Pain, Addiction & Prevention #242

Dr. Dave Salko:

highlights from this week's program as we progress. I mean nationwide, statewide. We know there's an opiate problem. We know there's an epidemic. We see not just the use but the abuse of controlled prescription drugs just increasing astronomically.

Jim Godbout:

People in addiction or opiate addiction especially, they've led from prescription drugs, which are legal drugs. They started with that and they're readily accessible, Unfortunately.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to Love Maine radio show number 242, Pain, Addiction and Prevention, airing for the first time on Sunday, May 8, 2016. How do we protect our communities from issues related to addiction? Prescription and non prescription drugs have a complicated history in our society. Health care providers and community members alike are seeking ways to deal with addiction both through primary prevention and through treatment. Today we speak with Central Maine Medical center family physician Dr. Dave Salko and Jim Godbu, co chair of the Red Ribbon Committee of the Biddeford Saco Rotary, about their efforts in this area. Thank you for joining us.

Dr. Lisa Belisle:

Today it is my great pleasure to talk with one of my colleagues at Central Maine Medical Center. This is Dr. David Salko, who is the Chief of Family Medicine at Central Maine Medical center, the Medical Director of the Freeport Nursing Home and also the Coastal Primary care lead provider. He and his wife Jen have four children and they live in Brunswick. You and I have known each other a long time, Dave.

Dr. Dave Salko:

Yes, I was pleased you said colleagues. You were one of my mentors, so.

Dr. Lisa Belisle:

Well, that's a strong word. I at least was one of your teachers at Maine Medical center at the Family Practice Residency Program. And my dad also is one of your teachers.

Dr. Dave Salko:

Your dad was a great guy. He's the reason we selected the residency that we went to.

Dr. Lisa Belisle:

They do a good job up there.

Dr. Dave Salko:

Yeah.

Dr. Lisa Belisle:

Now, you also have a family history of family medicine. You actually spent time practicing with your father in Pennsylvania.

Dr. Dave Salko:

After I completed my residency in Maine, I had the opportunity to work with my father. So we did that for three years. I got. I think it was really more like another fellowship. We were doing hospitals, we were doing nursing homes. The only thing we didn't do was deliver babies. And I got an exposure to a lot of medicine and call it an older way of caring, that the practice of medicine has changed, that you don't necessarily get the deep relationships that might have been there before. People selected their provider, their physician, their doctor to stay with them for the rest of their life, and they didn't move. Communities stayed the same, and they relied on that person. I grew up in that. I was trained in it, and I got to go back and work in it. And that probably set me off to the direction that I am now in family medicine and why I love it as much as I do.

Dr. Lisa Belisle:

You've been up in Topsham as a provider for how long now?

Dr. Dave Salko:

I think we're going on seven years. Somewhere between seven and eight there. I came back to Maine in 2007, before our third child was born. We had a goal to have them all born in the state of Maine. So the girls were born while we were in residency, and then we had to hightail it back to the state with my wife pregnant so we could have the third and fourth in the state. So James was born in 2007, and we moved just before that.

Dr. Lisa Belisle:

And you and your wife, Jen, both have a really strong commitment both to family and to health. That Jen actually does health coaching.

Dr. Dave Salko:

Yep. I think it's around us. It's something we use to help raise the kids with because we want them to have a good sense of their own health and their bodies, and it's something that we try to live. So I think when you adopt something like that, the practice, what you preach idea, it doesn't so much feel like work as it feels like, you know, you're helping other people. You're coaching them along, you're giving them information only so that they could be. They could improve themselves in a way.

Dr. Lisa Belisle:

One of the reasons when I left private practice, I think I've told you this before. One of the reasons that I chose to go with Central Maine Medical center and the practices in Topsom and Brunswick was because you were practicing there. And you and I had interacted when you were a resident and I was a teacher, and you always had this very caring way about you with patients, but also very intelligent. You know, that's a really important mixture in family medicine. I think family medicine is harder than

Dr. Dave Salko:

people think it is. I think one of the statements I made recently at one of the talks or education sessions I gave was you have to listen to the music, not just the lyrics. So I think it does take a special breed of person to listen to what the patient is saying, but also to watch them, observe them, and to have an understanding of the situation, to really supply what they need. And what they need may not be what they're asking for. And that it really takes a relationship that you have to set up fairly quickly and a bond of trust with a patient that can then be very therapeutic for them. If they trust you and you're giving them good information, they can get better over time.

Dr. Lisa Belisle:

Well, this leads to something that I know you have an interest in, or at least you're willing to discuss.

Dr. Dave Salko:

Willingness, interest. Sure. They all apply.

Dr. Lisa Belisle:

Yeah. And that is the issue of pain and addiction and medication for those issues. This has become an increasing problem over the course of, I think, both of our medical careers. And it's something that not every doctor feels completely comfortable with.

Dr. Dave Salko:

You know, everybody, I think, has a different, almost a subspecialty within what they do, what they feel comfortable with, what they don't. I always loved family medicine because of its breath. There's a lot of things that you need to know a little bit about. Might have been your dad who told me that. But in being able to receive patients on any plane or any level that they come in with, or any problem, you got at least know where to start. And as far as, you know, pain management and the use of opiates or other pain management, things that really has been evolving. It's changed a lot since medical school. Medical school, pain was the fifth vital sign. It was. We had to treat pain, we had to stop pain. There were pain scales, there were ratings on ERs, whether or not they controlled people's pain. That was a very real thing that everybody had to step up to. People were given medicines the second they arrived in the emergency room, so they weren't in any pain. And pain was viewed as a bad thing. It really is a symptom, just like a heart rate or anything else. But as we learned to live with it, from acute to chronic pain, that's where a lot of things shifted. And people did not want to live in pain, and that's reasonable and understandable. But as family physicians, we had to figure out a way to help people live healthy and live well despite their chronic conditions, not just to bury them aside with a medicine that they can take to forget about it. And as we progress, I mean, nationwide, statewide, we know there's an opiate problem. We know there's an epidemic. We see the. Not just the use, but the abuse of controlled prescription drugs just increasing astronomically. And if we don't educate the public, if we don't educate our patients, if we don't pay attention to that, it is going to get worse. And that's where I think a lot of the shift has been, both with state, national government to kind of shift over the control there and shift over how we treat pain, how we deal with pain, and how we look at chronic pain as a diagnosis.

Dr. Lisa Belisle:

There's a lot of interplay between pain and emotional issues, between pain and depression or pain and anxiety. And then it becomes complicated because there's a whole other set of treatments for emotional issues. And there's the. Sometimes you don't really know which is come first, the pain or the depression, for example.

Dr. Dave Salko:

That's true. And that's where I'll go back to that. Listen to the music rather than the lyrics. Somebody can come in and tell you, I'm in pain, I'm in pain, I'm in pain. And really what they're screaming out is that they're depressed, that there's something else about their life that they're not happy with. Now I think we've developed more of a broad approach where patients that will come and see me and talk about their pain. It's very easy to say the statement like, well, we have a multidisciplinary approach now. Your pain is about more than just what you're feeling for physical pain. We need to know that your life has taken on a new trajectory since that car accident 20 years ago or whatever happened that changed how your life has been going. And we need to pay attention to that. So the majority of people now are at least offered, if not go, for some co counseling. In the world of chronic pain, there's specific psychologists and therapists that are developed around just dealing with living with chronic pain. And that's helped a lot in a way. I think individual patients have been able to understand their pain, understand their body's reaction to it, and then be able to make better choices as to how they're treating it.

Dr. Lisa Belisle:

I think the more the most complicated thing for Many healthcare providers is that some of the medicines that we are using are physiologically addictive. So you have your benzodiazepines that we're using for anxiety, for example, or you have your opiates that you're using for pain. And we as healthcare providers know that this addiction is possible. It's a dependence. It's not a judgment that I'm making that you know someone is addicted. It is a physiologic dependence upon these medications. And how do you balance the need of the patient with something that maybe is in the long term, not the best medication for them?

Dr. Dave Salko:

I think you said it well right there. It's really about letting the patient know that, that this may not be the best long term solution. And a lot more of what we do now, especially around controlled medications, is informed consent. You're going to take this? I'd like you to take it for two to three weeks. Yes. Your body is going to get used to it. There may be some side effects when you stop it. Helping people understand what their body's feeling and translating those feelings, physical or otherwise, into this is really an effect from the medicine. When they understand that, I think they're much more willing to be able to either use or not use specific medicines. It's always a question of time. How much time do you have with a patient? How much time does it take to educate them through that? Some people that I see have come to me on those medicines and they've been on them for 20 years longer. And you really have to start somewhere. And I think that's where I sort of have this willingness to start wherever the patient is and make some progress in their healthcare by educating them, by telling them what they're using, how it's being used. We use a lot more handouts now. We can have a lot more resources, good Internet resources, things like that. And even specialists that people can go to that aren't right there just to write another prescription. They're there to kind of figure out the mechanism of the pain and how people can get better. I do often have that conversation with people of dependency versus addiction and tell them that physically your body is dependent on this, just like coffee, just like nicotine, just like any other substance that they might understand and make a comparison. Say you have three cups of coffee every day and you stop drinking, what happens? Everybody can recognize they get a headache from withdrawal. Same thing with their medicines. If they miss a dose, especially of an opiate, withdrawal can set in within 12, 24 hours. You can get body aches physically feel tired, nausea, vomiting, diarrhea. There can be a lot of effects depending on the dose, but they can come really quickly. And if people don't recognize them for what they are, you know, they might end up with a different outcome.

Dr. Lisa Belisle:

Sleep is also really big when it comes to both pain and depression and actually anxiety. I mean, and when people over the long term, for whatever reason, because they're in pain or because they're anxious, they're not getting enough sleep, then it just becomes a vicious cycle. And unfortunately, some of the medications that we use for sleep also have been proven over the long term to not be that healthy for patients. So it's so delicate.

Dr. Dave Salko:

It is. A lot of the medicines, they have an effect and they also carry on side effects. One of the assessments that we'll do for opiates, let's say, and there's a lot more screening and risk tools available to kind of evaluate people and have that conversation with what this med might do. People just want sleep. But the majority of her sleep meds just initiate sleep. They don't actually prolong it or help it or make it more restful. Refreshing sleep is a habit. I tell patients, I also tell them sleep is good medicine. You know, if you can do that well, if you can set that habit well, you can start your day better, your pain is going to be better, a lot of different things. So that is, I think it's a symptom of life, maybe that your sleep becomes poor and then your days will follow with difficulty. You know,

Dr. Lisa Belisle:

when I think about sleep medication, I think about the patients who often will tell me that even on the prescribed dose, the next day they feel hungover and it's less likely that they can actually perform the jobs that they're doing. I even worry a little bit about them driving. So often what we're told that we should prescribe as doctors is far more than what most people need. And it's something that we can really do on a fairly short term basis just to break whatever cycle that is until they get into a better pattern.

Dr. Dave Salko:

That's exactly to get into a better habit. And they may need a trigger for a while to reset that habit. But what I've noticed over time though is we will often pull out the sledgehammer when we might need just a finer tool. Alternative medicine does provide us a lot of windows of opportunity. Acupuncture, aromatherapy, these might seem more subtle. Massage therapy, things like that, that could help institute a better cycle of sleep for people, A better restful state, meditation, those are all very, very, very powerful. But they take time. They take time for people to learn them, they take time for people to use them as a routine. And all those alternative things would apply as well to the management of pain. Everybody has an individual or subjective experience with pain. But we also have the ability with our mind to control how we feel in certain situations. And based on how we've lived, that's the track record that's set before us. And that can be changed, it can be worked with, it can be altered. It's just about creating a new loop, a new habit, a new experience.

Dr. Lisa Belisle:

I find it really very encouraging that there are three of us in the Brunswick area who are physicians, you and Dr. Cindy Duchaine and myself. We all practice acupuncture and each of us have been doing acupuncture for a number of years. So having that kind of creeping into the medical mainstream, it makes me feel good because now we're offering people something that might actually help their lives in a bigger way than let's just deal with the symptoms.

Dr. Dave Salko:

Well, you know, 10 or 15 or 20 years ago it might have been odd to even suggest acupuncture to a patient. And now it is more mainstream. We know how many people are using alternative medicines and alternative treatments and they do provide good relief and they do provide, I'll say, individual success. Even if there's not some gigantic 10,000 person study that says it's going to work. We've seen a lot of individual success with that. And it's always good to offer people more options, more opportunities. If you limit yourself to one or two choices, you're very unlikely to be successful over time with patients. And that's where the relationship with medicine goes. Somebody can come and see you and if you only have two options for headache, you know you're going to be out pretty quick. You have to continue to go back and redefine the problem, redefine what successes they've had, what failures they've had, and try to come up with new solutions. And that's, I think the challenge of family medicine now is to integrate more of that, is to integrate more of the lifestyle. The things we hear about functional medicine, the things that we know about alternative treatments into people's lives so they can have those good skills and have those good, you know, we'll call them self adapting skills to, to be able to manage their problems.

Dr. Lisa Belisle:

We've been talking about acupuncture, but there are also doctors who for a long time have been practicing what's called osteopathic manipulative medicine or manual medicine, in addition to chiropractors who are doing the same sort of manipulative medicine. And often bringing together something like acupuncture with something like OMT or omm, manipulative medicine can be really life changing. I think for patients, you're right.

Dr. Dave Salko:

When somebody has the opportunity or has a successful acupuncture or even OMT session and they feel, even if it's for a moment or a few days or a few weeks, that their pain is more manageable or better, or that they're able to do some of the things that they didn't used to be able to do, or they can successfully do their job, take care of their kids, manage their life, that's way more powerful than any pill will ever be. And it's not something they have to think about how to cope with. People that take a pill or something, it's that moment they look for it to wipe everything away. Whereas when you've taught them a skill with meditation, or they've been able to have OMT and some manual muscle therapies, they go, wow, I can, I can do some of this myself and I can actually correct some of the malalignments and the other problems that they've been carrying for years. So that can be very useful for actually getting to the base of their problem. I think

Dr. Lisa Belisle:

another two kind of foundational things that you and I both incorporate into our practices are discussion of diet and discussion of exercise. Because exercise, if you can get past an acute pain flare, exercise over the long term actually has been shown to be helpful for chronic pain issues, for things like fibromyalgia. But diet is also important. You referred to functional medicine and this is a very specific way of looking at nutrition in the life of a patient. But we know that there are inflammatory foods that can set off most patients. And then in addition, some people are sensitive to foods, say citrus or wheat or dairy. How much do you bring this into your practice?

Dr. Dave Salko:

I think over time, as you develop a relationship with a patient, you're going to be able to offer them a lot. You know, I often think day one of the first person that comes in and I diagnose with diabetes, I think, wow, we can add five medicines today and 16 quality goals to your list. And we have all these things we have to do right now, but it's really a journey. And lifestyle definitely has to be part of their journey. No matter what medication or what medical problem they have, whether it's pain, sleep or something else, that investment of what they can do, what they have the control to change. A lot of what we do now with motivational interviewing is to get people to seek out what it is. They have control over what it is. They can change little changes that they've noticed and help them build on them, find those little bright spots where they say, you know what? Last night, I didn't hurt. Why didn't you hurt? Well, I didn't eat all those french fries. You know, it could be as simple as that, but you can build off that and start to find any little lifestyle thing that you can pick up on. I've had certainly patients come in and I really have not a great idea as to what's going on, But I will always often tell them something along this line now and say, there's always a foundation of what we can do. Okay, good sleep, good nutrition, some exercise, and eliminate, you know, any. Any real negative habits like smoking or alcohol. And those are the fastest five things I can tell somebody that they can start with. And it doesn't matter what their problem is, you're going to be able to impact the outcome based on their investment and their involvement in finding solutions through those means.

Dr. Lisa Belisle:

I would add in something that's not as quick, obviously, but that I think is also very important and part of the reason why I went into family medicine, I suspect you as well, and that is the importance of good relationships and understanding that if your primary relationship has some difficulties, that that's actually going to impact your mood, your pain level, your ability to sleep. It's a little bit harder to work through that sometimes.

Dr. Dave Salko:

It's true. I think you need a good relationship with the patient, you need a good rapport with them for them to start to develop that trust in you to tell you those things. And, you know, I think I've seen that a number of times over my career that someone will come in with major life medical problem, and you find out six months ago they went through a divorce, or they had to move, or they lost a job, some other big stressful thing, thing. And that will push them, it'll push their body in a direction. So that connection between their spirit or emotional state or mental state and their physical health is real. And it's something that when they recognize it, I think they can make amendments to it and they can change things. But it really does. It leads us in a way. And if we can protect those relationships and we can nourish those relationships, they'll come back and help us when we have a physical ailment to Be able to support our bodies and support us going, staying in a realm of good health.

Dr. Lisa Belisle:

One thing that I have thought a lot about and probably because I have children like you, is the things that we offer to our children when they are younger to help them integrate with their lives as they get older. And some children do fine. Some children cope well with the world around them. Other children, maybe they have sensory issues or maybe they have some attention deficit issues. And this has become an increasing issue. Autism, the autism spectrum. It's an interesting and complicated thing that family doctors and pediatricians and other healthcare providers are dealing with, right.

Dr. Dave Salko:

What kids have available now just in electronics, it may be a way for them to cope. It may be a way for them to have a nice tool. So a lot of them have, I guess, a double edge to them. Is this something that is supporting the child or is this something that's taken away their ability to cope too? I think a lot of times comes from those relationships that you mentioned. How good is their relationship with their caregiver, family member, mom, dad, who's ever around siblings and. And they learn support from that. They learn how to be strong through difficult situations. They learn a lot of things from those relationships growing up. And those are patterns. We know that we can track adverse childhood events now and say the more adverse childhood events that exist for a kid, the more difficulties they'll have when they become grown up. And to identify those and to get them to help and support, to get the emotional state settled, then they will be more successful.

Dr. Lisa Belisle:

Dave, how can people find out about the work that you do at Central Maine Medical center and your practice in Thompson?

Dr. Dave Salko:

Okay, they can call the office, I suppose we have websites. I think there's a Facebook site for Thompson Family Medicine. The office number is 798-6200. We are accepting new patients. We love working in that area. I love the job that I have and I really do enjoy the relationships I have with a lot of colleagues and people that I can share patient successes with. And also to see people get healthier from a system base of care and a team based approach to care rather than just a individual or a one time prescription.

Dr. Lisa Belisle:

We've been speaking with Dr. David Salko, who is the chief of Family medicine at Central Maine Medical center and so much more. He and his wife Jen have four children and they live in Brunswick. Thank you so much for coming in today and thank you for being the person who brought me back into family medicine up in the mid coast region.

Dr. Dave Salko:

I'll just say thanks for the opportunity thanks for joining us.

Dr. Lisa Belisle:

today I have with me a good friend of mine and also someone that I have profiled previously in the Wellness column for Maine Magazine. I believe that was in June of 2015. This is Jim Godboot who is the owner of Jim Godboot Plumbing and Heating Incorporated. He is also the co chair of the Red Ribbon Committee of the Biddeford Sacco Rotary Club. It's great to have you here again.

Jim Godbout:

Morning Lisa.

Dr. Lisa Belisle:

You are here today because you've been working on something that you touched upon the last time you were were in on the radio show and that is drugs. Drugs specifically in your area, but really all over the state and what you're seeing as a business person and what you're seeing as a longtime resident of the Biddeford Saco area. So tell me about that.

Jim Godbout:

Well, I've seen over many years of my life the cultural change that's been taking place and the acceptance of drugs and the use of drugs and misuse of drugs and substances and it really has taken me back. I've watched many people die in my life or friends or acquaintances over the years, a total of 42 to date and some have been my age, some have been children that I coached in my son's age in youth football or in hockey and it's really hard for me to accept that that we allow this to take place. So back in late 2015 I approached my Rotary Club, which I've been very active in many years, and I challenged the group that we make a change to the culture that we currently are in. We're seeing people dying from opiate abuse on a regular basis we see the acceptance of alcohol and marijuana, which are typical gateways to heavier use of drugs. So our group developed a focus group with the entire rotary club, about 50 individuals. We had monthly meetings for about three or four months and determined out of that focus group to develop education as our main goal. To provide and encourage healthy, thriving communities through education felt would be our best role to make change in our area. We're currently trying to developed this in the Biddeford, Saco and Olorcha beach area. We're starting out small. We'd like to replicate this for other communities throughout the state and possibly throughout the United States and maybe further. The reason I went to Rotary, there are people that are very knowledgeable in my club. They're very diverse group of people and they're people that get things done. I recognized this a long time ago. When they accept a task, these people really drive to make sure we, we get to an end goal. So the challenge took place back in the fall. Our group has been implemented as a standing committee with the Rotary Club of Biddeford and Saco, which is a big deal because it would be sustainable forever is what is my goal. So with that we've actually started the education process we felt was the most needed is to let's get the children, the school children from high school and junior high school. We've interviewed law enforcement, social workers, healthcare workers all over our community and recognized that maybe the best change we could really do as a Rotary group and the focus that we could make is to educate our students in the schools. So we directly went to the top to make this change. It's hard for municipalities and school districts to change curriculums because they're mandated by the federal government and by the state government to teach specific things. So there didn't seem to be any room to do drug education in the classroom or to take any time to do that. As a businessman, I've seen over many years that we're losing our workforce at an alarming rate. We don't have job ready students coming out of school or college for that matter. And I attributed some of that to the addiction issues and substance issues or substance misuse issues. So our Rotary group I think is going to be the telltale source of hoping to make change. You know, if we can get everybody to bite on, we can do something. So I talked about going to the top. We actually met with the school administrators, that would be the superintendents, the principals, the people that make decisions of all three communities that we're currently in. That's sarkobdefeit and Olotchid and Thornton Academy, which is a private high school. They all recognize the problem, obviously, and they are all open arms about having the Rotary Club help them implement the curriculum change and education process within their prospective school systems. Needless to say, that's a pretty big task to do. So the Rotary Club, the doers that we are, we got many meetings together with them, some very long. A little frustrating for me because I'm the kind of person likes things done quickly. I'm the motivator, so to speak, and to make things, make decisions. So we got together with the prospective school districts and their players from social workers, school resource principles and such for long meetings. And we've developed a series of events that are going to actually start to take place this coming April. In a very short time, we were able to put something together using our Red Ribbon Committee's model, and that is to develop healthy, thriving communities with the purpose of reducing substance and illegal drug use in our communities.

Dr. Lisa Belisle:

As a child of the 80s, I was around while we were talking about drug use and Nancy Reagan and just say, no, obviously I'm not a child anymore. I'm a doctor. And I see that drug use, actually use of both legal and illegal drugs has really continued to grow. And I'm wondering if you're surprised by the fact that you are creating this committee to deal with drug use in the state that you've grown up in. Did you think you would see this happening when you were younger?

Jim Godbout:

If I dial back to, let's call it 1979, late 70s and early 80s, absolutely not. I could not see myself doing this today because I was part of that whole culture. And, and as recently as a few weeks ago, I had a good friend of mine who I thought may have been number 43, actually get on me with Facebook and talk to me through Facebook, which has been a pretty good tool for actually getting the word out what we're doing. But he came back to me, this is 35 plus years later that this individual comes back and tells me about his story, why he's still here today, that I challenged him back in the early 80s to get out of the drug culture. He got into the Marines. He was heavily into cocaine at that time. He was destined for number 43, to tell you the truth. I mean, he would have been one of my friends that would have died. I was so ecstatic to hear how well he's done with his life. The challenge took him into the service for many years as a career, and now he's back here and he's an advocate for speaking about the misuse of different substances today. So to answer your question, those years were pretty scary when you think about it. And I think of the acceptance of marijuana and alcohol back then were very, very accepted at that time. And most of the people that I knew led into cocaine or barbiturates at that time. That was the driver. These people did not live an entire life. You know, I talk about that high number of people that I lost or known over the years. Many of them died from terrible accidents that may have been attributed to it, to overdoses to cardiac failure from the drug use. As you know, marijuana increases your heart rate, I think 10 times or 5 times its normal rate. Cocaine does the same thing. It makes your heart expand. So a lot of these people died from health issues attributed to the drug use or alcohol abuse at the same time. What's scary to me today is to see the marijuana push in this area. It's a little bit disturbing to me, or it's very disturbing to me because the potency of the marijuana is a bit more stronger than it used to be. There is a lot of known carcinogens used to using smoking marijuana. There's a lot of things attributed to marijuana. I don't think that the typical user understands that. You know, they say, well, if we make it as a drug that's accepted on a regular basis, like alcohol, you know, that marijuana stays in your system for three days, the THC stays in your system for 72 hours. Where are they going to work? I mean, you can't drive machinery. You can't do a lot of things. So again, we're going to diminish our workforce if we go to legalization. That and it also, I think, is a huge gateway to stronger drugs. I really do. As I watch many of my friends over the years do this, I'm in hopes that our red ribbon committee, along with a huge community support throughout our area, in the state and throughout United States, if we can all come together together to join forces, I think as a whole we can make a difference in our culture today.

Dr. Lisa Belisle:

So how are we going to do things differently now when it comes to education? Considering that we were trying to do some of this educational stuff back in the just say no era, how are we sure. Shifting our focus so that people can become more aware and don't just, especially kids, don't just kind of stop listening after a while.

Jim Godbout:

Okay, that's a great question because that was a huge topic of our discussion with the school Administrators and teachers. And our focus group came up with what we feel is the strongest. If you recall, there was a program called DARE who was mostly funded by, I believe, the Knights of Columbus and their group for many, many years and driven by adult mentors for the most part. And they felt that that was. Didn't really work that well and that's why the program kind of went away. Our focus group now has kind of looked at it in a variety of different ways. And one being specific is peer mentoring, is to develop peer mentoring. They feel that's the. The most influential piece that students could bite onto. Peer to peer mentoring and driving healthy lifestyles within the school systems with peers, we feel is the best way. However, this is not going to be the only way we attack this. We have people from addiction rehab facilities that have been in recovery for some time are going to be speaking to tell their experiences. There are many good speakers in southern Maine that do a great job of telling their stories. And they come from a wide array of demographics. I mean, there's this big. Everybody thinks that it comes from the poor or from the very rich. It's from everywhere. Every demographic group out there has issues with substance use and misuse. So we're going to have recovery people, we're going to have law enforcement. Law enforcement has been a big advocate for teaching. They feel that education is going to be the number one way to make change as well. So we've had great support from law enforcement throughout the state. We're working also with the University of New England and some of the professors over there. Professor Ed Bilski is a good friend and he is working on the physiological piece of it so that children understand and adults understand what it does. The brain and the irreversible things it does to your brain. They've been a huge, huge supporter of a coalition process that we're also working on. The Red Ribbon's got a lot of different things, but we're also working on a coalition with police, clergy, healthcare workers, such in municipalities. Three municipalities as well. So it's not just we're working the school system, we're working with another collaborative group as well. And University of New England has been a huge proponent of making this happen. There's a lot of pieces in the puzzle when you think about it really. And that's what it really takes to make a change.

Dr. Lisa Belisle:

Yeah, I'm thinking about, say, alcohol. Alcohol is a legal substance. Also marijuana, which is currently legal for some uses. And there are prescription medications which are legal if you are prescribed them for pain and for anxiety and other issues. And it's an interesting and slippery slope because for some people, you can have a drink with dinner or a couple of drinks with dinner, and it's fine. And for some people, their brain chemistry is such. Or maybe their genetics is such that they really can't. Some people just really can't ever have anything, even if it's legal, because it is for them a gateway. And I also think about the patients that I treat who use medical marijuana or who are on controlled substances, are on pain medication, and some of them really need the medications, and some of them are really dependent upon the medication, and they're using them very well. And others of them, I feel like they've been maybe started on something and probably decades before I even saw them. And basically they're in maintenance phase, and if they don't get them, they go into withdrawal, and then we can't actually control their pain or their anxiety. So talk to me about that. The fact that many of the things that we have access to are things that are legal.

Jim Godbout:

Yeah, and that's a huge problem because if you look at a lot of the current people in addiction or opiate addiction especially, they've led from prescription drugs, which are legal drugs. They started with that, and they're readily accessible, unfortunately. I personally try to stay away from them. I had a back surgery a few years ago, and I think I told you I like alternative. Maybe I have a higher tolerance to pain. I'm not sure. But I didn't take any type of oxycodones or oxycontins during that time. And I have a lot of other physical attributes. But I like the alternative piece. From massage to physical activity to acupuncture to just a good mental sound being too, you know, And I guess part of that mental sound being is connections. And I think if people have healthy connections in their lives, too, the substance misuse of prescription or alcohol tend to be less of an issue if you have those connections. I think connections with people can make a difference too. So that's part of the cultural change that I see. The connections that Maine Home + Design Maine Marie does is incredible. I think those good, healthy connections, and I hope that all our communities bite onto that because I think that is a. Is a big piece. Alcohol is really accepted heavily in our society, and it's nothing for me. You know, I, for one, have. I drink alcohol, I drink wine, and hopefully I don't overdo it. But I think about the people that are in recovery from alcohol abuse and things. So it's always on my mind. And so when I see a lot of people getting into heavy alcohol use, I think it's very important to talk to them about that because there are signals that you don't come back from, and sometimes it leads to greater problems socially and with your families and other things.

Dr. Lisa Belisle:

Yeah, I agree with you. I think it is important to. To talk to people. And I also, having been the person, has talked to some of these people, both in my personal life and my professional life. It's sometimes really hard to be that person because when you say, I'm really concerned about you and I see that this is really impacting your life, most situations as the messenger, you end up kind of being attacked. It makes people very defensive and they can't hear it, as I care about you as a friend or I care about you as a patient, and this seems like it's really impacting you negatively. Most people, they kind of defend the status quo.

Jim Godbout:

I totally agree with that because I've had friends with alcohol issues, and I tend to try to listen or to try to change the conversation or have open conversation about health, lifestyles that can maybe make their lives a little better. There's usually a reason for many of these people. In my own perspective of it, there's a reason people drink heavily or take drugs as an escape from maybe their current mental being that they're in. They maybe have some job issues, some family issues. I can't speak on all of them, but I think it's important to have that connection and to learn, listen to people that have these issues. And so part of our red ribbon thing, I'll go back to that again, is we're developing mentors within our group to be directly speaking with some students, whether it be about life skills, which we can really teach a lot about, because we have bankers, insurance people, we have people in the healthcare industry. All can have an important role in keeping these people focused, your students, focus to the next level.

Dr. Lisa Belisle:

I'm remembering back to my conversation with you the last time you were on the radio show and when you were talking about the drug issue and you were talking about how it impacted your own company and your own workforce and people's ability to come in and get the job done, and even your ability to hire people who could do the work for you, there was more of an edge, there was more of an anger and maybe more of a frustration. And what I'm getting from you now is the fact that even if you don't have the answers at Least you're working on it. At least there's a plan in place. At least there's something that you have been in conversation with others about that makes you feel more empowered as a citizen and as a business owner.

Jim Godbout:

I agree and I'll tell you one of the big reasons I've gone from anger to open minded discussions with the public and with anybody I can find. Andy Griff, who's our co chair with this is a very good friend who has a social background. He runs a community bike center in Benefit who's mentoring children every day. I've learned an awful lot about how to handle people with Andy and he's a special guy and he's toned me down a little bit in regards to put the hammer down type gym attitude. That's not always the answer. So I've learned a lot from Andy and he'd be a great person to actually interview here because he's a special person. He really is. So he does a lot with young children that may not have a home life to have a role model for. He provides that services through his community bike center and he's my co chair in the Red Ribbon. He's a very fitting person for that.

Dr. Lisa Belisle:

So I like that suggestion. It sounds like maybe he will be a future guest. I do like your comment about the connections because what I have seen, having now been a doctor for 20 years, is that it doesn't really matter whether you have a lot of money or not much money or whether you live in an upscale suburban Maine community or with whether you live in a former mill town, which may also be upscale. But you know, I mean, it doesn't really seem to matter as much because if there is some disconnect, if you don't feel like whatever, for whatever reason, you can talk to people about your concerns, whether they're school or whether they're money problems or whether they're emotional issues if you don't have that outlet. I think you're right that it is so tempting to just try to escape. And I think that's hard. I think that's a, that's a hard question that we have to answer is why are people feeling so alienated?

Jim Godbout:

I agree. And part of it I think is electronic age, to tell you the truth. I mean, it really drives me crazy when I go out to dinner and I watch a couple sitting there and they both have their iPhones on the table, my wife and I. What kind of conversation is going on there? I hope they're texting each other at least. You know, But I just. There is some, some disconnect with people today and I think we need to bring that connection back. I love the movement in Biddefit. That's a really interesting thing that's happening down there with the arts people, with the. The mayor, Alan Cassavant and Doug Sanford in the mill complex down there. There's a real sense of community down there. You have some thriving restaurants, you have some art, some people in the art world that are doing some fantastic things. We have ingen driving some wonderful business programs down there. And there's some really great young entrepreneurs down there. Delilah is doing a good thing with a heart of benefit. I really like the excitement and how they're building community. They're bringing people together and they're just like you said, they're from all the different demographics. I mean from. From the very poor to the very rich. I mean, everybody's involved. We recently had a fundraiser. It's called, ironically enough, it was a wine and beer tasting. But of course we get good following from that from our Rotary group. But we did it at the North Damn mill complex. We didn't label it Red Ribbon, by the way. It was a fundraiser that we do on an annual basis. It was wonderful to see 350 odd people come to this together and socialize and interact as a community. There was no heavy drinking of any sort. It was a wine and tasting. So it was a wonderful event and a real sense of community. And I commend our Rotary Club for putting on such a beautiful event and bringing our towns together.

Dr. Lisa Belisle:

You know, that's an important point, I think that we talk about substance abuse and misuse, but there are some people who have their glass of wine because it is. They just enjoy it. It just makes them feel happy. And it's a social experience. And so that is the other side of it. And you know, it's. I think to kind of hit everybody with the big hammer and say nobody should ever drink anything ever. I think that comes across as being really judgmental sometimes.

Jim Godbout:

I would agree. And that's kind of why our mission statement statement says misuse of substances because substances are allowed. And misuse is probably the term that's most fitting for that. And I for one love a nice glass of red wine with my dinner at night. I call it heart healthy wine. So it's beautiful, beautiful evening. My wife. But I agree that's part of our vision. Mission statement was to describe illegal substances and legal substances is misused as part of our. Because there is a tolerance and an acceptance and it's not going to go away. And I think we all enjoy that glass of wine or whatever it might be.

Dr. Lisa Belisle:

Well, and I have to say that it bothers me because now that I've seen the marijuana being legalized and I've also seen what long term use can lead to. Having had people that I've known for 40 years that have heavily used pot and it does have more of an impact than I think we initially thought. It actually bothers me a lot to see it portrayed in television and movies as being something that's okay. So it's such a strange place to be. We know so much and yet there's still so much that we don't know. And so just the use of some of these substances and putting them out there in the media as being okay. I worry about that.

Jim Godbout:

Yeah, it's kind of a. It's almost a joke to people. Like they just don't really recognize the potency and the problems that are associated with using that. And I always. One thing I always think about is if it's such a great drug, why aren't the major pharmaceutical companies jumping on board to manufacture this as a prescribed drug in the field? That's never been talked about. It's always being done in a barn or farm that's being developed by somebody who wants to be an entrepreneur and grow weed. I'm a huge proponent of THC use for adolescents and babies that have seizure disorders. I think it's a huge benefit to them. I have no idea how it's manufactured, but I just know it really works well. And I'm really happy that these families have a resource to go to. However, the medical card for smoking marijuana on a regular basis, I'm just not totally sold on that. I just don't see it. I've seen too much negative from it, more than positive. So I really don't think it's the future of our country is to continue this well.

Dr. Lisa Belisle:

And you're speaking of someone who had seizures, so you actually know this very well yourself. And I kind of agree with you. This is me personally. This is not me representing the entirety of the medical community. This is just my own personal feeling about the medical marijuana card that I just don't know that we have quite figured out how to manage this in a systemic way yet. It doesn't mean that people don't need it. It just means that we don't. We don't know how to incorporate it very well yet.

Jim Godbout:

Yeah, we're not utilizing it properly at this point. I See, there's a dispensary and benefit. And I look at there, there are some people that, and maybe I'm profiling them, but they look like they actually could use that medical marijuana. And then there are others that I'm not so sure they're even, even close to being needed for that. I mean, I think it's just been a part of their life for their entire life and that's why they use it. So.

Dr. Lisa Belisle:

And that's hard to tell because sometimes just looking at somebody from the outside, you don't really know profiling, which I shouldn't do. Well, I mean, I think we all do it. Jim, how can people find out about the red Ribbon Committee of the Biddeford Sacco Rotary Club?

Jim Godbout:

Well, we're going to hear, you're going to hear more and more about it. It's a very grassroots organization, like I said, which just became a standing committee beginning of this year. You're going to see I've developed a Facebook page, a takeoff of mine, that's going to provide information on a regular basis, I hope. It's tough for me to find the time sometimes running a business and trying to do this as well, as well as my other things I do in the community. I do a lot of things as well. But I'm trying to promote healthy choices, teach people about certain things. There are a lot of resources out there, so I hope to be posting them at different times and talking about our upcoming events through the school systems and through the local coalition. Our Rotary Club is very active in this. Our Rotary benefits, soccer Rotary page. We'll actually have more, more about this as well. Our website and our Facebook page about that. We will be doing a major fundraiser to try to drive this. In the early stage of this, we recognized that we needed major cash flow to try to get these schools. Schools need money to do these type of programs, whether it be speakers and videos, information, all takes money. And that's where the ROTA really comes in strong because we have the way to create the resources to help these municipalities and their school systems. So in a very short time we raised about $20,000 and we haven't reached outside of our organization yet. Just in my local community in Kinney Shores, which is a small community of 90 beach homes, which there are very few people living there. In the wintertime we had a dinner party and we raised almost $10,000 in my neighborhood just by reaching out and discussing the issues of drugs. So was huge takeoff. So we hope to implement a fundraising campaign along with our April 25 kickoff at the same time so that we keep this a sustained committee and a sustained programming in our schools. We really want to model this so it will be there for future generations to use and to hopefully expand in our Rotary Network. You know, we're a small group of PittiFC and Lujit and then there are other districts within our state and then there are other districts throughout the United States. We hope to model this so it can be utilized for other areas to really take a step forward and make change in the community.

Dr. Lisa Belisle:

We've been speaking with Jim Godbu who is the owner of Jim Godbu Plumbing and Heating Incorporated. He is also the co chair of the Red Ribbon Committee of the Biddeford Sacco Rotary Club. Thanks for coming back in again to speak with me today.

Jim Godbout:

Thanks Lisa.

Dr. Lisa Belisle:

Follow me on Twitter as DrLisa and see my running travel, food and wellness photos as bountiful1 on Instagram. We love to hear from you, so please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged that they enable us to bring Love Maine Radio to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our Pain, Addiction and Prevention show. Thank you for allowing me to be a part of your day. May you have a bountiful life.

Jim Godbout:

Yeah.

Dr. Dave Salko:

where I been

Dr. Lisa Belisle:

I can't say.

Jim Godbout:

Why would you want to know what happened?

Dr. Dave Salko:

Anyway, even though I'm here today it's

Dr. Lisa Belisle:

not enough for you to hear the word I say

Dr. Dave Salko:

when you ask me I say la la la When I answer you say la la la la

Jim Godbout:

la don't tell me you don't want

Dr. Dave Salko:

to hear the ins and outs My

Jim Godbout:

we and how I spend my time without you la.

Dr. Dave Salko:

Who is it and is it real?

Dr. Dave Salko:

Believe you me I'd rather be

Dr. Lisa Belisle:

emo

Dr. Dave Salko:

when you ask me I say la la When I answer.