What happens when teenagers start using opioids?
In May 2018, I spoke with Orlando Castro, the program director of an inpatient adolescent unit at a hospital in South Miami. His unit cares for young people aged 12 to 17 in crisis. We talked about opioid use at an early age, new ways of using nicotine, and families caught up in all of it.
This is an archive episode, recorded when the show covered addiction and recovery broadly. Orlando also spoke openly about his own recovery, which shapes how he does this work.
What brings adolescents into crisis care?
At 1:05, Orlando explained that most teenagers on his unit arrive with a different primary diagnosis, such as depression, self-harming behavior, or bipolar disorder. In his experience, a large share of them also have an underlying problem with substance use.
At 1:30, he said that some were already using opioids at 15 or 16. From 2:12, he described the unit’s role. It treats the immediate crisis, then refers each young person to the right aftercare.
Is long-term medication becoming more accepted for opioid use disorder?
At 3:48, I said I expected a trend toward maintenance medication for people with opioid use disorder. Traditionally, many programs used medication only for a short time and then tapered people off. Yet the evidence was showing that long-term maintenance is generally a safer and better approach.
Orlando agreed, at 4:22, that the change was coming little by little. He had already seen a couple of programs in Broward County start offering maintenance. From 5:28, he described losing young men to overdose, often from drugs mixed with something they did not know about.
How is working with younger patients different?
At 7:12, Orlando said the youngest patients he saw were often using marijuana and Xanax, and they tended to minimize it. In his view, they were chasing a change in mood, and for some of them that search later led to opioids.
So, his approach was to help them look at where their use began, what consequences followed, and what was happening in their family when they felt the need to use. He asks whether they use because they like it or because they are masking pain.
What should parents and teachers know about vaping devices?
At 11:02, I asked about a nicotine device I had heard about at a lecture. Orlando explained, from 11:13, that the Juul looks like a small flash drive, comes in several flavors, and holds a sealed pod already filled with nicotine. Students were using it in school bathrooms.
At 12:52, I said that even with nothing in it, a device like this gets young people used to drug-using behavior. Orlando agreed and pointed out that it does not smell like smoke, slur speech, or redden the eyes, which are the signs adults are trained to watch for.
Interestingly, the warning signs he described at 13:52 were small ones, such as an unfamiliar fruit smell or a change in a student after a trip to the bathroom.
Should more doctors learn to treat opioid use disorder?
At 15:14, I said I had been encouraging doctors who were unhappy in large hospital systems to consider making care for substance use a foundation of a small practice of their own. It is a model that works, and it helps the community during the opioid epidemic.
From 16:01, Orlando described how psychiatry residents at his hospital rotate through inpatient and outpatient care, including the substance use programs. In his view, doctors with that training would be needed as more public funding reached the field.
Can care for opioid use disorder start in the emergency room?
At 19:41, I described programs, which I believed began at Yale, where emergency doctors start medical treatment right after an overdose and move the patient straight into a clinic for ongoing maintenance.
Orlando said, at 20:27, that his hospital had begun something similar about eight months earlier, with medical detox in the same building and follow-up care afterward. Still, in his view, the person has to be ready to accept help. At 21:57, I answered that with the opioids now on the street, many people never get the chance to reach that point. Unfortunately, for many of them, the bottom is death.
Should naloxone be as easy to find as a fire extinguisher?
I asked whether his team was helping to get naloxone, sold as Narcan, out into the community. Orlando said they were still exploring it, though police officers and firefighters already carried it. At 22:51, I suggested that Narcan could hang on the wall next to fire extinguishers and automatic defibrillators.
At 23:10, Orlando called it a wonderful concept. Officers had told him how many lives it had saved by buying time to reach a hospital.
Why does family matter so much in adolescent care?
At 26:42, I asked what his ideal program for adolescents would look like if money were no object. Orlando described strong clinical work, schooling on site so young people do not fall behind, and above all family therapy, including a monthly group for several families together. In his view, the person who is struggling never goes through it alone, because it hurts spouses, brothers, sisters, and other family members too.
At 29:21, he added that many teenagers first take drugs from their own parents’ supply. He also described drugs being injected into gummy bears in Miami.
How does his own recovery shape his work?
At 23:56, Orlando told me he is in recovery himself, and that someone once saved his life. That is why he takes this work so personally. From 31:51, he described the role that regular peer support meetings and a comfortable home group had played for him and for the people he works with.
From 35:50, Orlando said that many people working in the field are in recovery themselves. In his view, having been there gives them a particular kind of strength with the people they help.
Who is Orlando Castro?
Orlando Castro was the program director of an inpatient crisis stabilization unit for adolescents at a hospital in South Miami when we spoke. He leads group and individual therapy, works closely with local schools on prevention education, and has been in recovery for more than a decade.
What can listeners take away from this conversation?
Young people can be drawn into opioid use far earlier than most parents expect, and the warning signs are often quiet. Of course, no single program solves that. Care that starts quickly, involves the whole family, and puts naloxone within reach gives a young person a real chance.
How do I approach this today?
My thinking has kept developing since this conversation was recorded. Today my practice is built on one idea that runs through all of it: when the body has adapted to a substance, the safest way off is usually gradual, with the smallest steps the person’s nervous system can tolerate. Physical dependence is not addiction.
Where a medication can make the process gentler, I use it. Patients direct their own care, and a good plan includes the risks, the alternatives, an exit plan from day one, and the right to change course.
For opioid dependence I prescribe buprenorphine, which steadies the body so a person can rebuild their life without the cycle of withdrawal. Visits are monthly, or weekly when needed. Some people stay on it for a long time, and that is a legitimate choice. Others later taper slowly, using the same gradual approach I use for every other medication.
I believe medication for opioid dependence should be available wherever people need it. I prescribe in Florida only.
Call 911 or go to an emergency department if there is a seizure, confusion or hallucinations, or thoughts of self-harm. For thoughts of suicide or any mental health crisis, you can also call or text the 988 Suicide and Crisis Lifeline.
This page is educational. It is not medical advice, and listening to the episode or reading this page does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
Full transcript
A note from Dr. Leeds: my guests speak from their own experience and expertise, and the terminology they use is their own. Whatever the topic, this show holds to one distinction: physical dependence on a prescribed medication is not addiction. This transcript is educational content, not medical advice, and nothing here creates a doctor-patient relationship.
Read the full transcript (38 minutes)
Dr. Mark Leeds [00:09] Welcome to The Rehab on the Mental Health News Radio Network. I am Dr. Mark Leeds and I will be your host. Join me in exploring the world of addiction treatment. How can we improve the ways that we help individuals to overcome addiction? The goal of treatment is to save lives and help people to get back on track to a path towards success and happiness in life. Welcome to the Rehab Podcast. My guest today is Orlando Castro, and thank you for joining me.
Orlando Castro [00:53] Absolutely. Thank you for having me on your show.
Dr. Mark Leeds [00:55] Now, you work at Larkin Hospital in South Miami, and you are the program director for the adolescent program, and a significant part of your program is addiction treatment. Is that correct?
Orlando Castro [01:05] That is correct. A lot of it, I mean, they come in with a primary diagnosis that’s not substance abuse. You know, they come in for depression, self-harming behaviors, bipolar, but I want to say about 80% of them have an underlying issue with substance abuse.
Dr. Mark Leeds [01:23] Of that group that does have an issue with substance abuse, Are you seeing a lot of the kids coming in with opioid use disorder?
Orlando Castro [01:30] Yes, we do. We do have a lot of kids that are using opiates already at an early age because our unit treats 12 to 17 years old, which is the age group that we treat. And I’ve already sent we average one to two kids a month that are that really need help and really admit and pass the denial period that they are addicted to opiates and we have sent them to treatment centers I’m talking about kids that are 15 16 we sent one last week that’s 17 years old due to his opiate use
Dr. Mark Leeds [02:07] Now is your facility is it an inpatient facility or is it a outpatient treatment program?
Orlando Castro [02:12] We have a combination, Dr. Leeds. On my specific unit, we treat the inpatient crisis stabilization. So what we do is we treat the crisis immediately, and then we refer out accordingly as needed for what’s best for the patient, what type of aftercare, individual therapy, medication management. But we also have a very good PHP, IOP outpatient for adults that treats you know the substance abuse the opiates and guys it’s a dual diagnosis treatment center but we focus with substance abuse disorders
Dr. Mark Leeds [02:53] Yeah as far as PHP and IOP I understand that it’s different levels of care of care so we start you might someone might start with residential and then from there step down to php which is I believe something like eight hours a day, five days a week, or that might vary.
Orlando Castro [03:10] Correct. Yes, sir. Dr. Leeds, what we’ve been working with, we do send a lot of guys that are in our level of care, which is a less restrictive setting, and then they might not be able to continue in their recovery, so they have to go back or into a treatment center. Or we do work with treatment centers that do a step down after 60, 90 days in a treatment center, and then they step them down to our PHP, which is five times a week. And then we even step them down from the PHP to the IOP in terms of outpatient, which is three times a week, sir.
Dr. Mark Leeds [03:48] I don’t know if you’re seeing this yet, but I think we’re going to be seeing a trend in the very near future. A trend of more maintenance medication treatment for people with opioid use disorder. Traditionally, the treatment centers have been against it, and they may use medication, you know, they may use it for a short period of time and taper people off. And what we’re finding is that evidence shows that long-term maintenance is generally a safer and better way to treat people with opioid use disorder. And it is finally coming to the, I’m hearing more and more of programs that are recommending that.
Orlando Castro [04:22] It is, little by little, because a lot of the treatment centers are used to the old traditional setting and not the tapering of them with their own medications. But you’re right, with the maintenance program, I’ve already seen maybe two treatment centers up in Broward that started that, you know, that are trying to do just a maintenance program instead of the traditional medication and the traditional, you know, detoxification of the treatment for these opiate use, which the epidemic is just amazing. Amazing. And the addiction is amazing how When you hear their stories and you hear why they use it, the addiction of it is just an amazing component to when you do therapy with them.
Dr. Mark Leeds [05:08] It really is significantly more deadly compared to other forms of addiction. Well, I don’t want to say other forms of addiction because addiction is addiction, but there’s different kinds of use disorder. There’s cocaine use disorder and alcohol. These days, currently, opioid use disorder far surpasses all the others as far as being deadly.
Orlando Castro [05:28] It’s very interesting what you said because it’s all about a matter of the changes of time. In the treatment center that I did my hours in, you do have cocaine use, you have alcohol use, which is a very scary one because when you go through the withdrawal of alcohol, they could be deadly if you don’t taper it and do the correct detoxification. But now when we started seeing the opiate use, these young men that I work with, and I’m talking about ranges from 21 to 27, we were losing one every three months, you know, due to an overdose. And then within a week’s time you had other kids just relapse because the addiction is so powerful because the opiates is not just opiates you don’t even know they’re mixed with something else or laced with something else you know and then that’s where the psychotic features comes in just by one use of an opiate or the addiction of just being addicted to it or just having one bad reaction to it and it may cost your life you know so the therapeutic component of that is so important to try to do therapy in working with these individuals and change their addiction behaviors which is very very tough very strong
Dr. Mark Leeds [06:57] That’s a scary thing to you know to think that kids are starting that young with you know with these hard drugs what are the differences and How do you treat someone who’s an adolescent or a young adult compared to someone who’s older coming into a program? Are there any differences?
Orlando Castro [07:12] Well, the difference that I use, at least the style and the form that we use in our center and when I work my personal opinion and how I work with them, is the younger kids that I work with, they’re using the marijuana and they’re using the Xanax. They’re abusing that. And then what happens is that these young kids always have a story. They minimize, well, marijuana is not bad. It makes me feel better. I mean, that’s all just they’re minimizing of becoming an addict. We don’t know if they have it in their genes. We do not know if they have it in their family history because they’re always chasing that high. You know, once they smoke marijuana or they take a pill, it alters their mood. So you’re always chasing that mood. Then what happens is, which is the oldest saying in the book, you know, all these drugs are gateway to more harder drugs. And then that’s what happened. They’re going and they’re mixing into the opiate world, you know, and that opiate world is so powerful and that high that they get, they never could repeat it. So they’re always chasing it, you know. And what we try to do is just educate them of where they started, what type of consequences they’ve had, if any, and what’s going on within the family and their lives at the moment that they feel that they need to use that drug. Is it because they like it? Is it because you’re masking a pain? Because a lot of these drugs are painkillers, you know? Yes. So I mean it’s very interesting the responses that you hear from our youth and then as I mean I’ve been doing this for a long time as you get older how the world has transpired into these hardcore drugs starting at a very young age
Dr. Mark Leeds [09:06] I’m glad you said that about marijuana being a gateway drug I mean recently I felt like I was going crazy online I had gotten involved in some discussions and I made a comment at one point that, you know, marijuana is a gateway drug and, you know, the pro-legalization people jumped all over me saying, that’s not true, go look it up. And, you know, I feel like everything is being rewritten because people are so much in favor of legalization that…
Orlando Castro [09:32] Well, yeah, everybody’s going to have their opinion on that and because… And I hear that story with my kids. Well, if I move to Denver, it’s legal. You know, if I move to a state, marijuana is legal. But it is the oldest saying and from my experience you’re going to get both sides of the aisle you know the ones know it isn’t once it is in my experience the kids that I’ve sent to treatment have all started with smoking a marijuana joint that they were lucky enough that it was just marijuana because nowadays you smoke marijuana and you don’t know if it relates with anything you have no idea what you’re smoking what you’re getting yourself into it does open the doors to other type of drugs do to Dr. Leeds because they’re always chasing that high or the original high that they got.
Dr. Mark Leeds [10:23] And just because marijuana, you know, they say no one’s ever died from marijuana. It’s not safe for children. I mean, the children, it affects their brain and their short-term memory.
Orlando Castro [10:32] Absolutely. Absolutely affects the short-term memory. You’re talking about neurons, you’re talking about kids that are 14 to 17 that their brains are not developed, they’re smoking marijuana while their brains are not developed. You know, so yes, in our argument and with our physicians and the way we treat in our substance abuse setting, absolutely it does have an effect on our youth.
Dr. Mark Leeds [11:02] Now there’s also there’s the issue of nicotine and there’s a thing that I heard about recently at a lecture
Orlando Castro [11:09] Oh
Dr. Mark Leeds [11:11] That’s it yeah that’s a little device the usb thing
Orlando Castro [11:13] I just did a show on that and it was funny because I learned about it maybe three months ago and the kids are smarter than we are it looks like a flash drive it’s like a little flash drive and then it comes like in four or five different flavors. And then the scary part of it, on that specific instrument, Dr. Leeds, on the vapors and the e-cigarettes, yes, you could put THC oil, and the kids were doing that before. But on this particular, on the juuling, it’s like a little cup that’s already full of nicotine. You can’t open it. So it goes on top of the, it looks like the flash drive, and then they’re doing it in the bathrooms. They are doing it in the classroom. They’re getting high instantly because of the nicotine. One of those pods has enough nicotine as a cigarette box. Over 200 hits of cigarettes, you know, puffs of a cigarette. And what they’re doing is if the teacher doesn’t know or the people doesn’t know, they’re catching on to it now. You know, it looks like a flash drive. So you charge it like on a computer. You put the pod of the flavor that you get and you get all this through the internet which is the scary part
Dr. Mark Leeds [12:30] Yeah I mean now you have to on top of everything else we have to watch our kids with that and you know with the juuling
Orlando Castro [12:37] Yeah
Dr. Mark Leeds [12:38] Yeah the juul how do you spell that I guess look it up
Orlando Castro [12:41] It’s called j it’s called the instrument itself is j-u-u-l but the kids call it hey are you’re juuling so they add the ing to it
Dr. Mark Leeds [12:52] Oh okay okay yeah and that’s right away I mean even if it had nothing in it’s getting these kids used to drug using behavior
Orlando Castro [12:59] Exactly let’s say that has no more nicotine is a drug and it’s the one of probably the most addictive drug there is you know you’re talking about smoking cigarettes you know and that was created as a non-combustible you know form to weed off people that are you know trying to get off cigarettes but these kids are abusing it and using it to alter their brain and alter them for five minutes. They do it in the bathroom. They do the pod that’s pure, pure nicotine, and then they go back to the classroom. And it doesn’t smell. It doesn’t slur your speech. You know, it doesn’t give you red eye, which are all the symptoms of what we’re trained to look at to see if somebody’s under the influence.
Dr. Mark Leeds [13:45] Yeah, and so what would maybe parents and teachers look for? Like maybe just withdrawal symptoms or behavior changes?
Orlando Castro [13:52] Well, what we’re trying to do now is we’ve been educating the school system because this is fairly new. I want to say it’s about a year, year and a half. So we’re trying to educate the parents and the teachers in the community and the administrator, even the police, law enforcement involved, of just looking and smelling if you smell something different. It could be an ice cream flavor. It could be a fruit flavor. Maybe you see the kids’ reaction from the time they went to the bathroom to the time they came back to class, because that’s what they’re doing it. Or they’re doing it in between, period, of going from one classroom to another. We work very, at Larkin Hospital, we’re very associated with the school system, and we’re always trying to promote and educate. You know, just educating. And we’re also trying to keep up with everything that’s new and coming out.
Dr. Mark Leeds [14:44] Now, Larkin Hospital is an educational center. You’re training doctors in the field of addiction treatment also with fellowships and that sort of thing?
Orlando Castro [14:53] We do have a fellowship there mostly. We have so many fellowships that my father and me, we have mostly a psychiatric. We have psychiatric residents. We do have neuroscience. We have dentistry. I think it’s the third largest teaching hospital in the country.
Dr. Mark Leeds [15:14] Oh, that’s incredible. Now, I’ve been recommending doctors in general who are unhappy with the medical establishment as it is. Doctors who are unhappy working for large hospital systems and large clinics, when they want to drop out and start their own small clinic. I’ve been recommending that they consider possibly making addiction treatment an important foundation of their practice. And it’s a model that works that allows them to get started, and it’s something they can do that’s good for the community and good to help out in fighting this new opioid epidemic. Now, if someone gets into doing addiction treatment and they really love that kind of work and they want to take it a step higher, doctors can become board-certified in addiction treatment through these programs.
Orlando Castro [16:01] Absolutely. Yes, Dr. Leeds. And the good thing about Larkin is, and I’ve been there a year and a half, and every day I learn something new that we have to offer, is that these residents do rotations. So they do inpatient rotation. They do outpatient rotation, which covers substance abuse. Some of them love, when they do the psychiatry round, some of them love psychiatry. Some of them don’t. Some love working with the adolescent. Some of them don’t. And in the last three, four months, when they do do the rotation, because they also do it in the PHP, IOP with substance, they just love the addiction component, you know, because the future coming down as doctors, if you’re certified in a specific with substance abuse, it’s going to be, you know, there’s so many addictions coming down the road and government money that’s coming down the pipeline because of the opiate epidemic that’s happening. So the doctors get to get a chance and explore and see the type of treatment that we do, the group settings that we do, and the individual sessions that we do. So when they hear these guys talk, they have an idea of the underline of where the addiction process came from. So it’s very interesting for these doctors, these up-and-coming doctors that we’re lucky and fortunate enough to be working with. And we have a bunch of phenomenal residents and fellows that are wonderful.
Dr. Mark Leeds [17:38] And that’s a really good point that you make that not only does the doctor get a chance to learn about the field of addiction and all the various, you know, whether they want to work with children or adults and what area, But also a good point, that great excellent point that you make there is about government funding and maybe working with addiction treatment facilities and insurance companies that you may need to be board certified in addiction to work in certain areas.
Orlando Castro [18:04] Yes, sir. Yes, doctor. And right now, as it is, we work very closely in Miami with South Florida Behavioral, which a lot of the funding that comes from the government and the state goes there because we do have a lot of unfunded clients that need help. And we treat them all the same. A client is a client and addiction is addiction. So there’s already money being funneled down to them. We use them to get them help. And there’s going to be a lot more funding that’s going to be coming down for mental health and for addiction because there’s not enough appropriate resources, Dr. Leeds, to help with our clients. And one of the biggest things since I’ve been at Larkin is that we’ve tried to incorporate proper aftercare so they don’t come back. You know, where the doors are open if you need us, but so you don’t come back into our crisis stabilization mode.
Dr. Mark Leeds [19:00] So an aftercare would be, would that be like stepping down from the different levels of PHP to IOP?
Orlando Castro [19:10] Yes, sir. That’s one component. The other component is getting the right psychiatry if they’re in the right medication, if they leave the hospital with medication. And I’m a big believer, my number one believer is getting the appropriate therapeutic process, getting the right therapy that the patient could bond with so they could get a cord, you know, therapy once a week while they live their life. You know, if they’re adults, they go to school, they work and they go to therapy. Or if they’re a child, they go to school and then they go to therapy after school.
Dr. Mark Leeds [19:41] Another thing you bring up as far as getting people started in the hospital, there’s several programs around the country. I think it started at Yale, and now there’s one I know in Palm Beach County, and I know of another one in Mississippi, and maybe you’re doing this at Larkin, where they’re actually starting addiction treatment in the ER. When someone shows up with an overdose, rather than telling them you need to go to a clinic and maybe get started on Suboxone or Methadone, they wouldn’t start Methadone, But there’s actually emergency room doctors in these settings where they can actually start the patient on medical treatment and then within that hospital system, get them right into the clinic to continue with maintenance and never send them out again so you don’t have to worry about them relapsing again out in the streets.
Orlando Castro [20:27] That’s a very good point because what we started maybe about eight months ago is we started a new vision medical detox. Okay and let’s say we do get somebody through the ER that’s just like that it’s the same way you just explained Dr. Leeds we medical clear we do all the medical clearance in the ER that we have and if the patient meets criteria under that you know opiates alcohol or anything that they’ve taken then we do what we call a medical detox medical clearance detox within our own building So they go maybe from the ER to the third floor, which is a medical floor, and that’s where the new vision detox center is. And then from there, we continue the therapy because if you did an overdose or you did something related to substance and we do the detox, you should always follow up with some type of treatment, either outpatient treatment or inpatient treatment. And that’s where we help this brand new service that we have that helps the patient just from point A to point B get the proper level of steps and level of care as long as they want it because that’s the other component. You know, a lot of our users, we have to be ready to be ready. You know what I mean? You have to be tired of being tired and having consequences and being borderline between life and death. Because substances will take your life.
Dr. Mark Leeds [21:57] Yeah, and unfortunately with the opioids that are out there, people don’t always have a chance to reach their bottom and be ready for recovery because their bottom, in many cases, is going to be death. Are you guys involved in the current movement of getting naloxone or Narcan out in the community and making it more available for harm reduction and reversing?
Orlando Castro [22:23] We haven’t started that movement yet. We’ve been exploring, you know, we’ve been talking about it because, you know, I mean, everybody has a Narcan on them and everybody has that, you know, for safety reasons. But we’ve been addressing and speaking about that at this point because all the officers are trained with that, the firefighters, you know, they’re all carrying that with them because that at least brings them back with enough time to be able to get them to an ER, you know?
Dr. Mark Leeds [22:51] Yeah, and that’s something that I was having that discussion with someone recently about the possibility of Narcan even being made as prevalent as things like fire extinguishers and automatic defibrillators. You know, we see these things on the wall, these life-saving devices and equipment, and why not have the Narcan right up on the wall next to it?
Orlando Castro [23:10] That is, I’ve never heard of it on that format, but it’s a wonderful idea and a wonderful concept because that’s exactly when we deal a lot with law enforcement and they say how many lives they’ve saved to within five to ten minutes to be able to get that patient or client to the hospital because of the Narcan that they had. So if you’re right, if we have that on our wall, in our hospital wall, why can’t we? Yeah, that’s a very good point that you bring up.
Dr. Mark Leeds [23:42] I actually recently spoke to an ER doctor who told me that they had a patient who actually overdosed right in the middle of an N.A. Meeting. They actually fell on the floor, turned blue, and they had to call for 911 to come pick them up.
Orlando Castro [23:56] And I have never seen that. I myself am in recovery. You know, I’ve been 11 years sober, but I have gone to a lot of it. That’s why I take substance abuse so passionately, you know, and I work with one client at a time. And that is my, somebody saved my life, so I’m here to try to work and educate it the best I can. And in this component, I’ve been in AA meetings that people, I’ve never seen somebody overdose, you know, in an AA meeting. But I’ve seen them drunk, I’ve seen them passed out, you know, I’ve seen them so, you know, they’re not there to get the message. They’re safe there for 40, 45 minutes, but unfortunately, they’re not getting the message at that specific time. Recovery of addiction, any addiction, but with substances is very, very hard. It’s a combination of dealing, like I said, with, you know, a mental disorder or the underline of why they’re using it. Most of them are using it because they like to hire the way they make them feel to masquerade something else that we were talking about. And then that addiction process is very, very powerful. Very, very hard to stay in recovery and to stay with your support system to do that.
Dr. Mark Leeds [25:12] And your programs that you run at the hospital, do you interface with the 12-step programs in some way?
Orlando Castro [25:20] Absolutely. Yeah, we do the 12-step for A and A. And again that’s mostly focused on our outpatient php iop which which we’re going to start something very good within the next two weeks we’re going to do a php iop for adolescents here in miami there isn’t many and we’re getting a lot of requests to do that but we do have the four the module of the 12 steps we do the 12 steps forward
Dr. Mark Leeds [25:47] There’s no reason why spirituality shouldn’t be a part of medical treatment for mental illness.
Orlando Castro [25:53] If you look at the 12 steps program, you could correlate them a lot to just living a good normal life with you follow the 12 steps. And it’s magical because when you go into these 12 steps program, they tell you what is your higher power. Some people could say the doorknob. Okay. But in reality, if I think you’re going to need something more powerful than a, than a doorknob to keep me from, from injecting myself or from taking an opiate. You know what I mean? So if you follow the process, if you follow your support system, if you follow the 12 steps, you add that beautiful component of spirituality. I see magical things happen in recovery and in treatment. Some people believe in it. Some people don’t want to go to a center that’s faith-based, but I was blessed enough to be able to be a part of one.
Dr. Mark Leeds [26:42] I wanted to ask you about, you know, when it comes to treating the adolescents, There’s someone that I spoke to recently that is talking about, you know, he has some interest in starting a program. And this is someone who has run a large-scale residential treatment program for adults. And he’s talking about starting a program similar for adolescents. What would you recommend from your own experience if you know, if, you know, finances were not an object and you could start any kind of program you wanted, whether it be maybe like a ranch or a fancy high-end treatment, what would your ideal thing be if money wasn’t an object and you can give these kids the best possible treatment? What would your idea for designing that sort of program be?
Orlando Castro [27:30] That’s a million-dollar question, Dr. Leeds, because I’ve been asked that question for 15 years, and I’ve been trying to explore, and there’s been funding for it. And I guess, again, here in Miami, there isn’t any. A residential, my ideal residential treatment center will be, first and foremost, very powerful, strong clinical modalities, okay? Very powerful modalities of the 12-step programs. And then as physical plant-wise, like you say, a ranch setting would be nice. You add ropes course to it. Ropes course is an object that we use in residential that helps you build trust. It’s a ropes course. They live in an area that you could go and get schooling, so you don’t miss schooling. Let’s say you’re there three months, six months, you get schooling within that county. I would my dream would be to have family therapy meaning that I bring in the families once a month and we all talk about their experience my component of having a multi-family group is very powerful because you hear stories from other families and what they’ve gone through because remember whoever is going through the addiction they’re not going through it alone you know you’re hurting spouses you’re hurting brothers you’re hurting sisters you’re hurting family members so it entails everybody
Dr. Mark Leeds [28:57] And that there’s all different situations that for example there was a discussion of the person who was struggling with addiction actually had parents that got her involved with her addiction and you know parents you know this person when she was 13 the parents were giving her drugs and using drugs with her so there’s not surprising Yeah, some really difficult situations out there, you know, when it comes to families.
Orlando Castro [29:21] We deal with that. See, on that specific case, I don’t want to say they’re giving the drugs by the mom or dad. It has happened, but the kids are stealing their mom and father’s drugs. You know what I mean? So they have it available that they steal it from them and they start using it and they incorporate that’s where their career of substance abuse starts. But yes, we have had young kids coming to our unit under crisis due to being on blackouts because somebody within their family gave them a drug. And that’s all it took was one try or one attempt. We have kids here in Miami that are injecting drugs into gummy bears. You know so imagine you eat a gummy bear and it’s full of heroin it’s full of a drug yeah so it’s very scary it’s very scary things are out there we’re going to keep up with what’s out there we learn from the kids when they come in and then we just treat whatever is in front of us and why they’re there
Dr. Mark Leeds [30:25] Like what you’re saying where the kids are getting the you know the drugs might be provided in different forms and I know they also have these tablets that are that look might look like manufactured tablets but they’re street drugs and this yeah heroin and fentanyl and carfentanil these highly toxic substances might be a part of that
Orlando Castro [30:44] Yeah and that’s that’s what happened here in the broward in the west palm beach area that everyone was all laced with fentanyl and all that and the guys were not making it you know once all it took was one one shot one injection and it cost them their lives you know and then most of these treatment centers are great. They really are good. And then they have the sober living houses, you know, but the addiction is so powerful that they go out and they find it. They can’t stay sober. It’s hard. Or they don’t put the tools that they’re learning. You know what I mean? The support system, your sponsor, pick up the phone, call somebody, you know, you could make that choice rather than just picking up, you know, and that’s our strategy. I’m a very reality base when I do my groups and my individuals, I like for them to think a thousand of a second right before they pick up or do something, what’s going on in their mind, and how can we distract them before they pick up and they use.
Dr. Mark Leeds [31:45] Yeah, and it’s about changing their habits, I guess, getting them into the habit of going to meetings and making the phone calls.
Orlando Castro [31:51] Correct, because that in itself is work. You know, with recovery, it’s hard, but can it be done? Absolutely. Going to a meeting is hard, but can it be done? Absolutely, Dr. Leeds. And you really got to go to those meetings when you don’t want to go. And you really have to go to those meetings when you’re having your worst day, you know, because those group meetings are like medication. You come out of there with a clear mind because you might not say a word, but you heard something or you heard a message that just changed your mood for that moment. So instead of picking up you were distracted at that heat of the moment there’s tons of meetings in spanish in english in the morning in the daytime there’s some that are open 24 hours there’s no excuses not to go to meetings and usually not all meetings are for everybody so that’s why it’s always good to go to meetings or different ones where you should really feel the most comfortable with and then on top of that’s the meeting that you will call your home group. You know what I mean? That’s where you will be able to call your home group. You’ll be able to present, share your story.
Dr. Mark Leeds [33:01] Now, the idea of a home group, that’s where you find a meeting, like where you’re completely comfortable and you know, maybe you get to know people and maybe find your sponsor there.
Orlando Castro [33:11] Absolutely. You should find your sponsor in a meeting and it should be in your home group because that’s the meeting that you’re usually going to go to every day. You’re doing in the 90-90, you know, 90 minutes and 90 days. Your home group is where you should really feel the most comfortable with. And when you’re ready, you raise your hand and you say, you know, I’m looking for a sponsor. And, you know, they’re very loving. They’re very open and they want you. It’s a very different environment because a lot of these guys have some short period of time of clean. Some people only have one day and some people have years of being clean and sober. And they welcome you. It’s very loving. And they want you to get help.
Dr. Mark Leeds [33:52] From my understanding is that the, I mean, South Florida, I mean, for the people listening who are here, it just has an incredible community of recovery where you can, you know, like you said, you can find meetings anywhere, anytime. If you’re not comfortable in one, you can easily go to, you could probably go to several a day if you wanted to.
Orlando Castro [34:15] You could. And I know when I first started in my recovery process, You know, I went to a couple meetings, and then later on I found out through others that there’s some that are 24 hours, and now I’ve been doing this for, you know, for 11 years at least. And every day there’s a new meeting that pops up. And, you know, I deal with Spanish-speaking clients that say, well, I need a Spanish-speaking. There’s hundreds of them at all different hours because you’re talking about professionals that are in recovery that go after work. You know, so they go to specific meetings. Even that they have, you know, people that don’t want to go just to any other meeting and they go to specific meetings because they’re what they call professional lawyers, attorneys, doctor, pilots, you know.
Dr. Mark Leeds [35:00] Yeah, yeah. And addiction can affect anyone. I mean, it’s not.
Orlando Castro [35:06] Anybody. Yeah. Yeah, it doesn’t have a cause. Addiction is, addiction, Dr. Leeds, could happen to anybody. It’s not a stereotype of what people think of. Some people are less than or not no addiction is across the board and like you say addiction could be anything but when it comes to substances you know it could affect anybody
Dr. Mark Leeds [35:25] Yeah and even you know like you said health care professionals and you know and for people in the health care field who are struggling with addiction they don’t have to keep it a secret they can get help themselves and maybe you know once they come out on the other side of getting treatment maybe they want to get involved in helping other people get better from addiction and maybe work in the addiction treatment field.
Orlando Castro [35:50] Which happens very commonly. A lot of people that are working in treatment centers are in recovery, and they’re starting on the, you know, little by little they’re getting their CAP, or they’re getting their bachelor’s, or they’re getting their master’s, and they help. In my opinion, they’re very powerful because they’ve been there, done that. So they have a different type of training that is a little bit more tough love. So, yes, it doesn’t matter if you’re in the healthcare professional and you have an addiction. When you come out through the other side, you’re going to be more powerful and more impactful than just a basic therapist, which do phenomenal jobs also. You know, phenomenal therapists. Phenomenal therapists that specify an addiction. You know, they’re wonderful. You know but a lot of the guys that work in treatment centers a lot of them themselves are in recovery and are trying to help that population
Dr. Mark Leeds [36:44] Yeah so thank you for joining me today I’m going to I’m going to wrap up the podcast and I and I really appreciate you joining me for the time doctor and like I said I would definitely like to come on down and see the facility and get together with you and maybe do another follow-up episode you know live and you know, that would be excellent.
Orlando Castro [37:03] Perfect. And it will be my pleasure. And I really want to thank you for having me on your podcast show. And whenever you put this on live or not, just let me know so we could follow it.
Dr. Mark Leeds [37:15] Thank you for joining us today on The Rehab on the Mental Health News Radio Network. I hope that you have found this show to be interesting and useful. If so, please subscribe to The Rehab Podcast and share on social media. I appreciate your taking the time to listen to The Rehab.
