Monthly Archives: April 2017

How the trauma of life is passed down in SPERM, affecting the mental health of future generations


How the trauma of life is passed down in SPERM, affecting the mental health of future generations


  • The changes are so strong they can even influence a man’s grandchildren
  • They make the offspring more prone to conditions like bipolar disorder

The children of people who have experienced extremely traumatic events are more likely to develop mental health problems.

And new research shows this is because experiencing trauma leads to changes in the sperm.

These changes can cause a man’s children to develop bipolar disorder and are so strong they can even influence the man’s grandchildren.

Psychologists have long known that traumatic experiences can induce behavioural disorders that are passed down from one generation to the next.

However, they are only just beginning to understand how this happens.

Researchers at the University of Zurich and ETH Zurich now think they have come one step closer to understanding how the effects of traumas can be passed down the generations.

The researchers found that short RNA molecules – molecules that perform a wide range of vital roles in the body – are made from DNA by enzymes that read specific sections of the DNA and use them as template to produce corresponding RNAs.

Other enzymes then trim these RNAs into mature forms.

Cells naturally contain a large number of different short RNA molecules called microRNAs.

They have regulatory functions, such as controlling how many copies of a particular protein are made.

The researchers studied the number and kind of microRNAs expressed by adult mice exposed to traumatic conditions in early life and compared them with non-traumatised mice.

They discovered that traumatic stress alters the amount of several microRNAs in the blood, brain and sperm – while some microRNAs were produced in excess, others were lower than in the corresponding tissues or cells of control animals.

These alterations resulted in misregulation of cellular processes normally controlled by these microRNAs.

After traumatic experiences, the mice behaved markedly differently – they partly lost their natural aversion to open spaces and bright light and showed symptoms of depression.

These behavioural symptoms were also transferred to the next generation via sperm, even though the offspring were not exposed to any traumatic stress themselves.

The metabolisms of the offspring of stressed mice were also impaired – their insulin and blood sugar levels were lower than in the offspring of non-traumatised parents.

‘We were able to demonstrate for the first time that traumatic experiences affect metabolism in the long-term and that these changes are hereditary,’ said Professor Isabelle Mansuy.

‘With the imbalance in microRNAs in sperm, we have discovered a key factor through which trauma can be passed on.’

However, certain questions remain open, such as how the dysregulation in short RNAs comes about.

Professor Mansuy said: ‘Most likely, it is part of a chain of events that begins with the body producing too many stress hormones.’

Importantly, acquired traits other than those induced by trauma could also be inherited through similar mechanisms, the researcher suspects.

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Dr. Kim Corace, Dr. Melanie Willows, Brynna Lemmex, Slavica Popovic,Carelle Levac, and Dr. Christine Saveland. Missing: Pam Jackson, Nick Shubert,Nathaniel Leduc, Dr. John Grymala

People who work in emergency departments know there are certain people who come in needing help more often than others. Many of these frequent visitors at the emergency department have substance use problems, mental illness, or both. For those with substance use problems, the vast majority struggle with alcohol problems.

“We have a significant portion of people with alcohol use problems coming to the emergency department, then coming back again within 30 days for similar reasons,” says Dr. Kim Corace, director of clinical programming and research at The Royal’s Substance Use and Concurrent Disorders Program.

“This shows that these people aren’t getting the help they need.”
Back in May 2016, a new rapid-access medical alcohol withdrawal clinic opened here at The Royal.
“Since May 2016, the clinic has eliminated 83 per cent of its patients’ 30-day returns. More than that, it has reduced alcohol-related emergency visits in the system by 13 per cent.”

The Alcohol Medical Intervention Clinic (AMIC) is a smart response to a challenging question: how do we reduce the number of people coming to the emergency department repeatedly, sometimes multiple times 
a month? As with most smart answers, this one lay in getting a bunch of people together and coming up with a really good plan. Led by the Substance Use and Concurrent Disorders Program at The Royal, a group of community partners asked the Champlain Local Health Integration Network (LHIN) to fund the project. The clinic received pilot funding until March 2018. 

Since May 2016, the clinic has eliminated 83 per cent of its patients’ 30-day returns. More than that, it has reduced alcohol-related emergency visits in the system by 13 per cent.

“This, combined with the other numbers coming in, show that AMIC is a pilot project that patients actually find helpful,” says Dr. Corace. “It’s so exciting to see all these positive outcomes, not just for the patients you serve, but for a system as a whole.” 

Bill is a 43-year-old white man with a college degree. He lives alone and works a full-time job, but is severely dependent on alcohol. Meanwhile, he has symptoms of both depression and anxiety. 

Bill is the ‘average’ client at The Royal’s Alcohol Medical Intervention Clinic, but he’s not every client. One in five patients is under 30. One in three is female, which is significant because women with alcohol addiction are vastly underserved. One in 10 AMIC patients is at risk of losing his or her housing.

“This is a pilot that patients really find helpful, and the numbers don’t lie — it’s reducing the strain on our crowded emergency rooms by bringing these people to a place where they can get the best help at the time they need it the most.”

Dr. Kim Corace, director of clinical programming and research, Substance Use and Concurrent Disorders Program, The Royal
Here’s how it works: a patient comes in to the emergency department at one of The Ottawa Hospital’s two sites with an alcohol-related issue. They’re referred to AMIC, and told they can drop in anytime between 8 and 11a.m. Monday to Friday. An astonishing 61 per cent of them do. Most of them show up within three days of the referral, and then continue to come. “This is an unusually high rate, and it shows that the service is actually accessible and done in a way that’s acceptable for these clients,” says Dr. Corace.

They come to The Royal, and are met with the services of an interdisciplinary team that can provide treatment for withdrawal and triage the patient to the best location for care. Whether that’s at The Royal, or with our community partners, AMIC is the hub where they find help when they need it most.

“It’s the ideal time to intervene when someone has just had an emergency room visit related to their alcohol use. Now, they are able to get help when they need it most — right away when they are motivated to make changes and accept help,” says Dr. Melanie Willows, clinical director at The Royal’s Substance Use and Concurrent Disorders Program. 

The partnerships AMIC represents are the key to its success. Strong partnership with The Ottawa Hospital, and strong connections and support from community organizations mean that patients can get help quickly. These connections include an Ottawa Addictions Access and Referral Services (OOARS) navigator who helps connect AMIC clients with the most appropriate community resources. 

“This is a pilot that patients really find helpful, and the numbers don’t lie — it’s reducing the strain on our crowded emergency rooms by bringing these people to a place where they can get the best help at the time they need it the most,” says Dr. Corace. 

The pilot project has funding until March 2018.

Conversations on alcohol: Women, their partners, and professionals


3rd in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 2

“International Research on Discussing Alcohol with Women and Their Partners, and Empowering Professionals to Have These Conversations”


Tatiana Balachova, PhD, Associate Professor, University of Oklahoma Health Sciences Center & Prevent FAS Research Group; Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists; Lisa Schölin, Consultant at WHO Regional Office for Europe – Alcohol, Illicit Drugs and Prison Health; Leana Oliver, CEO of FARR; Cheryl Tan, Health Scientist CDC

Research shows that building awareness and offering brief interventions can help women reduce alcohol-exposed pregnancies. For a variety of reasons, not all providers feel comfortable or confident in giving information or asking about alcohol use, and they may not be sure it makes a difference in preventing alcohol-exposed pregnancies. Consequently, researchers from around the world presented their findings at the 7thInternational FASD Conference Prevention Plenary. They discussed whether or not brief interventions work, and if they do, then which strategies work best.

Russian study picRussia – Positive Messaging Improves Knowledge and Action

Tatiana Balachova, PhD, and her research group conducted a 3-part study to develop, implement, and test a prevention program in Russia. They found that women in Russia most trusted their OB/GYN physicians, so they developed FASD educational materials and trained physicians to deliver prevention information in two face-to-face structured interventions. FASD brochures using positive messages and images improved women’s knowledge of FASD and reduced risk for alcohol-exposed pregnancies. As well, they found that women who received the intervention reduced their frequency of alcohol use – most quitting – during in pregnancy.

JOGC picCanada – Care/Service Provider Education is key

Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists of Canada (SOGC) detailed the Vision 2020 strategies: advocacy, quality of care, education, and growing stronger. These strategies underpin their goals for care providers to focus on preconception as well as pregnancy, and deliver consistent messaging. In line with these goals. Alcohol Use and Pregnancy Consensus Clinical Guidelines that were first published by the SOGC in August 2010 were updated in 2016. The guidelines highlight the value of brief interventions and will be supported in the coming year with online education and training that recognizes “red flags” and provide best practices for supporting women’s health and engagement in discussions on potentially stigmatizing topics such as alcohol use.

who-coverWorld Health Organization – Prevalence Rates Inform Strategy

Lisa Schӧlin, consultant with the World Health Organization’s European office, described the data from Europe on alcohol consumption and drinking during pregnancy. The most recent prevalence data shows that Europe has the highest consumption rate of alcohol per capita of anywhere else in the world. As well, at 25.2%, it has the highest rate of alcohol consumption during pregnancy and the highest rate of FAS (37.4 per 10,000). These data were published in a review of the evidence and case studies illustrating good practices and areas of European action called “Prevention of harm caused by alcohol exposure in pregnancy” – you can view or download here.

FARR picSouth Africa – Short Messages Can Build Awareness

Leana Oliver, CEO of Foundation for Alcohol Related Research (FARR), explained how FARR builds upon existing health services by providing prenatal support, pregnancy planning and teaching of coping strategies to women through their programmes. Their “Do you have 3 Minutes?” campaign has been successful in building awareness within communities and in supporting prevention programmes (learn more here). As well, the FARR Training Academy offers accredited trainings and continued professional development on FASD to professionals, providers and educators. Research projects and FARR publications detail what has been learned such as the benefits of motivational interviewing and the need for preconception care and planning.

CDC picU.S. – Promoting Universal Screening and Brief Intervention

Cheryl Tan, Health Scientist, Centers for Disease Control and Prevention reviewed FASD activities currently underway. Surveillance of alcohol consumption by women of reproductive age is ongoing alongside efforts by the CDC to promote universal screening and brief interventions (aSBI) of adults 18+ years. She noted the wide discrepancy between how often providers say they conduct SBI (85%) and how often patients say they receive it (25%). As well, as a partner of the Collaborative of Alcohol-free Pregnancy, the CDC is helping to change healthcare practice through high-impact projects: 1) implement interprofessional model for prevention of AEP; 2) provide evidence for aSBI to insurers in the US; and, 3) reduce stigma associated with drinking during pregnancy.

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Reality check: Is it safe to use marijuana during pregnancy?


Cutting out illicit substances like alcohol, cigarettes and drugs is a no-brainer for most women when they learn that they’re pregnant (or are trying to get pregnant). But for a small subset of moms-to-be, one illicit substance in particular has been touted as a lifesaver: marijuana.

It was for Melissa, a Boston-area mom of two who had hyperemesis gravidarum, the same severe morning sickness that Kate Middleton experienced. Although pot wasn’t her first solution — her obstetrician prescribed medications that didn’t end up working — it was the only thing that could stop her from “constantly” vomiting, she told Yahoo Beauty.

“I talked to my friend’s neighbour, who is a midwife, and she said that [marijuana] was the only thing that got her through her first trimester,” Melissa said. “So I smoked a little bit of weed. I coughed, and the coughing made me throw up. But after that, the symptoms just disappeared. It was amazing.”

Eventually, Melissa turned to edibles (she baked small amounts of pot into brownies), and she said it “saved my pregnancy, basically.”

She isn’t alone in her unconventional choice of recreational activity. In a report published in JAMA in January, researchers at Columbia University found that 3.9 per cent of American women who are pregnant report marijuana use, while another recent U.S. study conducted by the National Institute on Drug Abuse found that teen girls are twice as likely to smoke pot if they’re pregnant. Overall, six per cent of pregnant females aged 12 to 44 reported using marijuana in their first trimester.

Things don’t look too innocent in Canada, either. A 2015 publication by the Canadian Centre on Substance Abuse (CCSA) quoted a Canadian Perinatal Health Report (2008) that said five per cent of women used illicit drugs during pregnancy (although it didn’t specify how many used cannabis). But cohort studies suggest that number is considerably off, and state that 10 to 16 per cent of middle-class women and 23 to 30 per cent of inner-city dwellers consume marijuana during pregnancy.

“The 2013 Canadian Tobacco, Alcohol and Drugs Survey found that 22 per cent of women of childbearing age (15 to 44) reported using cannabis in the past year, which shows the potential number of women who are using it during pregnancy,” says Dr. Amy Porath, director of research and policy at CCSA. “And we know the negative impacts of prenatal marijuana use on the fetus continue into late adolescence and early adulthood.”

The impacts include neurocognitive effects as well as behavioural ones, and start to display themselves as early as 18 months. Porath says girls born to mothers who consumed marijuana prenatally show aggressive behaviours and attention problems at 18 months, while all kids show deficits in memory and verbal skills at age three. By the time they turn six, they display impaired verbal performance, quantitative reasoning, and short-term memory, and at nine, there are deficits in reading, spelling and academic performance.

Once they get to their late teens and early 20s, these neurocognitive impairments persist. Behaviourally, they display hyperactivity, impulsivity, delinquency, and even anxiety and depression throughout their lifetime.

“There’s growing research in this area and as more studies come out, they come to the same conclusions, strengthening what we already know,” Porath says. “There’s definitely a reason to be concerned.”

In the case of hyperemesis, Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada, says that any claims that marijuana helps are purely anecdotal and misleading.

“The problem with severe nausea and vomiting is that it gets better eventually,” she says. “In most women, it devolves over time, so even if someone tells you that she took it and felt better, you don’t really know what made her feel better.”

Supporters of marijuana use in pregnancy often turn to a surprising study conducted in Jamaica in 1994. It found that babies whose mothers consumed the drug during gestation had better physiological stability, were more alert and less irritable at one month compared to babies who weren’t exposed to marijuana.

However, experts are quick to point out that the study was small (only 24 marijuana users and 20 non-users were monitored), and it’s difficult to know with certainty who’s telling the truth. As Blake says, it’s hard to get a full picture when you’re asking people to report on something that’s illegal.

There’s another factor to consider when pondering the use of marijuana during pregnancy: you never really know what you’re getting.

“The research we have is based on what we know about cannabis, but the problem is people never really know what they’re purchasing,” Blake says. “They’ve found fentanyl contaminants in samples purchased from dispensaries — there’s organized crime in the supply chain there. More effort needs to be put in the situation.”

And yet, some women swear they couldn’t have made it through their pregnancies and tolerated their extreme nausea if they hadn’t turned to pot. Carly, a Kawartha region mom, had hyperemesis in both her pregnancies — in her first pregnancy, extreme nausea and vomiting caused her to lose 30 pounds, in her second, she lost 20. So, she smoked just enough marijuana to curb her nausea and allow her to eat. She smoked up until her 17th week of pregnancy, and in both cases gave birth to healthy babies.

“I wish more women would turn to this amazing, natural plant medicine during pregnancy and the stigma behind it vanish, because it can help so many, naturally,” she says.

Lianne Phillipson, a registered nutritionist and founder of Sprout Right, hasn’t had any clients come to her seeking advice on tempering hyperemesis with cannabis, but she says “I don’t know how I would have handled that kind of situation if I were in their shoes, especially understanding the need of nutrition for a growing fetus.”

However, she says, there are ways to circumvent morning sickness naturally — and not in the “natural” way some women do. She advises her clients to take B6 and ginger and to eat protein.

“Eat as large a quantity as you can of protein, whether it’s meat, eggs, soy or dairy, as it helps clear the hormones that are building up in your liver, which is often the cause of nausea,” she says. “Eat often and don’t let yourself get hungry. If you need to eat dry toast or a cracker to get over the nausea, do that and then eat some protein. Grab any opportunity you have to eat something healthy.”

She also says that “the human body can do amazing things,” and many women have experienced severe morning sickness without turning to marijuana. And they, too, had healthy babies.

Blake sums it up simply by pointing out, “when you’re pregnant, you’re making choices that your baby has no say in. These are critical developmental moments for your baby. It’s the time to do the very best that you can.”

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The importance of dads

Happy family

The father’s role in producing a healthy baby doesn’t begin and end with conception.

Evidence is now pointing to an important link between the father’s health pre-conception and the health of their child over their lifetime.

“There’s this phenomenon called the developmental origins of health and disease where influences during early life, during pregnancy, during the early post-natal period change your metabolic set up for the rest of your life,” Dr Scott White, WA spokesman for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said.

“Babies born after a period of inter-uterine hostility — where they are a bit smaller than they want to be, their placenta is not fantastic, they are a bit growth restricted — are at significantly increased risk for diabetes and heart disease and some cancers and all sorts of ‘badness’ in later life.

“Traditionally the effect of that was looked at from the maternal point of view and the fathers were pretty much ignored but more recent studies looking at the paternal contribution suggest there is a significant role for the health of the father prior to pregnancy and the health of the offspring.”

Perhaps the clearest association between a dad’s health and that of his offspring is seen in obesity, where it has been shown that paternal BMI is linked with the birth weight of baby boys and a correlation between a father’s “fatness” with a daughter’s increase in body fat from age five to nine has been identified.

Sperm carry not just DNA, but also signals known as non-coding RNA which can influence how development proceeds, according to scientists from the Robinson Research Institute, writing for The Conversation. These non-coding RNA are different in the sperm of obese men than in men of a healthy weight and, in some research in mice, have been shown to make their offspring fatter.

“There are significant epigenetic changes in the sperm of obese men so we know the healthier the father is, the better quality the sperm is, the better-quality embryo you make and that seems to have important lifelong impacts,” Dr White, who also provides preconception counselling at King Edward Memorial Hospital, said.

Alcohol, too, can be a catalyst for epigenetic changes that either switch on or off, or turn up or down, the expression of different genes that are carried both in the sperm and the egg, influencing the long-term health of offspring.

James Fitzpatrick, head of alcohol and pregnancy and FASD research at Telethon Kids Institute, said while Fetal Alcohol Spectrum Disorder could only be diagnosed if there had been direct exposure to the foetus by the woman’s drinking, some studies linked behavioural problems in children and adolescents with changes in the genetic expression of male sperm that are associated with alcohol exposure.

“It is not as hard and fast as the direct toxic effects of alcohol if the woman drinks, but there is the possibility these epigenetic effects that are passed on before the point of conception can modify later behavioural and indeed health outcomes,” Dr Fitzpatrick said.

It takes three months to make a mature sperm so any changes required to ensure a father is in peak condition for conception must be made well in advance, Dr White recommends. Just like prospective mothers, dads are advised to adopt a healthy lifestyle in the lead up to trying to conceive by maintaining a healthy weight, limiting alcohol intake to safe levels and not smoking or using illicit drugs.

Factors such as obesity and alcohol could reduce the number and quality of sperm, making it harder to get pregnant in the first place.

There’s also a role for dad’s-to-be to support their partner in staying on a healthy path during the nine months of pregnancy and beyond.

One of the biggest drivers of a woman drinking in pregnancy is her male partner drinking in pregnancy, according to Dr Fitzpatrick.

“That’s why it is very important that men support their partners not to drink in pregnancy and ideally that would be through taking a pregnant pause themselves or having the nine months off with their partner to support her during pregnancy.”

Retrieved from: The West Australian

Warning labels about drinking while pregnant are working


A random encounter with a warning sign at a north Eugene grocery store put Gulcan Cilon the trail of research toward her UO doctoral degree and, now, a newly published paper.

The paper, published in the Journal of Health Economics, took a deep dive into extensive federal data to probe behavioral changes that likely resulted from point-of-sale warning signs urging women who are pregnant to avoid alcohol.

In states requiring the signage, drinking by pregnant women is down 11 percent, Cil found. She also found evidence of fewer premature births coming with less than 32 weeks gestation and fewer births of babies weighing less than 3.5 pounds. The biggest effects were among women 30 and older.

Cil, now a visiting instructor in the UO Department of Economics and postdoctoral fellow in the Mikesell Environmental and Resource Economics Research Lab, recalled how her research began.

New to Eugene in 2010, she said, she wasn’t pregnant, had no plans to be and didn’t have any friends who were. But that grocery store sign that depicted a woman with a baby inside and holding a cocktail glass and topped with the words “Pregnancy & Alcohol DO NOT MIX” captivated her.

“Every time I walked in the store I saw the sign at the front door and again at the register, and I was like: What is this? I saw it enough times, I guess, that I kind of knew that you’re not supposed to drink alcohol while pregnant, but that was like a confirmation to me,” she said. “I found it very educational, and I was interested in policy behind it.”

Cil was born and raised in Turkey, where such warnings are not used because, she said, drinking by pregnant women is not considered a public health concern.

With a background in environmental economics, Cil had chosen to pursue health economics as a doctoral student. She soon learned that 23 U.S. states and Washington, D.C., required such signs at all retail stores that sell alcohol.

“So I looked in the literature to see if they actually worked,” she said. “I found that the issue had never been studied and evaluated as a public education program or public awareness program.”

Cil mined two national databases — the National Vital Statistics Natality Detail Files and the Behavioral Risk Factor Surveillance System — for clues. Her focus was on information gathered between 1985 and 2010.

Using complex analytic techniques on data related to drinking by women, she compared signage-adopting states with a group of nonadopting states. Her control group included women who had lived in nonadopting states and women who lived in adopting states before signage requirements began.

Her approach allowed her to identify the direct relationship between drinking while pregnant and birth outcomes, while also reducing the likelihood that other factors such as cigarette smoking, drug abuse, nutritional deficiencies and other risky life choices were at play in any behavioral changes.

The study, she said, suggests a likely causal relationship, which had not previously been documented in relation to signage policies, between drinking while pregnant and birth outcomes.

Cil was not able to sufficiently probe effects related to heavy drinking, which is associated with fetal alcohol spectrum disorders. The lack of statistical significance for behavioral change related to these disorders may reflect the fact that they are rarely diagnosed at birth and reported on birth certificates, she said.

Point-of-sale warning signs, she said, are an effective, low-cost approach to protecting the health of pregnant women and the babies they carry.

The signs used by states that require warnings all contain similar language. A future study, Cil said, might explore whether variations in signage — the graphics, fonts, colors and language used — may best be effective.

—By Jim Barlow, University Communications

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Challenging the conversation around FASD


Changing perceptions and challenging the conversation, Dr. Peter Choate and Dr. Jacqueline Pei spoke at the 2017 FASD Network event.


“My mind is like a filing cabinet but no one alphabetized the [darn] thing” is a phrase that welcomes you to the complex world of Fetal Alcohol Spectrum Disorder (FASD). 

The FASD Network hosted their first annual 2017 FASD session: Challenging the conversation.

Shana Mohr, Training coordinator at FASD Network, said there is still a lot of misinformation about FASD.

“The racial problem in the view of FASD in this country is still prevalent,” Mohr said.

Peter Choate, a registered social worker and member of the Clinical Registry, stated there is an urgency to get away from race based FASD because if we stay on race as the topic, we will target community where we think race is the issue. “Race is not the issue”.

“There is a bias that FASD most influences the Aboriginal population, but research actually indicates, it is young university women. Women who engage in social drinking,” Choate said.

Choate said the perpetuation of stigma rests solely on the mother, while the perpetuators of FASD are actually the males, but they are given an out.

Choate asks, why are the men being excluded from this conversation? Go to a man and have a conversation about casual sex, whose sperm is coming into the equation.

 “Denial is huge, when it comes to educating young university women and men about alcohol,” Choate said.

He said there needs to be a conversation with these people and there is a general ineffectiveness of success in preventing FASD, because we are not reaching the right people.

Facts tell us that FASD does not discriminate, people discriminate.

“I have seen the enemy and it is us [referring to the front line workers],” Choate said, noting we are the ones most in need of changing the conversation.

“We need to expand the conversation to authority figures, judges, police, frontline workers, doctors, nurses, and teachers,” Choate said.

Choate said young men need to be shown what respect for a woman looks like.

He also said poverty and addiction play a big part in the world creating people living with FASD.

“We need to help them as humans who seek support without shame, stigma, or condemnation.”

Choate said, structurally the system creates relapse. There is a need to get away from deficit-based assessments, and the need to get away from external language.

He said that frontline workers need to build relationships before and after rehab, or it just won’t work; there will be relapses because rehabilitation is a step in recovery, not a solution.  

“What front line workers need to do is to build relationships with the people that need that help,” Choate said.

Choate strongly suggested to challenge policy makers who act as barriers to support.

He said that people living with addiction need to have a purpose and for front line workers to help find that in their lives, or else there’s no reason to be sober.

“My challenge, my hope is for you to have a conversation with somebody who would not normally have that conversation.”

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