What do you do when you can see the problem and don't have the solution?
For years, Ihuoma Chukwueke, MD, DrPH , FAAFP, DipACLM, would take a social history, hear about a patient's drinking or drug use, and write a referral to an addiction specialist. The wait to be seen runs about three months. Readiness rarely survives it. A family physician with a doctorate in public health and board certification in lifestyle medicine, she had built a career around prevention and root causes — and substance use was the one place her tools ran out.
Then a colleague talked her into applying for addiction medicine training for primary care providers. In this conversation she describes what changed: how she works substance use screening into visits that started with something else entirely, why quantifying a patient's drinking changes the conversation, and what happened when a woman who came in for a hand injury left having started treatment for alcohol use. She also lays out the arithmetic driving all of it. Roughly 3,000 addiction specialists nationwide against 48 million Americans who meet the criteria for a substance use disorder.
In this episode:
Why primary care providers are the first point of contact for substance use and mental health
The three-month wait for addiction specialists and what gets lost in it
Screening for substance use at well-child visits, including cannabis use at nine and alcohol at twelve
How quantifying "just a glass of wine" changes what patients understand about their own drinking
The connection between isolation, dopamine, and why the brain resists stopping
Treating chronic disease and substance use as one problem instead of two
Speaking about addiction in faith communities where stigma keeps people silent.
0:00 Introduction
0:22 Training Abroad and Six Years to a Medical Degree
1:52 Community Service in Communities That Had Nothing
2:24 From Public Health to a Doctorate in Preventive Care
3:21 Board Certification in Lifestyle Medicine and Addiction Medicine Training
4:30 Why You Cannot Separate Mental Health from Physical Health
5:35 The Referral She Could Not Make Work
6:03 3,000 Specialists and 48 Million Americans
7:16 Tobacco, Secondhand Smoke, and the Deaths We Are Not Addressing
8:28 The Colleague Who Talked Her Into Applying
10:12 Quantifying the Drink and Naming Alcohol a Carcinogen
11:27 Motivational Interviewing and the Shift from Empathy to Compassion
12:56 Screening at Well-Child Visits: Cannabis at Nine, Alcohol at Twelve
14:14 Prevention Versus Treating the Symptom
16:11 Chronic Disease and Substance Use as One Problem
18:34 Isolation, Dopamine, and the Hijacked Brain
21:01 A Hand Injury and the Conversation That Followed
23:35 Fifteen Minutes That Became Thirty-Five
25:15 Two Patients a Day, Every Day, Since March
27:38 Empowering Clinicians to Be the Hands and Feet
29:19 Speaking About Addiction Where Stigma Keeps People Silent
31:00 One in Eight High School Students
32:15 A Request That the Training Continue
🔗If you practice primary care, screen patients for substance use, or believe prevention belongs at the front of medicine — this conversation is for you. Learn more about TNT Open Mind Insights: www.tntopenmind.org
substance use disorder, addiction medicine, primary care, behavioral health, mental health, lifestyle medicine, prevention, alcohol use disorder, substance use screening, primary care providers, stigma, Ihuoma Chukwueke, TNT Open Mind Insights, TNT Primary Care Fellowships, UC Irvine, family medicine, opioid crisis, motivational interviewing, underserved communities, public health
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