices, or what have you.
And that wasn’t really the case. When I was in Pennsylvania, there were lots of government and nonprofit, organizational websites that were available. So, people could, you know, make their own decisions about where to go for treatment.
Certainly, I would say, you know, those of us who work at the Addiction Recovery Center, our resources many times people who call us or at a different level in their trajectory of a substance use disorder, then we treat one of the most important Indicators of success for people with a substance use disorder, is, are they treated at the same level of care as to where they are in their trajectory? In other words, things don’t always go to the terrible need for inpatient residential treatment, right away. Oftentimes there’s a period of time when people can be treated successfully using an outpatient model of care, which is what we do at the Addiction Recovery Center.
Other people for various reasons are not appropriate for that level of care and they really do need to be at a higher level of care with more accountability, more medical management, more supervisory clinical management through counselors. And that’s when you go to these, some of these resources that I mentioned, you’ll be able to figure out, you know, does my father and mother whoever need treatment in a residential center, or can we do this at an addiction psychiatrist’s office or what have you. So, There are not enough sources of information, but if you keep plugging on, you’ll find that we also obviously have two major university academic medical centers in this area in Duke and the University of North Carolina and each of them has departments of addictions treatment and, you know, those are oftentimes good places to start a search.
Ciara Pagels (Host): So speaking of the Addiction Recovery Center at MindPath, I’m aware that that’s an outpatient program. So would that be something where someone needs to like detox before coming? Or is it more of like a hold you accountable when they’re already a little further in their healing process, or?
Dean Drosnes, MD: Yeah. And that’s another terrific question. So at the Addiction Recovery Center, when somebody seeks help, we start by doing an assessment, a thorough assessment. And in that assessment, we make a determination. Is this patient or prospective patient appropriate to be at the Addiction Recovery Center for treatment, or do they need a different level of care?
And oftentimes, we find that they are appropriate and we, you know, we tell them about our program. We ask them if this is something that they’re interested in, we tell them what we do and what our expectations are and what they can expect.
If they’re not appropriate, for whatever reason to be in our care, we’re not going to keep them with us. That’s not ethical. We will ask, we will recommend them to go to a different level of care and different levels of care. We have a lot of people that we know through experience are very – what do I want to say there – they have good qual high-quality programs. They are ethical. They are responsible for who we work with. So if somebody needs a residential treatment center, we can’t take them, but we may say, you know, go here or go there these are places in North Carolina. If somebody is in a different area, we work with some of the places in a different state. So, treatment matching. That’s what we call that treatment matching is really important upfront to get the right level of care for the individual.
If somebody said at too low of a level of care, they’re not going to succeed. If somebody said a too high of a level of care, it may be an unnecessary expense and it may be in an unnecessary, kind of removal from society, right? You’re not available for your family and your workplace.
Ciara Pagels (Host): And then at our Addiction Recovery Center, do we offer telehealth for people in different locations?
Dean Drosnes, MD: We do and, I will say that, you know, MindPath Addiction Recovery Center has been really at the forefront of utilizing telehealth and virtual care for patients with substance use disorders. It’s been tremendous. There was a push for this prior to the COVID-19 pandemic because many people just don’t have access to go to the offices where they might have, you know, high-quality treatment but if we can bring them, bring the treatment to them wherever they are through a virtual platform, we’ve always known that that would be tremendously helpful. And that’s what’s happened across the country during the COVID-19 pandemic MindPath was doing it even before, but just got pushed into the next century in terms of its sophistication. So, one of the reasons that I’m so delighted to be wear I am now is that people have the option, you know, you know, are, if they feel that they are better served by inpatient, I mean, excuse me, by in-office visits. Then that’s what we arrange for them. If they feel more comfortable with, virtual visits, then that’s what we arrange for them. The degree of support that we provide is still the same. Some people need a face-to-face and in-person, interaction to benefit the most and other people, not necessarily so much. So those are decisions that we as providers and patients, make together what’s going to be the best way to go forward bluntly.
Ciara Pagels (Host): Yeah, definitely, and then just the last, two questions I have are; does the Addiction Recovery Center help with any substance abuse, and what services are offered?
Dean Drosnes, MD: So the answer is yes, pretty much any substance. There are certain substances now we won’t, we won’t be able to treat sufficiently until somebody has gone through the process known as detox and detox is another name for withdrawal management, medically managed withdrawal from the substance. And that can be, well, it’s very different depending on what substance you’re talking about. withdrawing from alcohol is very different than withdrawing from opiates, and that’s very different from withdrawing from sedatives and that’s very different from withdrawing from cannabis. So some withdrawal we can handle, because it is not so dangerous health-wise, other withdrawal is very dangerous health-wise in is best not managed in our outpatient setting.
So that’s part of our assessment. And you know, many times what we do is we say you are. Using so much of this substance, that if you don’t have a formal detox withdrawal management, you’re very high risk for complicated withdrawal and serious serious health effects. We can’t do that. But what we’re going to ask you to do is go to a detox center and we have options for that too. And get through that part of it and then come to us afterward. Once that. You know, get the poison out of the system quite literally is finished. So in some cases, we will do that as an outpatient. If it’s not too risky, we’re not gonna, you know, take risks with patients’ health, and if their use is such that we can do a, what we call ambulatory withdrawal. So they’re not in an inpatient facility to withdraw from their substances. If we can do that safely. and if both parties agree that this is something we can do together, then we will do that. If it’s not working, if we have any signs that it’s not working, we will just continue that and we will send somebody to. A detox center to do that. So, you know, again, every case is different. We can’t, I can’t make sweeping across-the-board statements for what we can and we can’t do what I can tell you is that we’ll be honest with you and you know, your family member, if whoever’s listening is on a call and we’ll tell you, no, this is not, this is not safe. We’re not going to do this, or yes, we can do this. And it’s going to take a lot of effort and I will say this treatment of addictions kind of grew up outside of the realm of medical practice and so the kind of overarching ethical framework that is applicable in medicine was not necessarily. Part of the culture of addiction treatment, many places were called out in 2000’s-2010’s, for some ethical practices about urine drug screening and, and, readmitting patients when they weren’t necessary, et cetera, et cetera. And what, what people who do some investigation will find is that that’s, those are not medically facilitated or medically run organizations. So, you know what I can tell you as an organization like MindPath, when we’re treating addiction, we’re going to do it, we’re going to treat you like anybody else who’s going to any physician who has an ethical code of conduct that they must abide by. So, you know, if you come to us and we say, no, you’re not appropriate for here. Here’s where here’s, here’s an option for you and if we can, if we’re treating you and you’re not making progress like we like to see, we’re going to say, we’re going to stop what we’re doing now. We’re going to send you to a different level of care. That’s more appropriate for you.
Ciara Pagels (Host): That’s good. That’s really good. Yeah, that’s really-
Dean Drosnes, MD: That’s what you want. Right? That’s what I want to find. You have to send my family to treatment.
Ciara Pagels (Host): Absolutely!
Dean Drosnes, MD: That’s what you want. If you, if you want to send your family to treatment, you want to know you’re getting the best care. And if they’re unable to provide that care, they’re going to get you the best care.
Ciara Pagels (Host): Absolutely. That is everything I have. I’ve really enjoyed this opportunity to kind of pick your brain and learn more about all of this. It’s really interesting to me. Do you have anything else you’d like to add before we say our goodbyes?
Dean Drosnes, MD: No, I just, I, you know bringing it all right around to the beginning where you talked about the stigma. I think that all of us in this world of addiction treatment, or I should more appropriately say substance use disorder treatment should, you know, recognize that we’re treating a disease, just like any other disease and that the stigma that has been heaped up upon people that have a substance use disorder. It just needs to go and I call all of us stigma busters. That’s one of our jobs is to treat people with the respect that we would give to anybody else. And, you know, not that kind of look down your nose upon somebody with a substance use problem that was so common in years past.
So, you know, I think it’s all about moving forward. I mean, as the science shows us more about what addiction is all about, we get to recognize that people were people and our job is to help them be the best people they can be.
Ciara Pagels (Host): Absolutely, Well, thank you so much for joining me today.
Dean Drosnes, MD: Thank you, Ciara.