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Eldah Elias

Independent Research I - GT

Chawkat

22 January 2018

Interview with Dr. Hernandez

Me: Hello?

Dr. Hernandez: Hi, Eldah, this is Dr. Hernandez. How are you?

Wonderful, how are you?

Fine, thank you.​ ​I'm all ready for you.

Alright, thank you so much! First of all, are you okay with me recording you during this

interview?

Yeah, that’s okay.

Great. Thank you so much for giving me the opportunity to interview you. This will greatly

propel my research. I intend to ask about substance abuse and how its comorbid effects with

mental illness have an effect on the patient.

Right.

My first question is, overall, do you think that substance abuse is a rising issue, or have you seen

an increase in certain types of substances being used more, or which ones are more potent or

more fatal? What is your input on that?

Well the answer is yes, there’s an increase, in the number of dually diagnosed patients that we’re

seeing here at the jail. In our population in particular, we see a lot of hallucinogens and
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amphetamines. We see a lot of PCP, K2, Molly, ecstasy. We don't see the opioids- we see heroin,

but we’re not seeing the fentanyl abuse. And, we don’t see ​so​ much heroin as in other counties.

With regards to your statement about how you don't see opioids as much, that interests me

because I've come across statistics saying that it is the well it's the most prevalent of drugs being

used that contribute to deaths especially in people under the age of 50 in this nation.

Correct. That statistic is is correct nationally and in several counties in Maryland and Virginia.

We're seeing a preponderance of evidence of that but in Prince George’s County in particular, we

have not seen the numbers that equal other counties.

Right.

We’re not seeing the kinds of you know deaths that they’re having in Anne Arundel County, in

St. Mary’s, in Howard. We're just not seeing that in P.G. County at this time.

Okay- that's very interesting. Do you think that society or the environment that you conduct your

work in is well aware of this drug epidemic?

Absolutely. We are well aware of it and anticipate that we will see this kind of increase in opioid

use in our county. And I know that several of the treatment programs are well aware to address

when it comes to us. Here at the jail, we are prepared by having a lot of popular medication that

is given to counter the effect of an overdose and help revive the person should that person

overdose. So, you know, we’re able to provide them with Narcan to stabilize them and then

administer appropriate medical care.

Right. To follow up, do you think that there's enough public awareness aside from inside the

workplace?
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I think so. I mean, I think that it's becoming… since there have been so many public service

announcements, I know that many of the treatment organizations are advocating for increased

awareness in schools or the community. I think there is an increasing awareness of the

prevalence of the need for prevention in the community. What I don’t think is happening yet is- I

don't know if within the substance abuse community users are as afraid of the effects of this

stronger drugs because they know that there is an “antidote”; so there’s the expectation that if I

should overdose then there's something that can be done to resuscitate me. So I think that there's

a false security that's created by it with the knowledge of having this stuff.

Very interesting perspective. I hadn’t received insight of that sort. What do you think is the best

treatment approach for the newly diagnosed individuals? I’ve understood that trying to treat each

disease as an isolated factor does not do well, because one [illness] becomes neglected.

Correct. The best treatment for dual diagnosis to treat both conditions simultaneously in a

holistic manner because generally what we say many times is that someone with a with a history

of mental illness is really either unaware that they're experiencing a mental illness or they're

reluctant to accept that this is in fact happening to self medicate. So they treat some of the

symptoms ​through​ the substance, and then that creates a cycle, one cycle. The other cycle is

when substance abuse is the genesis and the effects of the drug creates the mental illness. So, it's

sort of two concentric circles to be treated simultaneously. It is medication for the mental illness,

and also stabilization for the substance abuse. And then also education, for an understanding of

how your mental illness makes you feel, and how bad that you may have tried to treat the

symptoms, and how the substance abuse makes you feel, and how that mental illness has

emerged from that substance abuse.

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Okay, I see. Wow! So, since you informed me that patients often believe that they have a backup

plan or an option to secure themselves when they do overdose, are there other barriers that you

think affects either their willingness to get treatment? Aside from economic factors, their actual

access to treatment, like have you perhaps noticed in different areas treatment isn't as readily

available to patients?

Well, let’s see. I think that treatment facilities- the cost of treatment can be prohibitive, so there

are limitations with respect to the access to care. Because of the way substance abuse treatment

is structured, it becomes a voluntary process. A person might be willing to participate in the

treatment process in order to be admitted and remain because at any given point, they withdraw,

and that becomes the biggest of the barriers: the dropout rate. But as far as accessibility, I think

there is barrier in terms of accessible care.

Are you familiar with programs that aim to close this barrier? If so, what are the most effective

ways to do so?

I don't know any programs off the top of my head now. I can put you in touch with someone who

might be able to answer that specific question for you. I think that the director of one of our

treatment programs probably has more information about that. I could put you in touch with her,

as well.

Okay, that would be great. Thank you so much for your time, Dr. Hernandez! This information

has been invaluable, and I appreciate your help in getting me involved in this field… I hope to

meet with you again, one day.

Okay! No problem! And let me get you the contact information for my colleague. Her name is …

Thank you.
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You’re so welcome, anytime.

I plan to keep you updated on my project! I look forward to presenting it, at the end of the year.

Excellent. Thank you. I’m very very impressed by your questions, and very proud of what you’re

doing. Very nice, very nice.

Thank you!